Abstract Objectives : Recent data shows a relationship between aortic valve (AV) inflammation and calcification. However, direct evidence linking early valve inflammation (prior to hemodynamic ...compromise) to subsequent calcium (Ca) deposition is lacking in humans. We sought to test the hypothesis whether local AV inflammation predisposes to subsequent AV Ca deposition. Methods : We identified 111 individuals (age 6049, 68, 50.5% male) without active cancer or aortic stenosis who underwent 2 PET/CT studies 1–5 years apart for cancer surveillance. AV inflammation was determined by measuring FDG uptake (maximum standardized uptake value, SUVmax) within the AV on baseline PET/CT. Subsequent deposition of AV Ca was determined by comparing baseline and follow-up CT scans, determined as an increase in AV Ca volume score (CaVS). Patients were classified as “non-progressors” or “progressors” based on Square Root difference in CaVS (using a pre-determined cut-off value of 2.5). CT and PET measurements were conducted by 2 mutually blinded laboratories. Results : During follow-up, AV Ca increased in 23 patients (20.2%) classified as “progressors”, of whom 9 (9.2%) demonstrated subsequent ‘incident’ AV Ca. The AV SUVmax (mean ± SD) was higher in progressors vs. non-progressors (2.03 ± 0.52 vs.1.74 ± 0.36, p = 0.02) and especially in patients with-vs. without-incident AV Ca (2.28 ± 0.42 vs. 1.73 ± 0.36, p < 0.001). Moreover, AV inflammation (AV SUVmax) independently predicted subsequent calcification after adjusting for cardiovascular risk factors OR (95%CI): 4.99 (1.30–19.15), p = 0.02. Conclusion : The findings suggest that early AV inflammation may predispose to AV sclerosis. The evaluation of valvular metabolic activity may prove useful for developing a better understanding of calcific valve disease.
Abstract Background Upper body subcutaneous fat is a distinct fat depot that may confer increased cardiometabolic risk. We examined the cross-sectional associations between upper body subcutaneous ...fat volume and cardiometabolic risk factors. Methods Participants were patients from the Framingham Heart Study who underwent multi-detector computed tomography between 2008 and 2011. Sex-specific multivariable-adjusted regression analyses were conducted. Covariates included age, ethnicity, smoking status, alcohol intake, physical activity, postmenopausal status, and hormone replacement therapy. Additional models included adjustment for body mass index (BMI), neck circumference, or abdominal visceral adipose tissue. Results There were 2306 participants (mean age 60 years, 54.4% women) included. Mean upper body subcutaneous fat was 309.9 cm3 in women and 345.6 cm3 in men. Higher upper body subcutaneous fat volume was associated with adverse cardiometabolic risk factors. In women and men, each additional 50-cm3 increment in upper body subcutaneous fat was associated with a 3.23 and 2.65 kg/m2 increase in BMI; 2.16 and 0.88 mm Hg increase in systolic blood pressure; 2.53 and 1.66 mg/dL increase in fasting plasma glucose; 0.12 and 0.11 mg/dL increase in log triglycerides; and 4.17 and 3.68 mg/dL decrease in high-density lipoprotein cholesterol, respectively (all P ≤.008). Similar patterns were observed with prevalent cardiometabolic risk factors. These associations remained significant after additional adjustment for BMI, neck circumference, or abdominal visceral adipose tissue. Conclusions Higher upper body subcutaneous fat is cross-sectionally associated with adverse cardiometabolic risk factors. Our findings underscore the importance of subcutaneous adiposity in the upper body region that may provide a better understanding of the pathogenic properties of obesity in the development of cardiometabolic sequelae.
Cross-sectional study.
To evaluate the association between lumbar spine facet joint osteoarthritis (FJ OA) identified by multidetector computed tomography (CT) and low back pain (LBP) in the ...community-based Framingham Heart Study.
The association between lumbar FJ OA and LBP remains unclear.
This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40 to 80 underwent multidetector CT imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this ancillary study to assess radiographic features associated with LBP. LBP in the preceding 12 months was evaluated using a self-report questionnaire. FJ OA was evaluated on CT scans using a 4-grade scale. The association between FJ OA and LBP was examined used multiple logistic regression models, while adjusting for gender, age, and BMI.
CT imaging revealed a high prevalence of FJ OA (59.6% of males and 66.7% of females). Prevalence of FJ OA increases with age. By decade, FJ OA was present in 24.0% of <40-years-olds, 44.7% of 40- to 49-years-olds, 74.2% of 50- to 59-years-olds, 89.2% of 60- to 69-year-olds, and 69.2% of >70-years-olds. By spinal level the prevalence of FJ OA was: 15.1% at L2-L3, 30.6% at L3-L4, 45.1% at L4-L5, and 38.2% at L5-S1. In this community-based population, individuals with FJ OA at any spinal level showed no association with LBP.
There is a high prevalence of FJ OA in the community. Prevalence of FJ OA increases with age with the highest prevalence at the L4-L5 spinal level. At low spinal levels women have a higher prevalence of lumbar FJ OA than men. In the present study, we failed to find an association between FJ OA, identified by multidetector CT, at any spinal level and LBP in a community-based study population.
Objective
To systematically investigate the literature for the influence of sublingual nitroglycerin administration on coronary diameter, the number of evaluable segments, image quality, heart rate ...and blood pressure, and diagnostic accuracy of coronary computed tomography (CT) angiography.
Methods
A systematic search was performed in PubMed, EMBASE and Web of Science. The studies were evaluated for the effect of sublingual nitroglycerin on coronary artery diameter, evaluable segments, objective and subjective image quality, systemic physiological effects and diagnostic accuracy. Due to the heterogeneous reporting of outcome measures, a narrative synthesis was applied.
Results
Of the 217 studies identified, nine met the inclusion criteria: seven reported on the effect of nitroglycerin on coronary artery diameter, six on evaluable segments, four on image quality, five on systemic physiological effects and two on diagnostic accuracy. Sublingual nitroglycerin administration resulted in an improved evaluation of more coronary segments, in particular, in smaller coronary branches, better image quality and improved diagnostic accuracy. Side effects were mild and were alleviated without medical intervention.
Conclusion
Sublingual nitroglycerin improves the coronary diameter, the number of assessable segments, image quality and diagnostic accuracy of coronary CT angiography without major side effects or systemic physiological changes.
Key Points
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Sublingual nitroglycerin administration results in significant coronary artery dilatation
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Nitroglycerin increases the number of evaluable coronary branches
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Image quality is improved the most in smaller coronary branches
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Nitroglycerin increases the diagnostic accuracy of coronary CT angiography
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Most side effects are mild and do not require medical intervention
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Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular related death, particularly in those with hepatic fibrosis. We determined the prevalence of predicted ...fibrosis based on non-invasive fibrosis markers and the association of hepatic fibrosis with cardiovascular risk factors.
Cross-sectional study of 575 Framingham Heart Study participants with NAFLD based on computed tomography. We determined the prevalence of predicted fibrosis based on the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, AST to platelet ratio index (APRI), the Fibrosis-4 score (FIB4), and the NAFLD Fibrosis Score (NFS). Using multivariable logistic regression models, we examined the association between low, indeterminate, or high risk for fibrosis according to the NFS and various cardiometabolic risk factors.
The predicted risk of fibrosis was 12%, 4%, 5%, and 32% for the NFS, FIB4, APRI, and AST/ALT ratio, respectively. In multivariable models, participants with a high risk for advanced fibrosis by the NFS had a wider pulse pressure (adjusted mean difference = 6.87 mm Hg; p = 0.0002) and an increased odds of hypertension (OR 2.92; p = 0.007) compared to those with low risk of fibrosis. There were no statistically significant differences between other cardiovascular risk factors for those with a high versus low risk of fibrosis.
The AST/ALT ratio, APRI, and NFS give widely disparate predictions of liver fibrosis. Participants with a high risk for fibrosis based on NFS had wider pulse pressure and increased odds of hypertension. Whether modifying these risk factors impacts cardiovascular endpoints in NAFLD patients remains unknown.
Background Men and women are labeled as obese on the basis of a body mass index (BMI) using the same criterion despite known differences in their fat distributions. Subcutaneous adipose tissue and ...visceral adipose tissue (VAT), as measured by computed tomography, are advanced measures of obesity that closely correlate with cardiometabolic risk independent of BMI. However, it remains unknown whether prognostic significance of anthropometric measures of adiposity versus VAT varies in men versus women. Methods and Results In 3482 FHS (Framingham Heart Study) participants (48.1% women; mean age, 50.8±10.3 years), we tested the associations of computed tomography-based versus anthropometric measures of fat with cardiometabolic and cardiovascular disease (CVD) risk. Mean follow-up was 12.7±2.1 years. In men, VAT, as compared with BMI, had a similar strength of association with incident cardiometabolic risk factors (eg, adjusted odds ratio OR, 2.36 95% CI, 1.84-3.04 versus 2.66 95% CI, 2.04-3.47 for diabetes mellitus) and CVD events (eg, adjusted hazard ratio HR, 1.32 95% CI, 0.97-1.80 versus 1.74 95% CI, 1.14-2.65 for CVD death). In women, however, VAT, when compared with BMI, conferred a markedly greater association with incident cardiometabolic risk factors (eg, adjusted OR, 4.51 95% CI, 3.13-6.50 versus 2.33 95% CI, 1.88-3.04 for diabetes mellitus) as well as CVD events (eg, adjusted HR, 1.85 95% CI, 1.26-2.71 versus 1.19 95% CI, 1.01-1.40 for CVD death). Conclusions Anthropometric measures of obesity, including waist circumference and BMI, adequately capture VAT-associated cardiometabolic and cardiovascular risk in men but not in women. In women, abdominal computed tomography-based VAT measures permit more precise assessment of obesity-associated cardiometabolic and cardiovascular risk.
Noninvasive Assessment of Plaque Morphology and Composition in Culprit and Stable Lesions in Acute Coronary Syndrome and Stable Lesions in Stable Angina by Multidetector Computed Tomography
Udo ...Hoffmann, Fabian Moselewski, Koen Nieman, Ik-Kyung Jang, Maros Ferencik, Ayaz M. Rahman, Ricardo C. Cury, Suhny Abbara, Hamid Joneidi-Jafari, Stephan Achenbach, Thomas J. Brady
With contrast-enhanced submillimeter 16-slice multidetector computed tomography (MDCT), we noninvasively assessed morphology and composition of 40 culprit and stable coronary lesions. Culprit lesions in patients with acute coronary syndrome (ACS) had significantly greater plaque area and a higher remodeling index than stable lesions both in patients with ACS and in patients with stable angina (p = 0.02 and p = 0.04; respectively). Lesion composition was also different between the three groups. This study introduces the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS, emphasizing the potential of MDCT to improve noninvasive risk stratification in patients with acute chest pain.
The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT).
Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain.
Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined.
We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 ± 5.9 mm2vs. 9.1 ± 4.8 mm2vs. 13.5 ± 10.7 mm2, p = 0.02; and 1.4 ± 0.3 vs. 1.0 ± 0.4 vs. 1.2 ± 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina.
We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.
Background and Aims
The factors associated with incident hepatic steatosis are not definitively known. We sought to determine factors associated with incident hepatic steatosis, as measured on ...computed tomography, in the community.
Methods
We studied Framingham Heart Study participants without heavy alcohol use or baseline hepatic steatosis who underwent computed tomography scans between 2002‐2005 (baseline) and 2008‐2011 (follow‐up). We performed a stepwise logistic regression procedure to determine the predictors associated with incident hepatic steatosis.
Results
We included 685 participants (mean age: 45.0 ± 6.2 years, 46.8% women). The incidence of hepatic steatosis in our sample was 17.1% over a mean 6.3 years of follow‐up. Participants who developed hepatic steatosis had more adverse cardiometabolic profiles at baseline compared to those free of hepatic steatosis at follow‐up. Multivariable stepwise regression analysis showed that a simple clinical model including age, sex, body mass index, alcohol consumption and triglycerides was predictive of incident hepatic steatosis (C statistic = 0.791, 95% CI: 0.748‐0.834). A complex clinical model, which included visceral adipose tissue volume and liver phantom ratio added to the simple clinical model, and had improved discrimination for predicting incident hepatic steatosis (C statistic = 0.826, 95% CI: 0.786‐0.866, P < .0001).
Conclusions
The combination of demographic, clinical and imaging characteristics at baseline was predictive of incident hepatic steatosis. The use of our predictive model may help identify those at increased risk for developing hepatic steatosis who may benefit from risk factor modification although further investigation is warranted.
Abstract Objectives The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary ...artery disease (CAD). Background Although established CAD presentations differ by sex, little is known about stable, suspected CAD. Methods The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression. Results Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men. Conclusions Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.
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