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1.
JACC Basic Transl Sci ; 7(8): 747-762, 2022 Aug.
Article in English | MEDLINE | ID: mdl-36061342

ABSTRACT

Hepatocyte growth factor (HGF) is released by stressed human vascular cells and promotes vascular cell repair responses in both autocrine and paracrine ways. Subjects with a low capacity to express HGF in response to systemic stress have an increased cardiovascular risk. Human atherosclerotic plaques with a low content of HGF have a more unstable phenotype. The present study shows that subjects with a low ability to express HGF in response to metabolic stress have an increased risk to suffer myocardial infarction and stroke.

2.
Eur Heart J ; 43(48): 5020-5032, 2022 12 21.
Article in English | MEDLINE | ID: mdl-36124729

ABSTRACT

AIMS: Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. METHODS AND RESUTS: Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64-77) vs. 67 (61-73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01-1.47), P = 0.043] were independently associated with long-term mortality. CONCLUSION: Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.


Subject(s)
Anterior Wall Myocardial Infarction , Heart Septal Defects, Ventricular , Myocardial Infarction , Humans , Shock, Cardiogenic/etiology , Aftercare , Treatment Outcome , Patient Discharge , Heart Septal Defects, Ventricular/surgery , Registries , United Kingdom/epidemiology , Retrospective Studies
4.
Angiology ; 72(5): 442-450, 2021 May.
Article in English | MEDLINE | ID: mdl-33467865

ABSTRACT

Epicardial adipose tissue has a paracrine effect, enhancing coronary artery atherosclerotic plaque development. This study evaluated epicardial fat volume (EFV), adipokines, coronary atherosclerosis, and adverse cardiovascular events in a cohort of asymptomatic patients with type 2 diabetes mellitus (T2DM). Epicardial fat volume was calculated using data from computed tomography coronary angiograms. Adipokines and inflammatory cytokines were also assayed and correlated with EFV. Epicardial fat volume was also assessed as a predictor of coronary artery calcium (CAC) score, number of coronary artery plaques, and significant plaque (>50% luminal stenosis). Data from the EFV analysis were available for 221 (85.7%) participants. Median EFV was 97.4 cm3, mean body mass index was 28.1 kg/m2, and mean duration of T2DM was 13 years. Statistically significant, but weak, correlations were observed between several adipokines, inflammatory cytokines, and EFV. Epicardial fat volume was a significant univariate (P = .01), but not multivariate, predictor of the number of coronary plaques, but not of CAC score or significant plaque. After a mean follow-up of 22.8 months, 12 adverse cardiovascular events were reported, exclusively in participants with EFV >97.4 cm3. Epicardial fat volume has limited utility as a marker of coronary artery plaque in patients with T2DM and is weakly correlated with adipokine expression.


Subject(s)
Adipose Tissue/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Diabetes Mellitus, Type 2/complications , Pericardium/diagnostic imaging , Adipokines/blood , Adipose Tissue/metabolism , Adult , Aged , Asymptomatic Diseases , Biomarkers/blood , Coronary Artery Disease/blood , Coronary Artery Disease/complications , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Female , Humans , Inflammation Mediators/blood , London , Male , Middle Aged , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Time Factors
5.
Sci Transl Med ; 12(572)2020 12 02.
Article in English | MEDLINE | ID: mdl-33268513

ABSTRACT

Placental growth factor (PlGF) is a mitogen for endothelial cells, but it can also act as a proinflammatory cytokine. Because it promotes early stages of plaque formation in experimental models of atherosclerosis and was implicated in epidemiological associations with risk of cardiovascular disease (CVD), PlGF has been attributed a pro-atherogenic role. Here, we investigated whether PlGF has a protective role in CVD and whether elevated PlGF reflects activation of repair processes in response to vascular stress. In a population cohort of 4742 individuals with 20 years of follow-up, high baseline plasma PlGF was associated with increased risk of cardiovascular death, myocardial infarction, and stroke, but these associations were lost or weakened when adjusting for cardiovascular risk factors known to cause vascular stress. Exposure of cultured endothelial cells to high glucose, oxidized low-density lipoprotein (LDL) or an inducer of apoptosis enhanced the release of PlGF. Smooth muscle cells and endothelial cells treated with PlGF small interference RNA demonstrated that autocrine PlGF stimulation plays an important role in vascular repair responses. High expression of PlGF in human carotid plaques removed at surgery was associated with a more stable plaque phenotype and a lower risk of future cardiovascular events. When adjusting associations of PlGF with cardiovascular risk in the population cohort for plasma soluble tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) receptor-2, a biomarker of cellular stress, a high PlGF/TRAIL receptor-2 ratio was associated with a lower risk. Our findings provide evidence for a protective role of PlGF in CVD.


Subject(s)
Atherosclerosis , Cardiovascular Diseases , Placenta Growth Factor/physiology , Plaque, Atherosclerotic , Endothelial Cells , Female , Humans , Vascular Endothelial Growth Factor Receptor-1
6.
Cardiovasc Diabetol ; 18(1): 51, 2019 04 23.
Article in English | MEDLINE | ID: mdl-31014330

ABSTRACT

BACKGROUND: Evidence from imaging studies suggests a high prevalence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, there are no criteria for initiating screening for CAD in this population. The current study investigated whether clinical and demographic characteristics can be used to predict significant CAD in patients with T2DM. METHODS: Computed tomography coronary angiography (CTCA) and laboratory assessments were performed in 259 patients diagnosed with T2DM attending clinics in Northwest London, UK. Coronary artery calcium (CAC) was calculated during CTCA. Significant plaque was defined as one causing more than 50% luminal stenosis. Associations between groups and variables were evaluated using Student's t test, Chi-square tests and univariate and multivariate regression analysis. P < 0.05 was considered statistically significant. RESULTS: Among patients with a median duration of T2DM of 13 years and a mean age of 62.0 years, median CAC score was 105.91 Agatston Units. In a multivariate analyses, duration of diabetes, CAC score and the presence and number of coronary artery plaques and presence of significant plaque were significant predictors of cardiovascular adverse events. Systolic blood pressure (SBP) had borderline significance as a predictor of cardiovascular events (p = 0.05). In a receiver operating characteristic curve (ROC) analysis, duration of diabetes of > 10.5 years predicted significant CAD (sensitivity, 75.3%; specificity 48.2%). Area under the ROC curve was 0.67 when combining duration of T2DM > 10.5 years and SBP of > 139 mm Hg. Adverse cardiovascular events after a median follow-up of 22.8 months were also significantly higher in those with duration of T2DM > 10.5 years and SBP > 140 mm Hg (log rank p = 0.02 and 0.009, respectively). CONCLUSIONS: Routine screening for CAD using CTCA should be considered for patients with a diagnosis of T2DM for > 10.5 years and SBP > 140 mm Hg. Trial registration Clinicaltrials.gov identifier: NCT02109835, 10 April 2014 (retrospectively registered).


Subject(s)
Blood Pressure , Computed Tomography Angiography , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Diabetes Mellitus, Type 2/epidemiology , Mass Screening/methods , Vascular Calcification/diagnostic imaging , Adult , Aged , Asymptomatic Diseases , Biomarkers/blood , Blood Glucose/metabolism , Coronary Stenosis/epidemiology , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/physiopathology , Female , Humans , London/epidemiology , Male , Middle Aged , Predictive Value of Tests , Prevalence , Prognosis , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Vascular Calcification/epidemiology
7.
Angiology ; 70(7): 613-620, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30813747

ABSTRACT

Endothelial dysfunction is common in patients with type 2 diabetes mellitus (T2DM) and is associated with atherosclerotic disease. This study aimed to determine prognostic factors for endothelial dysfunction and identify relationships between reactive hyperemia index (RHI) score, clinically relevant coronary artery disease (>50% stenosis), and major adverse cardiovascular events (MACEs) in patients with T2DM. Endothelial function was assessed using peripheral arterial tonometry and correlated with patient characteristics and cardiovascular outcomes during a median follow-up of 22.8 months. Among 235 patients with a median duration of T2DM of 13 years, mean (standard deviation) RHI score was 2.00 (0.76). Serum low- and high-density lipoprotein cholesterol levels positively (P = .004) and negatively (P = .02) predicted RHI score, respectively. Median coronary artery calcium (CAC) score was 109 Agatston units, but no correlation between CAC and RHI scores was observed. The RHI score did not predict the number or severity of coronary plaques identified using computed tomography coronary angiography. Additionally, there was no association between RHI score and the risk of an MACE during follow-up. Overall, endothelial function was not predictive of CAC score, extent, and severity of coronary plaque or MACEs and did not demonstrate utility in cardiovascular risk stratifying patients with T2DM.


Subject(s)
Coronary Artery Disease/diagnosis , Coronary Stenosis/diagnosis , Diabetes Mellitus, Type 2/complications , Diabetic Angiopathies/diagnosis , Endothelium, Vascular/physiopathology , Fingers/blood supply , Manometry/methods , Aged , Computed Tomography Angiography , Coronary Angiography/methods , Coronary Artery Disease/etiology , Coronary Artery Disease/physiopathology , Coronary Stenosis/etiology , Coronary Stenosis/physiopathology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/physiopathology , Diabetic Angiopathies/etiology , Diabetic Angiopathies/physiopathology , Female , Humans , Male , Middle Aged , Plaque, Atherosclerotic , Predictive Value of Tests , Risk Assessment , Risk Factors , Severity of Illness Index
8.
Am J Cardiol ; 121(8): 910-916, 2018 04 15.
Article in English | MEDLINE | ID: mdl-29499924

ABSTRACT

Carotid intima-media thickness (CIMT) measurement and carotid plaque detection by B-mode ultrasound are frequently used as surrogates to predict coronary artery disease (CAD). However, their systematic use in routine clinical management of asymptomatic patients with diabetes mellitus (DM) has not been studied. The aim of the study was to identify carotid parameters that predict cardiovascular events in patients with asymptomatic type 2 DM by evaluating the relation between carotid disease and CAD. This multicenter, observational, prospective study included 259 asymptomatic patients with type 2 DM followed-up for 34 months after measurement of CIMT and carotid plaque with carotid ultrasound, and CAD assessment with computed tomography coronary angiography. Statistically significant differences between patients with and without carotid plaque were found for coronary plaque >50% stenosis (59 vs 36, p = 0.02). Greater maximal CIMT was associated with an increased risk of coronary plaque >50% (odds ratio 1.21 [1.02, 1.44], p = 0.03) and >70% stenosis (odds ratio 1.23 [1.01, 1.50], p = 0.04) after adjusting for traditional risk factors. At 34-month follow-up, the occurrence of total major adverse cardiovascular event was estimated to be 7.1% (mean age 68 years, 6% male and 1.1% female) in the whole study population. The subgroup of patients with carotid plaque showed increased incidence of major adverse cardiovascular event compared with patients with no carotid plaque (p = 0.005). In conclusion, carotid plaque was a strong predictor of future cardiovascular events and may be a prognostic marker in asymptomatic patients with type 2 DM. Carotid plaque and maximal intima-media thickness were independently associated with obstructive CAD.


Subject(s)
Asymptomatic Diseases , Carotid Artery Diseases/epidemiology , Coronary Stenosis/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Plaque, Atherosclerotic/epidemiology , Aged , Carotid Artery Diseases/diagnostic imaging , Carotid Intima-Media Thickness , Computed Tomography Angiography , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Odds Ratio , Plaque, Atherosclerotic/diagnostic imaging , Prospective Studies , United Kingdom/epidemiology
9.
Clin Cardiol ; 40(9): 752-758, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28543093

ABSTRACT

BACKGROUND: The value of screening sub-clinical atherosclerosis in asymptomatic patients with type 2 diabetes mellitus (T2DM) remains controversial. HYPOTHESIS: An integrated model incorporating carotid intima-media thickness (CIMT) and carotid plaque with traditional risk factors can be used to predict prevalence and severity of coronary artery calcification in asymptomatic T2DM patients. METHODS: A cohort of 262 asymptomatic T2DM patients were prospectively studied with carotid ultrasound to evaluate CIMT and carotid plaque and also a computed tomography coronary artery calcium (CT-CAC) scan. RESULTS: Carotid plaque was detected in 124 (47%) patients and mean CIMT was 0.75±0.14 mm. Two hundred (76%) patients had a CAC score >0, of whom 57 (22%) had severe coronary atherosclerosis (>400 Au). In this group, carotid plaque was present in 40 (70%) patients (p<0.001). Univariable analysis revealed significant associations between non-zero CAC score and age (p<0.001), hypertension (p=0.01), gender (p=0.003) and duration of diabetes (p=0.004). Carotid plaque and mean CIMT were also significantly associated with non-zero CAC score (odds ratios [95% CI], 3.12 [1.66 -5.85] and 2.98 [0.24 -7.17], respectively). After adjusting for traditional risk factors, carotid plaque continued to be predictive of non-zero CAC score (2.59 [1.17 -5.74]) and CIMT was borderline significant (p=0.05). When analysed with binary logistical regression, the prevalence of carotid plaque significantly predicted severe CAC burden (CAC >400 Au; 3.26 [2.05 -5.19]). Upper CIMT quartiles showed a similar association (2.55 [1.33 -4.87]). CONCLUSION: Carotid plaque is more predictive of underlying silent coronary atherosclerosis prevalence, severity and extent in asymptomatic T2DM patients.


Subject(s)
Carotid Artery Diseases/epidemiology , Coronary Artery Disease/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Vascular Calcification/epidemiology , Adult , Aged , Asymptomatic Diseases , Carotid Arteries/diagnostic imaging , Carotid Arteries/pathology , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/pathology , Carotid Intima-Media Thickness , Computed Tomography Angiography , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Diabetes Mellitus, Type 2/diagnosis , Female , Humans , Logistic Models , London/epidemiology , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Plaque, Atherosclerotic , Prevalence , Prospective Studies , Risk Factors , Severity of Illness Index , Ultrasonography, Doppler , Vascular Calcification/diagnostic imaging
11.
Angiology ; 66(1): 65-9, 2015 Jan.
Article in English | MEDLINE | ID: mdl-24576983

ABSTRACT

We determined whether increased carotid intima-media thickness (cIMT) and prevalence of carotid plaque (CP) are predictive of prevalence and severity of coronary atherosclerosis. Consecutive patients (n = 150) with no history of coronary artery disease (CAD), who underwent both carotid ultrasound and computed tomographic coronary angiography, were included in the analysis. The mean cIMT was higher in patients with CAD than in those without CAD (0.76 vs 0.66 mm, P < .003). In a logistic regression analysis, diabetes (P = .03) and CP (P = .02) were associated with significant coronary plaque. Backward selection analysis (after removing nonsignificant variables) showed higher mean cIMT measurement correlated well with prevalence of any coronary plaque (P = .03) and obstructive coronary plaque disease (P = .05), whereas presence of CP was a good predictor of both obstructive (>50% stenosis P = .003) and any coronary plaque (P = .003). In conclusion, CP and cIMT can be useful predictors of prevalence of CAD and its severity.


Subject(s)
Carotid Arteries/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Carotid Intima-Media Thickness , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Plaque, Atherosclerotic , Tomography, X-Ray Computed , Aged , Carotid Artery Diseases/epidemiology , Coronary Artery Disease/epidemiology , Female , Humans , Logistic Models , London/epidemiology , Male , Middle Aged , Odds Ratio , Pilot Projects , Predictive Value of Tests , Prevalence , Risk Factors , Severity of Illness Index
12.
Eur Heart J Cardiovasc Imaging ; 15(8): 886-92, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24513880

ABSTRACT

BACKGROUND: Coronary artery calcium (CAC) imaging by unenhanced computed X-ray tomography (CT) is recommended as an initial diagnostic test for patients with stable chest pain symptoms but a low likelihood (10-29%) of underlying obstructive coronary artery disease (CAD) after clinical assessment. The recommendation has not previously been tested prospectively in a rapid access chest pain clinic (RACPC). METHODS: We recruited 300 consecutive patients presenting with stable chest pain to the RACPC of three hospitals. All patients underwent CAC imaging, followed by invasive coronary angiography (ICA) in patients with CAC ≥ 1000 Agatston units (Au) and CT coronary angiography (CTCA) in those with CAC <1000. Patients with 50-70% stenosis on CTCA underwent myocardial perfusion scintigraphy (MPS) while those with ≥ 70% stenosis underwent ICA. Obstructive CAD was defined as ≥ 70% stenosis on ICA or the presence of inducible ischaemia on MPS. Patients were followed up clinically for a mean of 17 (SD 6) months. RESULTS: The mean patient age was 60.6 (SD 9.6) years and 48% were males. Obstructive CAD was found in 56 (19%) patients, of whom 42 (14%) underwent revascularization. CAC was zero in 131 (44%) patients, of whom two (1.5%) had obstructive CAD and one (0.8%) underwent revascularization. The sensitivity, specificity, negative predictive value, and positive predictive value of CAC ≥ 1 for detection of obstructive CAD were 96, 53, 32, and 98%, respectively. None of the 57 patients with low pre-test probability of CAD and zero CAC had obstructive CAD or suffered a cardiovascular event during the follow-up. CONCLUSION: Patients with stable chest pain symptoms but a low likelihood of CAD can safely be diagnosed as not having obstructive CAD in the absence of detectable coronary calcification by unenhanced CT. Patients with CAC >400 Au have a high prevalence of obstructive CAD and further investigation with ICA or functional imaging may be warranted rather than CTCA. These findings support NICE guidance for the investigation of stable chest pain. ClinicalTrials gov identifier: NCT01464203.


Subject(s)
Calcinosis/diagnostic imaging , Chest Pain/diagnostic imaging , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Practice Guidelines as Topic , Tomography, X-Ray Computed/methods , Algorithms , Contrast Media , Electrocardiography , Female , Humans , Iopamidol/analogs & derivatives , London , Male , Middle Aged , Pain Clinics , Predictive Value of Tests , Prospective Studies , Radiographic Image Interpretation, Computer-Assisted , Sensitivity and Specificity
13.
Cardiol Res ; 5(3-4): 118-120, 2014 Aug.
Article in English | MEDLINE | ID: mdl-28348708

ABSTRACT

We have described a myocardial infarct scar identified by a standard dual source CT coronary angiography (CTCA). We were able to detect the scar during the routine coronary assessment without contrast late enhancement and without additional radiation exposure. It is therefore feasible to assess chronic scar using a standard CTCA technique.

15.
Obesity (Silver Spring) ; 20(10): 2113-7, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22402739

ABSTRACT

Pericardial fat is emerging as a unique risk factor for coronary disease. We examined the relationship between objectively measured physical activity during free-living and pericardial fat. Participants were 446 healthy men and women (mean age = 66 ± 6 years), without history or objective signs of cardiovascular disease (CVD), drawn from the Whitehall II epidemiological cohort. Physical activity was objectively measured using accelerometers (Actigraph GT3X) worn around the hip during waking hours for 7 consecutive days (average daily wear time = 889 ± 68 min/day), and was classified as sedentary (<200 counts/min (cpm)), light (200-1,998 cpm), or moderate-vigorous physical activity (MVPA; ≥1,999 cpm). Pericardial fat volume was measured in each participant using electron beam computed tomography. Average daily cpm in men was 338.0 ± 145.0 and in women 303.8 ± 130.2. There was an inverse association between average cpm and pericardial fat (B = -0.070, 95% confidence interval (CI), -0.101, -0.040, P < 0.001), and this remained significant after adjusting for age, sex, registered wear time, BMI, lipids, glycemic control, blood pressure, smoking, statins, and social status. Both sedentary time (B = 0.081, 95% CI, 0.022, 0.14) and MVPA (B = -0.362, 95% CI, -0.527, -0.197) were also associated with pericardial fat, although associations for sedentary time did not remain significant after adjustment for MVPA. The inverse association between physical activity and pericardial fat was stronger among overweight and obese adults than in normal weight. Objectively assessed daily activity levels are related to pericardial fat in healthy participants, independently of BMI. This might be an important mechanism in explaining the association between physical activity and CVD prevention.


Subject(s)
Adipose Tissue , Coronary Artery Disease/prevention & control , Motor Activity , Pericardium , Sedentary Behavior , Activities of Daily Living , Aged , Blood Glucose/metabolism , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/epidemiology , Female , Humans , Male , Obesity/complications , Obesity/epidemiology , Pericardium/diagnostic imaging , Risk Factors , Tomography, X-Ray Computed
16.
PLoS One ; 7(2): e31356, 2012.
Article in English | MEDLINE | ID: mdl-22328931

ABSTRACT

BACKGROUND: Psychosocial stress is a risk factor for coronary heart disease (CHD). The mechanisms are incompletely understood, although dysfunction of the hypothalamic pituitary adrenal (HPA) axis might be involved. We examined the association between cortisol responses to laboratory-induced mental stress and the progression of coronary artery calcification (CAC). METHODS AND RESULTS: Participants were 466 healthy men and women (mean age = 62.7±5.6 yrs), without history or objective signs of CHD, drawn from the Whitehall II epidemiological cohort. At the baseline assessment salivary cortisol was measured in response to mental stressors, consisting of a 5-min Stroop task and a 5-min mirror tracing task. CAC was measured at baseline and at 3 years follow up using electron beam computed tomography. CAC progression was defined as an increase >10 Agatston units between baseline and follow up. 38.2% of the sample demonstrated CAC progression over the 3 years follow up. There was considerable variation in the cortisol stress response, with approximately 40% of the sample responding to the stress tasks with an increase in cortisol of at least 1 mmol/l. There was an association between cortisol stress reactivity (per SD) and CAC progression (odds ratio = 1.27, 95% CI, 1.02-1.60) after adjustments for age, sex, pre-stress cortisol, employment grade, smoking, resting systolic BP, fibrinogen, body mass index, and use of statins. There was no association between systolic blood pressure reactivity and CAC progression (odds ratio per SD increase = 1.03, 95% CI, 0.85-1.24). Other independent predictors of CAC progression included age, male sex, smoking, resting systolic blood pressure, and fibrinogen. CONCLUSION: Results demonstrate an association between heightened cortisol reactivity to stress and CAC progression. These data support the notion that cortisol reactivity, an index of HPA function, is one of the possible mechanisms through which psychosocial stress may influence the risk of CHD.


Subject(s)
Coronary Artery Disease/etiology , Coronary Artery Disease/metabolism , Hydrocortisone/metabolism , Stress, Psychological/metabolism , Stress, Psychological/physiopathology , Age Factors , Aged , Blood Pressure/physiology , Female , Humans , Male , Middle Aged , Risk Factors , Sex Factors , Smoking
17.
Eur J Radiol ; 81(7): 1555-61, 2012 Jul.
Article in English | MEDLINE | ID: mdl-21382680

ABSTRACT

BACKGROUND: CT coronary angiography (CTCA) is an evolving modality for the diagnosis of coronary artery disease. Radiation burden associated with CTCA has been a major concern in the wider application of this technique. It is important to reduce the radiation dose without compromising the image quality. OBJECTIVES: To estimate the radiation dose of CTCA in clinical practice and evaluate the effect of dose-saving algorithms on radiation dose and image quality. METHODS: Effective radiation dose was measured from the dose-length product in 616 consecutive patients (mean age 58 ± 12 years; 70% males) who underwent clinically indicated CTCA at our institution over 1 year. Image quality was assessed subjectively using a 4-point scale and objectively by measuring the signal- and contrast-to-noise ratios in the coronary arteries. Multivariate linear regression analysis was used to identify factors independently associated with radiation dose. RESULTS: Mean effective radiation dose of CTCA was 6.6 ± 3.3 mSv. Radiation dose was significantly reduced by dose saving algorithms such as 100 kV imaging (-47%; 95% CI, -44% to -50%), prospective gating (-35%; 95% CI, -29% to -40%) and ECG controlled tube current modulation (-23%; 95% CI, -9% to -34%). None of the dose saving algorithms were associated with a significant reduction in mean image quality or the frequency of diagnostic scans (P = non-significant for all comparisons). CONCLUSION: Careful application of radiation-dose saving algorithms in appropriately selected patients can reduce the radiation burden of CTCA significantly, without compromising the image quality.


Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Radiation Dosage , Tomography, X-Ray Computed/methods , Algorithms , Cardiac-Gated Imaging Techniques , Contrast Media , Cross-Sectional Studies , Female , Humans , Linear Models , Male , Middle Aged , Prospective Studies , Signal-To-Noise Ratio , Statistics, Nonparametric
18.
Atherosclerosis ; 220(1): 223-30, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22015177

ABSTRACT

BACKGROUND: Epicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the heart, has been implicated in the pathogenesis of coronary artery disease (CAD) through possible paracrine interaction with the coronary arteries. We examined the association of EAT with metabolic syndrome and the prevalence and progression of coronary artery calcium (CAC) burden. METHODS: CAC scan was performed in 333 asymptomatic diabetic patients without prior history of CAD (median age 54 years, 62% males), followed by a repeat scan after 2.7±0.3 years. CAC progression was defined as >2.5mm(3) increase in square root transformed volumetric CAC scores. EAT and intra-thoracic fat volumes were quantified using a dedicated software (QFAT), and were examined in relation to the metabolic syndrome, baseline CAC scores and CAC progression. RESULTS: Both epicardial and intra-thoracic fat were associated with metabolic syndrome after adjustment for conventional cardiovascular risk factors, but the association was attenuated after additional adjustment for body mass index. EAT, but not intra-thoracic fat, showed significant association with baseline CAC scores (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04-1.22, p=0.04) and CAC progression (OR 1.12, 95% CI 1.05-1.19, p<0.001) after adjustment for conventional measures of obesity and risk factors. CONCLUSION: EAT volume measured on non-contrast CT is an independent marker for the presence and severity of coronary calcium burden and also identifies individuals at increased risk of CAC progression. EAT quantification may thus add to the prognostic value of CAC imaging.


Subject(s)
Adipose Tissue/diagnostic imaging , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Pericardium/diagnostic imaging , Tomography, X-Ray Computed , Analysis of Variance , Asymptomatic Diseases , Coronary Artery Disease/epidemiology , Diabetes Mellitus/diagnostic imaging , Diabetes Mellitus/epidemiology , Disease Progression , Female , Humans , London/epidemiology , Male , Metabolic Syndrome/diagnostic imaging , Metabolic Syndrome/epidemiology , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Prevalence , Prospective Studies , Regression Analysis , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Vascular Calcification/diagnostic imaging , Vascular Calcification/epidemiology
19.
Arterioscler Thromb Vasc Biol ; 32(2): 500-5, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22075247

ABSTRACT

OBJECTIVE: Physical activity is related to lower risk of cardiovascular disease, but data relating to coronary lesions have been conflicting. These inconsistencies may in part be due to unreliable assessment of physical activity and limitations imposed by self-reported data. The purpose of this study was to determine the relationship between objectively measured physical activity and coronary artery calcium (CAC). METHODS AND RESULTS: Participants were 443 healthy men and women (mean age=66±6 years), without history or objective signs of coronary heart disease, drawn from the Whitehall II epidemiological cohort. Physical activity was objectively measured using accelerometers worn during waking hours for 7 consecutive days (average daily wear time=889±68 minutes/day). CAC was measured in each participant using electron beam computed tomography and was quantified according to the Agatston scoring system. On average, 54.4% of the sample recorded at least 30 minutes/day of moderate to vigorous physical activity (MVPA). There was no association between MVPA and presence of detectable CAC. For the participants with detectable CAC (n=283) a weak inverse relationship between MVPA (minutes/day) and log Agatston score was observed (B=-0.008, 95% CI: -0.16 to 0.00, P=0.05), although the association was no longer present after adjustments for age, sex, and conventional risk factors. No associations were seen for light activity or sedentary time. CONCLUSIONS: Our results confirm no association between objectively assessed physical activity and CAC. Because CAC measures cannot identify more vulnerable lesions, additional studies are required to examine whether physical activity can promote plaque stability.


Subject(s)
Calcinosis/epidemiology , Coronary Artery Disease/epidemiology , Coronary Vessels/pathology , Motor Activity/physiology , Sedentary Behavior , Aged , Calcinosis/diagnostic imaging , Calcinosis/pathology , Calcium/metabolism , Cohort Studies , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/pathology , Coronary Vessels/metabolism , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed
20.
Postgrad Med J ; 87(1025): 180-8, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20693150

ABSTRACT

Non-invasive assessment of coronary artery patency has been attempted with different imaging modalities over the last few decades. The continuous motion of the heart, the respiratory movement, together with the small and tortuous nature of the coronary arteries, made this a technically challenging task. Over the last decade, significant advances in computed tomography (CT) technology helped CT coronary angiography (CTCA) to evolve as a non-invasive alternative to conventional catheter based coronary angiography. Clinical experience with CTCA has since grown rapidly and led to its acceptance as a useful diagnostic technique for coronary artery disease in certain patient populations. Recently, there has been exponential growth in the availability and use of CTCA in several centres across the world. In order to appreciate the potential impact of CTCA on current clinical practice, it is important to understand its advantages and limitations and its clinical performance in comparison with established techniques.


Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Tomography, X-Ray Computed/methods , Coronary Angiography/adverse effects , Humans , Risk Factors , Tomography, X-Ray Computed/adverse effects
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