ABSTRACT
BACKGROUND: Excess visceral abdominal tissue (VAT) is more strongly associated with risk factors of coronary artery disease (CAD) than body mass index (BMI) or waist circumference. However, whether adding VAT measurements to CAD risk factors provides better risk assessment for CAD progression has not been fully evaluated. METHODS AND RESULTS: This prospective cohort study comprised 553 CAD patients with coronary plaque with ≤50% coronary stenosis as assessed by computed tomography (CT) angiography. Quantification of VAT area was performed together with CT angiography using abdominal CT scanning. After a mean 38±8 months follow-up, 320 patients underwent repeated CT scans for worsening angina symptoms without findings of positive ischemia. Increased segments of noncalcified plaque were seen in 152 (48%) and an increased calcium score was seen in 261 (82%) patients. The risk for progression of noncalcified plaque increased steadily with higher VAT quartiles, independent of CAD risk factors. Patients in the higher quartiles were at increased risk of progression of noncalcified plaque (quartiles IV OR 4.7; 95% CI 2.3-9.4, p-value<0.001). In contrast, increases above the median calcium score showed no independent correlation to VAT. Compared to VAT, progression of noncalcified plaque showed no phased increase with higher waist circumference and weaker increase with higher BMI quartiles. CONCLUSION: VAT accumulation was positively associated with progression of coronary noncalcified plaque, but not of calcified plaque. This suggests that risk assessment of progression of noncalcified plaque can be improved by combining VAT measurements and CAD risk factors.
Subject(s)
Coronary Stenosis/etiology , Coronary Vessels/pathology , Intra-Abdominal Fat/pathology , Obesity/complications , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/pathology , Disease Progression , Female , Humans , Intra-Abdominal Fat/diagnostic imaging , Japan , Linear Models , Logistic Models , Male , Middle Aged , Obesity/pathology , Odds Ratio , Plaque, Atherosclerotic , Prospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: Cystatin C, a novel marker of kidney function, has been reported to be a predictor of adverse cardiovascular outcomes in patients without established chronic kidney disease. However, the relationship between serum cystatin C concentrations and early stage coronary atherosclerotic plaque morphology among patients with preserved kidney function has not been fully evaluated. METHODS AND RESULTS: 405 outpatients with early coronary artery disease with estimated glomerular filtration rate (eGFR) ≥ 60ml/min/1.73m(2) and <50% stenosis on 64-slice CT coronary angiography were enrolled. Subjects were categorized into quartiles by serum cystatin C (quartile I: ≤ 0.88mg/L - quartile IV: ≥ 1.16mg/L). Plaques in coronary segments were categorized as calcified or noncalcified. Multiple linear regression analysis revealed that lower eGFR, higher age, increasing numbers of noncalcified and calcified plaques, lower high-density lipoprotein cholesterol, and female gender were statistically significant predictors of increased cystatin C concentrations. The risk for presence of noncalcified plaques increased significantly with increasing quartiles of cystatin C. Compared with those in the lowest quartile, patients in each subsequent quartile were at steadily increased risk of having noncalcified plaque (quartile IV: OR 5.6; 95% CI 2.3-13.9, p-value <0.001). Both number of segments with calcified plaque and Agatston score were highly correlated with cystatin C concentrations (both p<0.001), but when adjusted for segments with noncalcified plaque and other risk factors, calcified plaque segments were no longer independently predictive. CONCLUSION: Higher serum cystatin C concentrations were correlated with early stage coronary atherosclerotic plaques among patients without established chronic kidney dysfunction. Noncalcified plaques increased with serum cystatin C concentrations, an association independent of eGFR and other cardiovascular risk factors.
Subject(s)
Atherosclerosis/blood , Atherosclerosis/pathology , Cystatin C/blood , Multidetector Computed Tomography/methods , Aged , Angiography/methods , Calcinosis/pathology , Cardiovascular Diseases/blood , Cross-Sectional Studies , Female , Glomerular Filtration Rate , Humans , Male , Middle Aged , Plaque, Atherosclerotic/pathology , Regression Analysis , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Pulmonary vein thrombosis is rarely detected in patients with cancer, lung lobectomy, trauma and so on. We report the case of idiopathic pulmonary vein thrombosis complicated with coronary heart disease. A-57-year-old man with suspected coronary heart disease underwent computed tomography coronary angiography. He did not show any sign of malignancy in lung or other organs. Multi-detector row computed tomography demonstrated 3-dimensional images for the thrombi in bilateral lower pulmonary veins besides an old anterior myocardial infarction. Previously, few reports have described the detection of pulmonary vein thrombosis, however, multi-detector row computed tomography was thought to be useful for detecting and evaluating pulmonary vein thrombosis.
