RESUMEN
Cardiovascular computed tomography (CCT) is a cutting-edge imaging technique providing important, non-invasive, diagnostic information. Concerns exist regarding radiation exposure to patient populations, but achieving optimal image quality at the lowest doses can be challenging. This guide provides practical advice about how quality can be assured in any CCT unit or radiology department. Illustrated by real-world vignettes and data analysis from our own experience, we highlight a multidisciplinary team approach to each stage of the patient journey, the effectiveness of regular dose audit overseen by a CT optimisation group, and the importance of underused systolic scanning techniques, in order to drive significant dose reduction without loss of image quality or clinical confidence.
Asunto(s)
Angiografía por Tomografía Computarizada/normas , Angiografía Coronaria/normas , Seguridad del Paciente/normas , Garantía de la Calidad de Atención de Salud/normas , Protección Radiológica/normas , Radiología/normas , Cardiología/normas , Humanos , Guías de Práctica Clínica como Asunto , Exposición a la Radiación/prevención & control , Exposición a la Radiación/normas , Reino UnidoRESUMEN
AIM: To assess the validity of virtual non-contrast (VNC) reconstructions for coronary artery calcium (CACS) and aortic valve calcium scoring (AVCS) in patients undergoing trans-catheter aortic valve implantation (TAVI). MATERIALS AND METHODS: Twenty-three consecutive TAVI patients underwent a three-step computed tomography (CCT) acquisition: (1) traditional CACS; (2) dual-energy (DE) CT coronary angiogram (CTCA); and (3) DE whole-body angiogram. Linear regression was used to model calcium scores generated from VNC images with traditional scores to derive a conversion factor [2.2 (95% CI: 1.97-2.58)]. The effective radiation dose for the TAVI protocol was compared to a standard control group. Bland-Altman analysis and weighted k-statistic were used to assess inter-method agreement for absolute score and risk centiles. RESULTS: CACS and AVCS from VNC reconstructions correlated well with traditional scores (r = 0.94 and r = 0.86; both p < 0.0001). There was excellent agreement between VNC and non-contrast coronary calcium scores [mean difference -71.8 (95% limits of agreement -588.7 to 445.1)], with excellent risk stratification into risk centiles (k = 0.99). However, the agreement was weaker for the aortic valve [mean difference -210.6 (95% limits of agreement -1233.2 to 812)]. Interobserver variability was excellent for VNC CACS [mean difference of 6 (95% limits of agreement 134.1-122.1)], and AVCS [mean difference of -16.4 (95% limits of agreement 576 to -608.7)]. The effective doses for the DE TAVI protocol was 16.4% higher than standard TAVI protocol (22.7 versus 19.5 mSv, respectively) accounted for by the DE CTCA dose being 47.8% higher than that for a standard CTCA [9.9 (5.6-14.35) versus 6.7 (1.17-13.72) mSv; p < 0.01). CONCLUSIONS: CACS and AVCS can be accurately quantified, and patients can be risk stratified using DECT VNC reconstructions. However, the dose from DE CTCA is significantly greater than the standard single-energy CTCA precluding the use of this technology in routine clinical practice.
Asunto(s)
Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Calcinosis/diagnóstico por imagen , Angiografía Coronaria/métodos , Prótesis Valvulares Cardíacas , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Imagen de Cuerpo Entero/métodosRESUMEN
AIM: To prospectively analyse the occurrence of right coronary artery (RCA) artefact and assess its relationship with patient heart rate (HR) and HR variability (HRV) in order to determine the most appropriate parameters for high-pitch cardiovascular computed tomography (CT) acquisition, minimize the likelihood of artefact, and maximize the clinical benefit in consecutive clinical high-pitch CT coronary angiography (CA) examinations. MATERIALS AND METHODS: One hundred and seventy-three patients undergoing high-pitch CTCA were prospectively assessed for the presence of RCA artefact. Median and maximum HR and the difference in predicted and actual acquisition HR (HR difference, HRD) were correlated from the electrocardiograms recorded at the time of acquisition. RESULTS: Sixty-six percent of the cohort was male, with a median age of 54 (range 16-84 years). There were 53 cases of RCA artefact (30.6%); 26 (49.1%) of these required further imaging to fully delineate the RCA. Of the 53 cases with artefact, 81.1% affected the distal RCA and 18.9% were more proximal. Gender was not associated with an increased likelihood of the artefact (p = 0.14). RCA artefact decreased by 2% with each year of increasing age (p = 0.04). When compared with a reference HR of >70 beats/min, univariate analysis demonstrated RCA artefact significantly increased with both increasing median and maximum HR, whilst the incidence of RCA artefact increased for all HRD >1, with a greater likelihood of artefact with increasing HRD. CONCLUSION: The present results highlight the importance of optimizing patient HR in order to reduce the likelihood of RCA artefact. In addition to aggressive HR control to a median HR of ≤60 beats/min, the present results suggest limiting high-pitch acquisition to patients with HR variability of <3 beats/min. Therefore, use of beta-blockers is of crucial importance to both reduce HR and HR variability to optimize use of high-pitch single-heartbeat CTCA.
Asunto(s)
Artefactos , Angiografía Coronaria/métodos , Frecuencia Cardíaca/fisiología , Adolescente , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Electrocardiografía , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
OBJECTIVES: By exploring differences between patients with high and low coronary artery calcification score (CACS), a plasma protein biomarker might be identified as an alternative to CACS screening. METHODS: We selected stored samples (12 per group) from a cohort study of patients with Type 2 diabetes and CACS >1000 or <100 Agatston units, with matching for age, BMI, blood pressure, lipids and lipoproteins and fibrinogen. Multiplex, immunobead-based assay or ELISA measured 18 cardiovascular-related protein biomarkers. SELDI-TOF mass spectrometry (MS) screened for proteins differing significantly between high and low CACS. RESULTS: Only monocyte chemotactic protein-1 was higher in the high compared with the low CACS group but concentrations overlapped appreciably. On SELDI-TOF MS, several mass/charge ratio peak intensities significantly discriminated high and low CACS but these differences were not confirmed in larger samples from the cohort. CONCLUSIONS: Plasma protein biomarkers are unlikely to provide an effective alternative to measurement of CACS.
Asunto(s)
Biomarcadores/sangre , Calcinosis/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Anciano , Quimiocina CCL2/sangre , Humanos , Persona de Mediana Edad , Radiografía , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
The widespread introduction of multidetector computed tomography (MDCT) into mainstream imaging departments has enabled many centres to undertake cardiac MDCT and, in particular, MDCT coronary angiography. This review highlights the areas that need consideration when introducing a new cardiac MDCT service and covers both technical and non-technical aspects. This includes equipment requirements, personnel, training, patient selection and preparation, cardiac CT protocols and post-processing techniques, and potential pitfalls.
Asunto(s)
Angiografía Coronaria/métodos , Servicios de Diagnóstico/organización & administración , Cardiopatías/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Artefactos , Medios de Contraste , Electrocardiografía , Humanos , Dosis de Radiación , Interpretación de Imagen Radiográfica Asistida por ComputadorRESUMEN
BACKGROUND AND OBJECTIVE: The aim of this study was to examine whether serum immunoglobulin G (IgG) levels to Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans are higher in type 1 diabetic patients than in controls and are associated with coronary artery calcification, a measure of atherosclerosis. MATERIAL AND METHODS: One-hundred and ninety nine type 1 diabetic patients (mean age 38 +/- 4 years) and 201 age- and gender-matched nondiabetic subjects had coronary artery calcification, as measured by electron beam computed tomography. Serum IgG levels to P. gingivalis W50 and to A. actinomycetemcomitans HK1651 whole cells were measured by enzyme-linked immunosorbent assay. RESULTS: A similar proportion of diabetic patients (29%) and controls (31%, p = 0.7) had elevated serum IgG to periodontal bacteria, defined as being above the median antibody level for both microorganisms. Elevated antibody levels were associated with higher systolic blood pressure (p = 0.02) and an increased odds of coronary artery calcification in all subjects combined (odds ratio = 1.7, p = 0.047) and in diabetic subjects examined separately (odds ratio = 2.01, p = 0.027). Association of serum IgG levels with coronary artery calcification was independent of social class, lipids and antibody levels to other microorganisms, but not systolic blood pressure (odds ratio = 1.4, p = 0.1 on adjustment for blood pressure). There was no association between serum IgG level and vascular endothelial function. CONCLUSION: Elevated levels of serum IgG to P. gingivalis and A. actinomycetemcomitans are associated with coronary artery atherosclerosis. This may reflect a direct role for periodontal infection or a role for the host response to infection in coronary atherosclerosis, particularly in patients with type 1 diabetes.
Asunto(s)
Aggregatibacter actinomycetemcomitans/inmunología , Enfermedad de la Arteria Coronaria/sangre , Diabetes Mellitus Tipo 1/sangre , Inmunoglobulina G/sangre , Porphyromonas gingivalis/inmunología , Adulto , Anticuerpos Antiidiotipos/sangre , Anticuerpos Antibacterianos/sangre , Calcinosis/sangre , Calcinosis/epidemiología , Enfermedad de la Arteria Coronaria/inmunología , Diabetes Mellitus Tipo 1/inmunología , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/inmunología , Enfermedades Periodontales/microbiologíaRESUMEN
We report the case of a patient with acute pulmonary homograft endocarditis secondary to Streptococcus agalactiae from a cat-bite. He had undergone a Ross procedure nineteen years earlier. In view of unremitting infection with large pulmonary trunk and right pulmonary artery vegetations, the patient underwent successful pulmonary vegetectomy and homograft replacement.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Gatos , Endocarditis Bacteriana/etiología , Implantación de Prótesis de Válvulas Cardíacas , Estenosis de la Válvula Pulmonar/cirugía , Infecciones Estreptocócicas/etiología , Streptococcus agalactiae/aislamiento & purificación , Adulto , Animales , Mordeduras y Picaduras/microbiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Reoperación , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trasplante HomólogoRESUMEN
AIMS: The PREDICT Study aims to determine: (i) the association between cardiovascular risk factors and coronary artery calcification score (CACS) obtained by electron beam tomography and (ii) the predictive value of CACS for coronary heart disease (CHD) events in Type 2 diabetes. METHODS: Having previously reported relationships between CACS and conventional risk factors, we have now studied the novel risk factors, plasma high-sensitivity C-reactive protein (CRP) and homocysteine, insulin resistance, serum apoprotein A1 and B concentrations, the serum triglyceride/high-density lipoprotein cholesterol ratio and metabolic syndrome (International Diabetes Federation definition) in 573 subjects of the PREDICT Type 2 diabetes cohort. RESULTS: In univariate analyses, the only significant positive novel correlate of CACS was homocysteine (P = 0.0004). CRP was increased in those with detectable calcification, but decreased with increasing calcification score (P = 0.006). In a multivariate model that included all significant univariate correlates, CACS was independently associated with age (P < 0.0001), waist-hip ratio (P < 0.02), male gender (P < 0.05) and duration of diabetes (P < 0.05), but the association with homocysteine was no longer significant. The negative association between CACS and CRP remained in multivariate analysis, and was independent of statin use. CONCLUSIONS: Age was the major factor influencing CACS in Type 2 diabetes, with weaker contributions from waist hip-ratio and duration of diabetes. Other novel cardiovascular risk factors appear to have little positive effect.
Asunto(s)
Proteína C-Reactiva/metabolismo , Calcinosis/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatías Diabéticas/diagnóstico , Homocistina/metabolismo , Adulto , Humanos , Masculino , Síndrome Metabólico/sangre , Persona de Mediana Edad , Isquemia Miocárdica/prevención & control , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
AIM: To determine the association between coronary calcification score (CACS) obtained by electron beam computed tomography (EBCT) and cardiovascular risk factors in Type 2 diabetic subjects entered into a prospective cohort study. METHODS: Type 2 diabetic subjects attending routine hospital diabetic clinics without known coronary heart disease (CHD) underwent EBCT to measure CACS. Demographic data were obtained and conventional cardiovascular risk factors were measured at baseline. RESULTS: Four hundred and ninety-five subjects were assessed of whom 67.7% were male. They had a mean (SD) age of 62.9 (7.1) years, with median (inter-quartile range) duration of diabetes of 8 (4-13) years. None had a history of coronary artery disease. Forty-five per cent were receiving lipid-lowering agents (including 36% statins). In a univariate analysis, there were significant associations between increased CACS and age, duration of diabetes, male gender, waist-hip ratio (WHR), systolic blood pressure, and the use of statins. In a multivariate model adjusting for the possible interaction of these and other factors, the significant association between CACS and WHR, systolic blood pressure, male gender and statin use remained. CONCLUSIONS: The close association between CACS and WHR and the association with systolic blood pressure suggest that coronary calcification may be particularly linked to the metabolic syndrome in Type 2 diabetes.
Asunto(s)
Calcinosis/patología , Enfermedad Coronaria/patología , Diabetes Mellitus Tipo 2/patología , Angiopatías Diabéticas/patología , Calcinosis/diagnóstico por imagen , Estudios de Cohortes , Enfermedad Coronaria/diagnóstico por imagen , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Angiopatías Diabéticas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Relación Cintura-CaderaRESUMEN
BACKGROUND: This study was designed to measure inter-observer variation between thoracic radiologists in the diagnosis of diffuse parenchymal lung disease (DPLD) using high resolution computed tomography (HRCT) and to identify areas of difficulty where expertise, in the form of national panels, would be of particular value. METHODS: HRCT images of 131 patients with DPLD (from a tertiary referral hospital (n = 66) and regional teaching centres (n = 65)) were reviewed by 11 thoracic radiologists. Inter-observer variation for the first choice diagnosis was quantified using the unadjusted kappa coefficient of agreement. Observers stated differential diagnoses and assigned a percentage likelihood to each. A weighted kappa was calculated for the likelihood of each of the six most frequently diagnosed disease entities. RESULTS: Observer agreement on the first choice diagnosis was moderate for the entire cohort (kappa = 0.48) and was higher for cases from regional centres (kappa = 0.60) than for cases from the tertiary referral centre (kappa = 0.34). 62% of cases from regional teaching centres were diagnosed with high confidence and good observer agreement (kappa = 0.77). Non-specific interstitial pneumonia (NSIP) was in the differential diagnosis in most disagreements (55%). Weighted kappa values quantifying the likelihood of specific diseases were moderate to good (mean 0.57, range 0.49-0.70). CONCLUSION: There is good agreement between thoracic radiologists for the HRCT diagnosis of DPLD encountered in regional teaching centres. However, cases diagnosed with low confidence, particularly where NSIP is considered as a differential diagnosis, may benefit from the expertise of a reference panel.
Asunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Estudios de Cohortes , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del ObservadorRESUMEN
PURPOSE: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS: The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION: In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.
Asunto(s)
Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Biopsia , Errores Diagnósticos , Femenino , Humanos , Modelos Logísticos , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares Intersticiales/clasificación , Enfermedades Pulmonares Intersticiales/patología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/patología , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Type 1 diabetes is associated with a high risk of coronary heart disease (CHD), despite the absence of dyslipidemia. Oxidative modification may render LDLs more atherogenic. We aimed to assess antioxidant status in type 1 diabetes and its association with coronary artery calcification (CAC). RESEARCH DESIGN AND METHODS: Total antioxidant status (TAS) of serum was measured using the Trolox equivalent antioxidant capacity assay in 48 type 1 diabetic and 25 nondiabetic subjects. The presence of CAC was assessed in the diabetic subjects using electron beam computed tomography. RESULTS: TAS was reduced in type 1 diabetic subjects compared with nondiabetic subjects (Mann-Whitney U test, P < 0.0001). There were associations between TAS and HbA(1c) (r = -0.43; P = 0.0026) and duration of diabetes (r = -0.35; P = 0.0157). Significant CAC was considered present if the Agatston score was >10. The diabetic subjects with significant CAC were older (P < 0.0001); had longer duration of diabetes (P = 0.0002); were more likely to have high blood pressure (P = 0.040); had higher total cholesterol concentration (P = 0.039), serum creatinine concentration (P = 0.003), and urinary albumin-to-creatinine ratio (P = 0.022); and had lower serum TAS (P = 0.018) compared with those without significant calcification. In logistic regression with CAC as the dependent variable, TAS was entered as a predictor, and the effects on its predictive value of adding other explanatory variables in bivariate analyses were assessed. The power of TAS to predict CAC was independent of many of the traditional CHD risk factors. Whereas TAS as a predictor was no longer statistically significant when age or duration of diabetes were entered into the model, the odds ratio for a TAS concentration above the median value predicting significant CAC only increased from 0.19 to 0.26 and 0.32, respectively. CONCLUSIONS: TAS is reduced in type 1 diabetes and is associated with the presence of CAC.
Asunto(s)
Antioxidantes/análisis , Calcinosis/sangre , Enfermedad Coronaria/sangre , Diabetes Mellitus Tipo 1/sangre , Adulto , Albuminuria , Glucemia/análisis , Presión Sanguínea , Calcinosis/complicaciones , Calcinosis/fisiopatología , HDL-Colesterol/sangre , Cromanos , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/fisiopatología , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/fisiopatología , Retinopatía Diabética/epidemiología , Femenino , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Valores de Referencia , FumarAsunto(s)
Tomografía Computarizada por Rayos X , Calcinosis/diagnóstico , Calcinosis/diagnóstico por imagen , Calcinosis/metabolismo , Calcio/análisis , Cardiomiopatías/diagnóstico , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/metabolismo , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/diagnóstico por imagen , Humanos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: We have previously shown, by means of electron beam tomography, the pattern of calcification of the aortic root wall of homografts and porcine xenografts after aortic root replacement. However, application of similar methods for cusp calcification raises specific problems that have not been addressed before. METHODS: A new method for localizing and quantifying calcification of the aortic valve cusps has been evolved. Intravenous contrast-enhanced electron beam tomography was introduced to visualize the aortic cusps. This technique was applied to quantify cusp calcification in 37 patients after aortic root replacement with a homograft (group H) or a Medtronic Freestyle valve (group F) at set intervals between 6 months and 2 years. A calcification score in Hounsfield units (HU) and a calcified volume score in cubic millimeters were calculated. RESULTS: The aortic leaflets were clearly visualized in all patients. The mean calcium score in the cusps was 28.8+/-64.4 HU in group F and 62.4+/-66.9 HU in group H (p = not significant). The mean calcified volume score was 327.0+/-425.9 mm3 in group F and 642.0+/-443.0 mm3 in group H (p = not significant). CONCLUSIONS: Contrast enhancement electron beam tomography is a useful tool for quantification of calcium in the aortic valve leaflets. Our preliminary results show a tendency toward more calcification in the homografts. This needs to be studied further in a bigger cohort of patients followed up for longer periods.
Asunto(s)
Válvula Aórtica/cirugía , Bioprótesis , Calcinosis/diagnóstico por imagen , Prótesis Valvulares Cardíacas , Válvulas Cardíacas/trasplante , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Válvulas Cardíacas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Reoperación , Trasplante HomólogoRESUMEN
PURPOSE: To identify a system for the quantification of pleural thickening with an acceptable level of interobserver variation and good functional correlation in individuals with pleural disease. MATERIALS AND METHODS: The extent of pleural thickening and plaques was assessed in 50 patients by using the following: (a) a radiographic score based on the International Labour Office system, (b) a subjective simple computed tomographic (CT) score, (c) a subjective comprehensive CT score, (d) an objective nonautomated method, and (e) an objective computer-aided semiautomated method. RESULTS: Similar correlations between the extent of diffuse pleural thickening and forced vital capacity were seen for each system (objective CT, r = -0.72, P <.001; simple CT, r = -0.69, P <.001; radiographic, r = -0.67, P <.001; comprehensive CT, r = -0.66, P <.001). Comparable correlations were observed for total lung capacity. After controlling for extent of diffuse pleural thickening, pleural plaque scores were functionally irrelevant. CONCLUSION: Comparable functional-morphologic correlations were achieved by using different CT and radiographic scoring systems for pleural disease. A subjective simple CT system had the advantages of ease of application and potential to aid in the accurate assessment of the lung parenchyma, which may be important in individuals exposed to asbestos.
Asunto(s)
Pleura/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Pleura/fisiopatología , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/fisiopatología , Probabilidad , Pruebas de Función Respiratoria , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To examine the association of heart-rate variability with cardiovascular risk factors and coronary calcification in type 1 diabetic and nondiabetic subjects without a history of cardiovascular disease. Reduced heart-rate variability is associated with increased risk of coronary events. Whether it is associated with coronary atherosclerosis is unknown. RESEARCH DESIGN AND METHODS: Power spectral analysis was used to define heart-rate variability in a cross-sectional study of 160 type 1 diabetic patients and 163 randomly selected nondiabetic adults from the general population aged 30-55 years. Coronary artery calcification was measured using electron beam-computed tomography. RESULTS: Reduced heart-rate variability was associated with similar risk factors in the diabetic and nondiabetic subjects, namely higher HbA(1c), triglycerides, systolic blood pressure, BMI, and albumin excretion rate. Reduced heart-rate variability was significantly associated with coronary artery calcification in all subjects (odds ratio per tertile lower total power = 1.5, P = 0.01). This association was not independent of blood pressure or BMI (odds ratio on adjustment = 1.3, P = 0.1). CONCLUSIONS: Reduced heart-rate variability clusters with other cardiovascular disease risk factors, especially those that are more common in the insulin resistance syndrome, and is associated with increased coronary calcification in asymptomatic young adults. Whether reduced heart-rate variability leads to other risk factor disturbances or mediates the effects of other risk factors on atherosclerosis deserves further study.
Asunto(s)
Calcinosis/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedad Coronaria/epidemiología , Diabetes Mellitus Tipo 1/fisiopatología , Angiopatías Diabéticas/epidemiología , Frecuencia Cardíaca/fisiología , Adulto , Albuminuria , Índice de Masa Corporal , Angiografía Coronaria , Diabetes Mellitus/epidemiología , Ejercicio Físico , Femenino , Hemoglobina Glucada/análisis , Humanos , Lípidos/sangre , Lipoproteínas/sangre , Londres , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sistema de Registros , Factores de Riesgo , Fumar , Sístole , Tomografía Computarizada por Rayos X , Triglicéridos/sangreRESUMEN
This study examined the role of cholesteryl ester transfer (CET), cholesteryl ester transfer protein (CETP) activity, and phospholipid transfer protein (PLTP) activity in the increased prevalence of coronary artery calcification (CAC) in diabetic subjects compared with nondiabetic subjects and in the loss of the sex difference in CAC in diabetes. CETP activity, PLTP activity, and CET were measured in 195 type 1 diabetic subjects without renal failure and 194 nondiabetic control subjects of similar age (30-55 years) and sex distribution (50% female). CAC was quantified with electron beam computed tomography. CETP activity was higher in diabetic subjects (mean 84 arbitrary units [AU]) than in nondiabetic subjects (80 AU, P = 0.028). PLTP activity was also higher in diabetic subjects (96 AU) than in nondiabetic subjects (81 AU, P < 0.001). However, CET was lower in diabetic men (geometric mean 32 nmol. ml(-1).h(-1)) than nondiabetic men (37 nmol.ml(-1).h(-1), P = 0.004) and did not differ between diabetic (30 nmol. ml(-1).h(-1)) and nondiabetic (32 nmol.ml(-1).h(-1), P = 0.3) women. CETP and PLTP activities were not associated with CAC. CET was positively associated with CAC in both diabetic and nondiabetic subjects (odds ratio per 10 nmol.ml(-1).h(-1) increase in CET in all subjects = 1.4, P = 0.001). The prevalence of CAC was similar in diabetic (51%) and nondiabetic (54%, P = 0.7) men but was much higher in diabetic (47%) than nondiabetic (21%, odds ratio 3.6, P < 0.001) women so that there was no sex difference in CAC in diabetic subjects. The odds of CAC in diabetic women compared with nondiabetic women was altered little by adjustment for CETP activity, PLTP activity, or CET (odds ratio on adjustment 3.7, P < 0.001). The greater effect of diabetes on CAC in women than in men, i.e., the loss of the sex difference in CAC, was independent of CETP and PLTP activity and CET. In conclusion, among both diabetic and nondiabetic subjects, higher cholesteryl ester transfer is a risk factor for CAC. However, abnormalities in cholesteryl ester transfer or lipid transfer protein activities do not underlie the increased CAC risk in diabetic women compared with nondiabetic women or the loss of the sex difference in CAC in diabetes.
Asunto(s)
Calcinosis/etiología , Proteínas Portadoras/sangre , Ésteres del Colesterol/metabolismo , Enfermedad Coronaria/etiología , Diabetes Mellitus Tipo 1/sangre , Angiopatías Diabéticas/etiología , Glicoproteínas , Proteínas de la Membrana/sangre , Proteínas de Transferencia de Fosfolípidos , Adulto , Proteínas de Transferencia de Ésteres de Colesterol , Estudios Transversales , Diabetes Mellitus Tipo 1/metabolismo , Femenino , Humanos , Lipoproteínas/sangre , Masculino , Persona de Mediana Edad , Valores de Referencia , Caracteres SexualesRESUMEN
PURPOSE: To determine computed tomographic (CT) differences between acute respiratory distress syndrome (ARDS) due to pulmonary injury (ARDS(p)) and extrapulmonary injury (ARDS(ex)). MATERIALS AND METHODS: CT appearances in 41 patients (27 male, 14 female; mean age, 47.1 years +/- 17.1 [SD]; age range, 17-79 years; those with ARDS(p), n = 16; those with ARDS(ex), n = 25) were categorized as typical or atypical of ARDS by two observers. The extent of individual CT patterns was also quantified. RESULTS: Typical CT appearances were more frequent in ARDS(ex) than ARDS(p) (18 [72%] of 25 vs five [31%] of 16 patients, respectively; P <.01). Sensitivity, specificity, and accuracy of a typical CT pattern for the diagnosis of ARDS(ex) were 72%, 69%, and 71%, respectively. Atypical appearances were characterized by more extensive nondependent intense parenchymal opacification (IPO) (P =.03) and cysts (P =.05), whereas typical CT appearances had more extensive dependent IPO (P =.01). Typical appearances at CT were independently related to the cause of ARDS (odds ratio, 8.9; 95% CI: 1.8, 44.2; P <.01) but were independent of the time from intubation. Foci of nondependent IPO were more extensive in ARDS(p) (P =.05) than ARDS(ex), but this finding was ascribable to differences in time to CT (after intubation) between ARDS(p) and ARDS(ex). CONCLUSION: The differentiation between ARDS(p) and ARDS(ex) can, with some caveats, be based on whether the CT appearances are typical or atypical of ARDS but not on any individual CT pattern in isolation.
Asunto(s)
Enfermedades Pulmonares/complicaciones , Lesión Pulmonar , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/etiología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria/patologíaRESUMEN
OBJECTIVES: To examine whether the gender difference in coronary artery calcification, a measure of atherosclerotic plaque burden, is lost in type 1 diabetic patients, and whether abnormalities in established coronary heart disease risk factors explain this. BACKGROUND: Type 1 diabetes abolishes the gender difference in coronary heart disease mortality because it is associated with a greater elevation of coronary disease risk in women than men. The pathophysiological basis of this is not understood. METHODS: Coronary artery calcification and coronary risk factors were compared in 199 type 1 diabetic patients and 201 nondiabetic participants of similar age (30 to 55 years) and gender (50% female) distribution. Only one subject had a history of coronary disease. Calcification was measured with electron beam computed tomography. RESULTS: In nondiabetic participants there was a large gender difference in calcification prevalence (men 54%, women 21%, odds ratio 4.5, p < 0.001), half of which was explained by established risk factors (odds ratio after adjustment = 2.2). Diabetes was associated with a greatly increased prevalence of calcification in women (47%), but not men (52%), so that the gender difference in calcification was lost (p = 0.002 for the greater effect of diabetes on calcification in women than men). On adjustment for risk factors, diabetes remained associated with a threefold higher odds ratio of calcification in women than men (p = 0.02). CONCLUSIONS: In type 1 diabetes coronary artery calcification is greatly increased in women and the gender difference in calcification is lost. Little of this is explained by known coronary risk factors.