RESUMO
BACKGROUND AND AIMS: Hypertension is associated with increased clinical and subclinical coronary artery disease (CAD); however, the relationship between blood pressure and coronary plaque volume is unclear. We examined the effect of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on coronary artery plaque volume. METHODS: 285 subjects with stable CAD on statin therapy underwent coronary computed tomographic angiography to measure volume of fatty, fibrous, noncalcified, calcified and total coronary plaque. RESULTS: Mean (SD) age was 63.1 (7.7); mean (SD) LDL-C, 78.7â¯mg/dL (28.5). Compared to the highest DBP tertile (>76â¯mmHg), those in the lowest DBP tertile (≤68â¯mmHg) had lower volumes of fatty: 10.0 vs. 7.7â¯mm3/mm, (p trendâ¯=â¯0.042), fibrous: 19.6 vs. 13.8â¯mm3/mm (p trendâ¯=â¯0.011), non-calcified: 29.7 vs. 22.5â¯mm3/mm (p trendâ¯=â¯0.017) and total plaque: 37.8 vs. 25.1â¯mm3/mm (p trendâ¯=â¯0.010) whereas there was no relationship with SBP tertiles. Similarly, when examined as a continuous variable, higher DBP was a significant independent predictor of higher plaque volume after multivariate adjustment: for every 1â¯mmHg increase in DBP, fibrous plaque increased 0.128â¯mm3/mm (pâ¯=â¯0.022), noncalcified plaque increased 0.176â¯mm3/mm (pâ¯=â¯0.045), calcified plaque increased 0.096â¯mm3/mm (pâ¯=â¯0.001) and total plaque increased 0.249â¯mm3/mm (pâ¯=â¯0.019) whereas SBP ranging from 95 to 154â¯mmHg did not predict plaque volume. CONCLUSIONS: Level of DBP predicts coronary plaque with a DBP tertile ≤68â¯mmHg associated with the least amount of coronary plaque in subjects with LDL-C < 80â¯mg/dL.
Assuntos
Pressão Sanguínea , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/etiologia , Vasos Coronários/diagnóstico por imagem , Hipertensão/complicações , Placa Aterosclerótica , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Diástole , Feminino , Fibrose , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etiologia , Calcificação Vascular/fisiopatologia , Adulto JovemRESUMO
Tailgut cysts, also known as retrorectal hamartomas, are very rare neoplasms located in the presacral/retrorectal space that originate from the embryonic hindgut. Although a majority of lesions in this location are benign, 30% of the reported cases in the literature were found to be malignant. This report describes a case of a presacral mass found on CT of a 37-year-old woman who initially presented with worsening abdominal pain and a history of ovarian cyst rupture. This patient's clinical picture was complicated by an enlarging ovarian cyst. The risk of progression to malignancy warranted excision. She recovered well with resolution of her presenting symptoms. We report this case along with a brief review of the literature with a focus on the surgical considerations.