P4451Screening for Coronary Artery Disease USing Primary Evaluation with Cardiac CT (SUSPECT) in Aviation Medicine in the Royal Netherlands Air Force

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R B Grobben ◽  
E Frijters ◽  
B K Velthuis ◽  
R T A Beekmann ◽  
R Rienks ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Air Force ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
False Negative ◽  
Calcium Score ◽  
Negative Results ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Military aircrew are subjected to both stress and excessive G-forces, which may be associated with an increased risk of coronary artery disease (CAD) and sudden cardiac death. Annual cardiac screening has therefore been implicated using exercise testing, which suffers from both false-positive and false-negative results. In this study, we have evaluated the prevalence of CAD in military aircrew using cardiac computed tomography (CT), and assessed whether cardiac CT would be a useful screening tool within this population. Methods Prospective, single-center, cohort study in 250 asymptomatic aircrew >40 years old in the Royal Netherlands Air Force. Included subjects underwent cardiac CT, in addition to the routine annual check-up that included an electrocardiogram, exercise test and laboratory analysis. Primary endpoint was obstructive CAD, defined as a coronary stenosis ≥50%. Secondary endpoints were non-obstructive CAD (<50% stenosis) and coronary artery calcium score (CACS) >100. Results Of the first 108 inclusions, mean age was 49 years (range 40–57), 99% were male and mean body mass index was 25.8 (SD 2.6). The prevalence of hypertension was 8%, hypercholesterolemia 9% and familial heart disease was noted in 22%. 16% were active smokers and none had diabetes. Obstructive CAD was observed in 2% of patients, non-obstructive CAD in 40% and CACS >100 in 11%. All subjects with obstructive CAD on cardiac CT underwent coronary artery angiography, which confirmed a stenosis >70% that required revascularization. Conclusion In asymptomatic military aviation aircrew >40 years old currently active in the Royal Netherlands Air Force, the prevalence of obstructive and non-obstructive CAD was 2% and 40%, respectively Acknowledgement/Funding Royal Netherlands Air Force

Abstract 491: Detection of Subclinical Coronary Artery Disease by Calcium Score in Patients With Atrial Fibrillation: Potential Clinical Implications

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Miguel Valderrabano ◽  
Sayf Khaleel Bala ◽  
Sama Alchalabi ◽  
Edward Graviss ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vascular Diseases ◽  
Calcium Score ◽  
Clinical Implications ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Original Definition ◽  
Artery Disease

Background: Clinical implications of detecting subclinical coronary artery disease (CAD) in patients with atrial fibrillation (AF) are unclear. Methods: A total of 430 AF patients (age 63 ± 10 y, 65% male, 62% hypertensive, 16% diabetic, 42% dyslipidemic) without known CAD undergoing pre-procedural CT for catheter ablation were included. We evaluated the change in: 1) numbers of patients with CACS-diagnosed CAD who could potentially be on statin. 2) CHA2DS2-VASc score after incorporating CACS>100 (related to increased risk of stroke) into the original definition of vascular diseases who could potentially be on anticoagulants. Results: 1) Prevalence of subclinical CAD (CACS>0) was 74% (319/430) and 25% (106/430) had CACS>100. There were 62% (267/430) who were not on statin. Of these patients, 71% (190/267) had subclinical CAD while 21% (34/163) of statin users had CACS of 0. 2) The median original CHA2DS2-VASc score was 2. After incorporating CACS>100 into the original score, 24% (18/75) with the original score of 0 had the score changed to 1 (7/35 in persistent AF [PST-AF] and 11/40 in paroxysmal AF [PRX-AF]) (figure A) and 17% (22/131) with the original score of 1 had the score changed to ≥ 2 (10/83 in PST-AF and 12/48 in PRX-AF) (figure B). PRX-AF had more frequent increase in CHA2DS2-VASc score than PST-AF (p=0.035)(figure C). Conclusion: In AF patients without known history of CAD, detecting subclinical CAD by CACS potentially has important therapeutic implications for prevention forprogression of CAD and stroke.

Abstract 449: Increased Risk of Coronary Artery Disease in Patients with Persistent Type of Nonvalvular Atrial Fibrillation

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Sama Alchalabi ◽  
Sayf Khaleel bala ◽  
Su Min Chang
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Framingham Score ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
Artery Disease

Background: This study is to examine relationship between coronary artery disease (CAD) and types of atrial fibrillation (AF) Methods: A total of 403 nonvalvular atrial fibrillation patients without known history of CAD underwent coronary artery calcium score (CACS) evaluation by multi-detector cardiac computed tomography. Clinical characteristics and CACS were compared between patients with persistent type of AF and paroxysmal type of AF. Results: The cohort comprised of 65% (279 of 430) male with a mean (SD) age of 63(10) years. Prevalence of persistent AF was 60% (259 of 430). Mean (SD) 10-year risk of CAD by Framingham score was 14(7)%. Median CACS was 22 (range 0-5402) with 75% CACS>0 (321 of 430). Compared to paroxysmal type, those with persistent type had higher prevalence of CAC>0 as shown in Figure1 and more history of hypertension (p<0.001) but less history of smoking (p0.004), statins use (p0.018) and warfarin use (p<0.001). There was no statistically significant difference in mean age (p0.783) and CAD risk by Framingham score (p0.477) between two groups. In multivariate analysis, persistent type is an independent predictor for CACS>0 (OR 1.938; 95%CI 1.197, 3.138; p0.007). Conclusion: In patients with AF, persistent type of AF is independently associated with CACS>0. Our findings suggest potential benefit from evaluation of CAD in this population.

scholarly journals The challenge of asymptomatic coronary artery disease in aircrew; detecting plaque before the accident

Heart ◽  
2018 ◽  
Vol 105 (Suppl 1) ◽  
pp. s17-s24 ◽  
Author(s):  
Gary Gray ◽  
Eddie D Davenport ◽  
Dennis Bron ◽  
Rienk Rienks ◽  
Joanna d’Arcy ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Disease ◽  
Invasive Coronary Angiography ◽  
Calcium Score ◽  
Atheromatous Plaque ◽  
Increased Risk ◽  
Artery Disease ◽  
Asymptomatic Coronary Artery Disease

Coronary events remain a major cause of sudden incapacitation, including death, in both the general population and among aviation personnel, and are an ongoing threat to flight safety and operations. The presentation is often unheralded, especially in younger adults, and is often due to rupture of a previously non-obstructive coronary atheromatous plaque. The challenge for aeromedical practitioners is to identify individuals at increased risk for such events. This paper presents the NATO Cardiology Working Group (HFM 251) consensus approach for screening and investigation of aircrew for asymptomatic coronary disease.A three-phased approach to coronary artery disease (CAD) risk assessment is recommended, beginning with initial risk-stratification using a population-appropriate risk calculator and resting ECG. For aircrew identified as being at increased risk, enhanced screening is recommended by means of Coronary Artery Calcium Score alone or combined with a CT coronary angiography investigation. Additional screening may include exercise testing, and vascular ultrasound imaging. Aircrew identified as being at high risk based on enhanced screening require secondary investigations, which may include functional ischaemia, and potentially invasive coronary angiography. Functional stress testing as a stand-alone investigation for significant CAD is not recommended in aircrew. Aircrew identified with coronary disease require further clinical and aeromedical evaluation before being reconsidered for flying status.

scholarly journals Evaluation of the Correlation between the rs4918 Polymorphism of AHSG Gene and Coronary Artery Calcification in Patients with Coronary Artery Disease

2020 ◽  
Vol 10 (2) ◽  
pp. 33-41
Author(s):  
Zeynab Ahmadihosseini ◽  
Morteza Moeinian ◽  
Saeed Nazemi ◽  
Sepideh Elyasi ◽  
Amir Hooshang Mohammadpour
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Calcium Score ◽  
Control Group ◽  
Healthy Individuals ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Artery Disease

Objectives: Fetuin-A is a circulating calcification inhibitor that prevents coronary artery calcification (CAC) by increasing calcium phosphate solubility and inhibiting VSMC differentiation and apoptosis. In this study, we investigated the correlation between rs4918 and CAC in patients with coronary artery disease (CAD). Methods: Forty-two healthy individuals and eighty-one CAD patients were recruited in the present study. The CAC score (CACS) was measured by CT angiography and the genotype analysis of rs4918 single-nucleotide polymorphism SNP was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Results: The CACS was significantly higher in CAD patients compared to healthy individuals (p < 0.001); however, there was no significant difference between the mean CACS in the presence and absence of rs4918 (p = 0.792). The mean calcium score of the left main coronary artery (LMCA) was significantly lower in carriers of the rs4918 allele (p = 0.036). The frequency of rs4918 SNP was almost similar in the control group and CAD patients (p = 0.846). Conclusions: in patients with CAD, we found no significant association between rs4918 SNP and CACS, indicating that carriers of this allele are not at increased risk of developing cardiovascular diseases compared with those without.

scholarly journals CORONARY ARTERY CALCIFICATION

2016 ◽  
Vol 23 (12) ◽  
pp. 1432-1441
Author(s):  
Liaqat Ali ◽  
Naeem Asghar ◽  
Muhammad Nazim ◽  
Maqbool Hussain ◽  
Ali Farahe
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Calcium Score ◽  
Cross Sectional Study ◽  
Severe Stenosis ◽  
Cross Sectional ◽  
Increased Risk ◽  
Artery Disease ◽  
Zero Calcium Score

Background: Due to increased risk of CAD and cardiovascular events,prediction of severity and/ or complexity of coronary artery disease (CAD) are valuable.Previously association between severity of CAD and total coronary artery calcium (CAC) scorewas not demonstrated but now there are lot of studies which have proven this associationbut still association between total CAC score and complexity of CAD is not well established.Objective: This study was conducted: (1) To investigate the association between coronaryartery calcium (CAC) score and CAD assessed by CCTA. (2) To find which one of the two, CADseverity or complexity, is better associated with total CAC score in symptomatic patients havingsignificant CAD. Study Design: Observational cross sectional study. Place and Duration: Thestudy was conducted at Shifa International Hospital Faisalabad from March 2013 to June 2016.Materials and Methods: Total 195 consecutive patients of both gender age ≥20 years whowas referred for CT angiography to our hospital and who fulfill the inclusion and exclusioncriteria was included in the study. Before enrollment in the study all patients gave informedconsent. Before CT angiography total CAC score was obtained by non- enhanced CT scans.Demographic characteristics of all patients were obtained. Regarding risk factors for CAD,history of hypertension, diabetes mellitus, family H/O ischemic heart disease and hyperlipidemiawas noted. In all patients before CT angiography, Lab. investigations including complete bloodcount, fasting blood sugar, fasting lipid profile, blood urea and serum creatinine levels wereobtained. Calcium scores were quantified by the scoring algorithm proposed by Agatston et al.All lesions were added to calculate the total CAC score by the Agatston method. Calcium scoreswere divided into the following categories: 0, 1–100, 101–400, and ≥400. The degree of stenosiswas classified into four categories: (1) no stenosis, (2) minimal or mild stenosis (≤50%), (3)moderate stenosis (50%–70%), and (4) severe stenosis (>70%). CAD was defined when lumendiameter reduction was greater than 50% (moderate or severe stenosis). Results: Total 195patients were studied. 136 (69.7%) were male and 59 (30.3%) were female. Mean age of studypopulation was 52.8±10.38 years. 81(41.54%) patients had H/O chest pain, 11(5.64%) hadH/O shortness of breath and 96(49.23%) presented with chest tightness. 104(53.33%) patientswere hypertensive, 71(36.41%) were diabetic, 67(34.35%) had increased cholesterol level. In57 (29.2%) there was no coronary artery disease, 58(29.7%) had mild CAD, 32 (16.4%) hadmoderate and 48 (24.6%) had severe coronary artery disease on CT angiography. Single vesselwas involved in 38(19.5%) patients, 20(10.3%) had two vessel disease and triple vessel diseasewas present in 22(11.3%) patients. 104(53.3%) patients had zero calcium score. 44(22.6%)had CAC score between 1-100, 37 (19%) had CAC score between 101-400 and more than 400CAC score was documented in 10 (5.1%) patients. Conclusions: This study in addition topatient based analysis also confirms the significant relationship between vessels based CADand CAC score. The prevalence of multivessel CAD increased in patients with CACS >100 andthere is 100% incidence of CAD in patients with CACS >1000. Zero calcium cannot exclude thepresence of significant CAD. Our data supports that in symptomatic patients calcium scoring isan additional filter before coronary angiography.

The inverse association between lipoprotein(a) levels and metabolic syndorome and its components on coronary artery disease patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kasahara ◽  
S Endoh ◽  
A Ohtahara ◽  
S Kawatani ◽  
R Amisaki ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Atherosclerosis ◽  
Cardiac Computed Tomography ◽  
Primary Cultures ◽  
Inverse Correlation ◽  
Calcium Score ◽  
Inverse Association ◽  
Lipoprotein A ◽  
Artery Disease

Abstract Purpose Neele DM (Diabetologia 1999) showed that insulin suppressed apolipoprotein(a) synthesis by primary cultures of cynomolgus monkey hepatocytes. Therefore, there is a possibility that inverse association exists between lipoprotein(a) [Lp(a)] and metabolic syndorome (Mets) with insulin resistance/hyperinsulinemia for coronary atherosclerosis. Sung KC (Nutr Metab Cardiovasc Dis 2013) described the inverse association between Lp(a) levels and Mets and its components on an asian occupational cohort. And high levels of Lp(a) were associated with preclinical atherosclerosis, as evaluated by coronary calcium score with cardiac computed tomography. There is no similar examination on coronary artery disease (CAD) patients. The purpose is to examine similar considerations on CAD patients. Method 610 subjects with angiographically demonstrated CAD were enrolled. The patients who receiving medication for dyslipidemia and Insulin administration were excluded. The blood samples for laboratory tests were collected after an over night fast. Subjects were divided into four groups according to quartiles of Lp(a) levels (mg/dL). Ranges of quartile groups of Lp(a) were Q1: &lt;9.0, Q2: 9.0–&lt;16.0, Q3: 16.0–&lt;30.0, Q4: ≥30.0. Results The inverse association Lp(a) levels and Mets and its component. The comparison of Q1 (bottom quartile) versus Q4 (top quartile) was shown below; the comorbidity rate of Mets 19.5% versus 8.0% (p&lt;0.01), BMI (kg/m2) 23.5 versus 22.7 (p&lt;0.05), trigyceride (mg/dL) 144.0 versus 107.5 (p&lt;0.0001), HDL cholesterol (mg/dL) 46.8 versus 50.7 (p&lt;0.05), the comorbidity rate of hypertension 60.4% versus 50.7% (p=0.084), glucose (mg/dL) 107.1 versus 100.6 (p&lt;0.05), insulin (μU/mL) 8.49 versus 5.85 (p&lt;0.0001), HOMA-R 2.26 versus 1.44 (p&lt;0.0001). The mean number of diseased coronary vessel was higher in the Q4 group (2.07) than in the Q1 group (1.87) (p&lt;0.05). Conclusion There was the inverse association between Lp(a) levels and Mets and its components on CAD patients. The robust association was found between Lp(a) levels and severity of coronary atherosclerosis despite this inverse correlation. Funding Acknowledgement Type of funding source: None

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