Carotid artery stiffness, digital endothelial function, and coronary calcium in patients with essential thrombocytosis, free of overt atherosclerotic disease

Abstract Background Patients with myeloproliferative neoplasms (MPNs) are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET), a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects. Patients and methods 40 ET patients without overt vascular disease, and 42 apparently healthy, age and sex-matched control subjects with comparable classical risk factors for atherosclerosis and Framingham risk of coronary disease were enrolled. All subjects were examined by physical and laboratory testing, carotid echo-tracking ultrasound, digital EndoPat pletysmography and CT coronary calcium scoring. Results No significant differences were found between ET patients and controls in carotid plaque score [1 (0-1.25) vs. 0 (0-2), p=0.30], β- index of carotid stiffness [7.75 (2.33) vs. 8.44 (2,81), p=0.23], pulse wave velocity [6,21 (1,00) vs. 6.45 (1.04) m/s; p=0.46], digital reactive hyperemia index [2.10 (0.57) vs. 2.35 (0.62), p=0.07], or augmentation index [19 (3-30) vs. 13 (5-22) %, p=0.38]. Overall coronary calcium burden did not differ between groups [Agatston score 0.1 (0-16.85) vs. 0 (0-8.55), p=0.26]. However, significantly more ET patients had an elevated coronary calcium score of >160 [6/40 vs. 0/42, p < 0.01]. Conclusions No significant differences between groups were found in carotid artery morphology and function, digital endothelial function or overall coronary calcium score. Significantly more ET patients had an elevated coronary calcium score of >160, indicating high cardiovascular risk, not predicted by the Framingham equation.

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Carotid Artery Doppler Ultrasound and Coronary Calcium Score in Assessment of Atherosclerosis in Patients with Suspected Coronary Artery Disease

The Medical Journal of Cairo University ◽

10.21608/mjcu.2019.65637 ◽

2019 ◽

Vol 87 (September) ◽

pp. 3401-3416

Author(s):

AMINA A. ELBEHERY, M.Sc.; MANAL E. BADAWY, M.D. ◽

NOHA M. ABD EL MAEBOD, M.D.; IBRAHIM A. NASSAR, M.D.

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Doppler Ultrasound ◽

Calcium Score ◽

Suspected Coronary Artery Disease ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Artery Disease

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Abstract 368: Serum Matrix Metalloproteinases 1, 2 and 9, Tissue Inhibitor of Metalloproteinases-1 and Inflammatory Markers in Patients with Aortic Valve Sclerosis

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.34.suppl_1.368 ◽

2014 ◽

Vol 34 (suppl_1) ◽

Author(s):

Jorge E Cossio-Aranda ◽

Rashidi Springall ◽

Sergio Trevethan-Cravioto ◽

Nilda Espinola-Zavaleta ◽

Rafael Bojalil ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Matrix Metalloproteinases ◽

Inflammatory Markers ◽

Carotid Plaque ◽

Cardiovascular Events ◽

Cox Regression ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Serum Concentrations

Background: Valvular Aortic Sclerosis (AVS) and Calcified Degenerative Valvular Aortic Stenosis (AS) are important risk factors for cardiovascular events. Matrix Metalloproteinases (MMPs) and other inflammatory markers might play an important role in the mechanisms underlying endothelial dysfunction described in AS. The participation of MMPs in AVS is poorly studied as of yet. We evaluated the concentrations of MMPs 1,2 and 9 and tissue-1 inhibitor (TIMP-1) and inflammatory markers in AVS patients. Methods: The research and the ethics committees of our institution approved the study. Samples were obtained from peripheral blood in a cohort of 107 subjects: 30 healthy blood donor controls, 47 with AS and 30 AVS. Serum concentrations of Interleukins (ILs) 1 and 6, Tumor Necrosis Factor (TNF-α) and MMPs 1, 2 and 9 and TIMP-1 were measured by quantitative immunoassay technique with commercial kits, while concentrations of C Reactive Protein (CRP) by nephelometry. In all patients endothelial function and carotid plaque, 256 slice coronary computed tomography and coronary calcium score were evaluated. A one way ANOVA nonparametric test (Kruskall-Wallis), Kaplan Meier and multivariate Cox regression model were performed. Results: Serum concentrations of CRP, ILs 6 and 10, MMPs-1, 2, 9 and TIMP-1 were higher in AVS and AS patients than in healthy controls (p<0.001), while no differences between the two patients groups were found. However, the MMP-9/TIMP-1 ratio was higher in patients with AVS than the rest of the groups (p<0.05). Endothelial dysfunction (73.9%), carotid plaque (34.2%), coronary plaque (39.7%) and coronary calcium score >400 (14%) was similar in both patients groups. During follow-up of 19.96±14.51 months, 50.7% of AVS and AS patients developed cardiovascular events. Type 2 diabetes was the stronger predictors for cardiovascular events in ASV (RR= 2.67, IC95% de 1.027 - 6.926). Conclusions: Our findings suggest an important inflammatory role of MMPs, TIMPs and cytokines in AVS disease, which could explain a higher prevalence of coronary artery disease in this patients.

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Coronary Artery Plaque Burden and Perioperative Cardiac Risk

Anesthesiology ◽

10.1097/00000542-200111000-00017 ◽

2001 ◽

Vol 95 (5) ◽

pp. 1133-1140 ◽

Cited By ~ 7

Author(s):

Elisabeth Mahla ◽

Martin N. Vicenzi ◽

Brigitte Schröttner ◽

Robert Maier ◽

Kurt Tiesenhausen ◽

...

Keyword(s):

Electron Beam ◽

Cardiac Troponin ◽

Cell Injury ◽

Troponin T ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Plaque Burden ◽

Cardiac Troponin T ◽

Electron Beam Computed Tomography

Background Electron-beam computed tomography-derived coronary calcium score correlates with the morphologic severity of coronary artery disease, reflecting both global atherosclerotic plaque formation and coronary artery luminal narrowing. The current study examines the impact of coronary atherosclerotic plaque burden, measured by coronary calcium score, on the potential for perioperative myocardial cell injury, as assessed by cardiac troponin T elevations in patients undergoing elective vascular surgery. The authors further investigated whether perioperative myocardial cell injury in those patients adversely affects noninvasive measures of left ventricular systolic function, such as ejection fraction and wall motion score. Methods Fifty-one consecutive patients scheduled for vascular surgery were enrolled in this prospective study. In addition to standard preoperative evaluation, including patient history and physical examination, electron-beam computed tomography scan, 12-lead electrocardiography, and transthoracic echocardiography were performed on the day before surgery. Subsequent evaluations on postoperative days 2 and 7 included transthoracic echocardiography and 12-lead electrocardiography. Cardiac troponin T determinations were performed on the day before surgery, immediately preoperatively, and on postoperative days 1, 2, 3, and 7. Results The median coronary calcium score of the 51 patients was 997.0 (25th percentile, 202.5; 75th percentile, 1,949.5). Cardiac troponin T elevations exclusively occurred in patients with a coronary calcium score greater than 1,000. The six patients (12%) with perioperative cardiac troponin T elevations had a 2.5-fold higher coronary calcium score than those without cardiac troponin T elevation (P = 0.021). In these patients, the ejection fraction decreased from 61 +/- 10% to 52 +/- 13% (mean +/- SD) on postoperative day 2 and was 54 +/- 16% on postoperative day 7 (P = 0.022). Conclusion A high electron-beam computed tomography coronary calcium score, reflecting substantial coronary plaque burden, carries an increased risk for myocardial cell injury after vascular surgery. In these patients, myocardial damage may result in deterioration of global systolic left ventricular function.

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Evaluation of Coronary Calcium Score by Multidetector Computed Tomography in Relation to Endothelial Function and Inflammatory Markers in Asymptomatic Individuals

Circulation Journal ◽

10.1253/circj.72.778 ◽

2008 ◽

Vol 72 (5) ◽

pp. 778-785 ◽

Cited By ~ 24

Author(s):

Mahmoud M. Ramadan ◽

Essam M. Mahfouz ◽

Gamal F. Gomaa ◽

Tarek A. El-Diasty ◽

Louie Alldawi ◽

...

Keyword(s):

Computed Tomography ◽

Endothelial Function ◽

Multidetector Computed Tomography ◽

Inflammatory Markers ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Asymptomatic Individuals

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569 Association between periodontal disease, coronary calcium score and markers of subclinical atherosclerosis in patients with unstable angina-a CT-based sub-study from the ATHERODENT clinical trial

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.299 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I-P Rodean ◽

L Lazar ◽

D E Opincariu ◽

N Rat ◽

R I Hodas ◽

...

Keyword(s):

Clinical Trial ◽

Carotid Artery ◽

Periodontal Disease ◽

Unstable Angina ◽

Subclinical Atherosclerosis ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Abdominal Circumference ◽

Plaque Vulnerability

Abstract Funding Acknowledgements PlaqueImage financed by the National Authority of Scientific Research and Innovation and the Romanian Ministry of European Funding Background The relationship between periodontal disease (PD) and chronic inflammation is well established. PD leads to increased cardiovascular risk and favours development of acute coronary syndromes; however, the association between PD and markers of subclinical atherosclerosis has not been elucidated so far. Purpose To evaluate the interrelation between severity of PD, coronary calcium, subclinical atherosclerosis and plaque vulnerability in patients with unstable angina, who underwent coronary computed tomography angiography (CCTA). Methods Fifty-two patients with unstable angina were enrolled in the ATHERODENT clinical trial (NCT03395041). All patients underwent: (1) complex dental examination for assessment of periodontal status, expressed by the total periodontal index (PI) evaluating the following indices: gingival index, plaque index, tantrum index, furcation index, mobility, loss of attachment, pocket depth and papillary bleeding index, (2) CCTA for analysis of morphology, composition and vulnerability features of the culprit plaques causing myocardial schema. For each patient, coronary calcium score, body mass index, neck circumference, abdominal circumference and Intima-media thickness of the carotid artery were calculated. According to the median value of the total PI (set by 22) the study population was divided into two groups: group 1 included 26 patients with low PI (normal gum or gingivitis) and group 2 included 26 patients with high PI (periodontitis and severe PD). Results In patients with high PI the plaque volume (p = 0.019) and the non-calcified volume (p = 0.002) were more increased compared with patients with low PI. In patients with high risk features in the culprit coronary plaques (positive remodelling, low density atheroma, spotty calcification and napkin ring sign) the severity of PD was more expressed compared with those with low risk plaques (28.20+/-13.34 vs. 18.71+/-11.31, p = 0.001). From all PI indices, loss of gingival attachments (3.6 +/-2.91 vs. 1.66 +/- 1.8, p = 0.009) and papillary bleeding index (4.5 +/-3.06 vs. 2.04+/-1.96, p = 0.002) were significantly correlated with the plaque vulnerability. there was no significant correlation between PI and the markers of subclinical atherosclerosis expressed by the neck circumference, abdominal circumference and IMT of the carotid artery. However, total PI presented significantly correlation with the total coronary artery calcium score (r = 0.45, p = 0.0008). A higher calcium score was identified in patients with high PI compared with those with low PI (505.29 +/-478.64 vs. 93.82+/-233.0, p = 0.0001). Conclusions In patients with vulnerable coronary plaques, subclinical atherosclerosis is not correlated with PI. However, the severity of PD is directly associated with the total calcium score and with a more vulnerable phenotype of the atheromatous coronary plaques.

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