Association of Aortic Arch Calcification on Chest X-ray with Procedural Thromboembolism after Mechanical Thrombectomy for Acute Ischemic Stroke

Background and Objective: Procedural thromboembolism after a mechanical thrombectomy (MT) for an acute ischemic stroke (AIS) has rarely been studied. It may occur from the artery-to-artery embolization of atherosclerotic plaque in the aortic arch. We investigated the relationship between aortic arch calcification (AoAC) on a chest X-ray and procedural thromboembolism on diffusion-weighted imaging (DWI) after an MT. Materials and Methods: From January 2017 to December 2020, 131 patients underwent DWI within two days following an MT for an AIS. Procedural thromboembolism was defined as new DWI-positive lesions in other territories from the occluded artery on DWI within two days after MT. Results: Procedural thromboembolism was observed in 30 (22.9%) patients. Procedural thromboembolism was associated with old age (72.3 ± 9.44 vs. 65.7 ± 12.8 years, p = 0.003), a longer procedural time (77.6 ± 37.6 vs. 60.1 ± 29.7 min, p = 0.024), and AoAC (calcification (73.3%) vs. no calcification (29.7%), p < 0.001). Multivariable logistic regression analysis showed that procedural thromboembolism was independently associated with AoAC (adjusted odds ratio (OR): 6.107, adjusted 95% confidence interval (CI): 2.374–15.705, p < 0.001) and a longer procedural time (adjusted OR: 1.015, adjusted 95% CI: 1.001–1.030, p = 0.031). Conclusions: Procedural thromboembolism after an MT for an AIS was related to AoAC on a chest X-ray and a longer procedural time. Our results suggest that although rapid recanalization is the most crucial goal of an MT for an AIS, the importance of the careful advance of the guiding catheter through the aortic arch should not be underestimated to reduce the risk of procedural thromboembolism, especially in patients with AoAC on a chest X-ray.

Prognostic Implication of Longitudinal Changes in Cardiothoracic Ratio and Aortic Arch Calcification in Hemodialysis Patients

Patients with end-stage renal disease have a high prevalence of cardiovascular disease. Chest radiography can be used to assess cardiothoracic ratio (CTR) and aortic arch calcification (AoAC). The aims of this longitudinal follow-up study were to investigate factors associated with changes in CTR and AoAC and understand whether these changes are associated with overall and cardiovascular mortality in hemodialysis (HD) patients. We enrolled 260 patients undergoing HD who had at least two available chest X-rays from 2008 to 2015. CTR and AoAC were assessed in each patient using measurements from baseline and annual chest X-rays. The CTR increased from 49.05% to 51.86% and the AoAC score increased from 3.84 to 9.73 over 7 years. The estimated slopes were 0.24 (p < 0.0001) for CTR and 0.08 (p = 0.0441) for AoAC. Increased AoAC, older age, female sex, coronary artery disease, and decreased albumin were associated with an increase in CTR, and older age, cerebrovascular disease, decreased albumin, increased Kt/V, and the use of antiplatelet agents were associated with an increase in AoAC. During follow-up, 136 of the 260 (52.3%) patients died, of whom 72 died due to cardiovascular causes. The change in CTR was greater in those who died (p = 0.0125) than in those who survived. The AoAC score was also higher in those who died than in those who survived, although there was no significant difference in the change in AoAC between the two groups (p = 0.8035). CTR and AoAC increased significantly over time in the HD patients in this longitudinal follow-up study, and the change in CTR was greater in those who died than in those who survived. Chest radiography is a simple and useful tool to assess the progression of CTR and AoAC as a prognostic marker.

Citric Acid-Based Bicarbonate Dialysate Attenuates Aortic Arch Calcification in Maintenance Haemodialysis Patients: An Observational Study

Introduction: The progression of aortic calcification is associated with mortality in haemodialysis patients. Blood calciprotein particle (CPP) levels are associated with coronary artery calcification, and was reported to be inhibited when using citric acid-based bicarbonate dialysate (CD). Therefore, we examined the effect of CD on the progression of the aortic arch calcification score (AoACS) and blood CPP levels in haemodialysis patients.Methods: A 12-month retrospective observational study of 262 haemodialysis patients who met the eligibility criteria was conducted at Joban Hospital. Patients taking warfarin or bisphosphonates and those with baseline AoACS of 100% were excluded. Progression, defined as ΔAoACS (12 months – baseline) > 0%, was compared between the CD and acetic acid-based bicarbonate dialysate (AD) groups.Results: The CD group had significantly lower AoACS progression than the AD group (P = 0.037). ΔCPP and ΔAoACS were not correlated in the AD group (R2 = 0.030, P = 0.098), but were negatively correlated in the CD group (R2 = 0.065, P = 0.022). Multivariate logistic analysis showed that the CD (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.27‒0.97, P = 0.042) was significantly associated with the AoACS progression.Conclusion: CD may suppress the progression of vascular calcification in haemodialysis patients.

Aortic Arch Calcification and Cardiomegaly Are Associated with Overall and Cardiovascular Mortality in Hemodialysis Patients

Patients with end-stage renal disease have a higher risk of cardiovascular morbidity and mortality. In this study, we investigated the predictive ability of a combination of cardiothoracic ratio (CTR) and aortic arch calcification (AoAC) for overall and cardiovascular mortality in patients receiving hemodialysis. We also evaluated the predictive power of AoAC and CTR for clinical outcomes. A total of 365 maintenance hemodialysis patients were included, and AoAC and CTR were measured using chest radiography at enrollment. We stratified the patients into four groups according to a median AoAC score of three and CTR of 50%. Multivariable Cox proportional hazards analysis was used to identify the risk factors of mortality. The predictive performance of the model for clinical outcomes was assessed using the χ2 test. Multivariable analysis showed that, compared to the AoAC < 3 and CTR < 50% group, the AoAC ≥ 3 and CTR < 50% group (hazard ratio [HR], 4.576; p < 0.001), and AoAC ≥ 3 and CTR ≥ 50% group (HR, 5.912; p < 0.001) were significantly associated with increased overall mortality. In addition, the AoAC < 3 and CTR ≥ 50% (HR, 3.806; p = 0.017), AoAC ≥ 3 and CTR < 50% (HR, 4.993; p = 0.002), and AoAC ≥ 3 and CTR ≥ 50% (HR, 8.614; p < 0.001) groups were significantly associated with increased cardiovascular mortality. Furthermore, adding AoAC and CTR to the basic model improved the predictive ability for overall and cardiovascular mortality. The patients who had a high AoAC score and cardiomegaly had the highest overall and cardiovascular mortality among the four groups. Furthermore, adding AoAC and CTR improved the predictive ability for overall and cardiovascular mortality in the hemodialysis patients.

Aortic Arch Calcification Is Associated With Death From Cardiovascular Disease, Infection, and Malnutrition in Patients on Hemodialysis: a Retrospective Cohort Study

Background: Aortic arch calcification (AAC) is a well-known risk factor of death in patients on hemodialysis (HD); however, the causes of death in those having severe AAC have not been well studied. This study aimed to clarify the association between AAC and causes of death in HD patients and investigate their long-term prognosis.Methods: A retrospective observational study was conducted on Japanese HD patients from two clinics. AAC was classified into grade 0 to 3 using chest radiograph. The patients were followed up to 7 years, and their mortality and causes of death were recorded. The Kaplan-Meier method was used to estimate the probabilities of death from any cause and cardiovascular disease (CVD) death. The Cox proportional hazard models were employed to investigate variables relevant to all-cause mortality.Results: Among 321 patients (211 male, 64 ± 11 years old, 10 ± 8 years of dialysis duration), AAC grade 0, 1, 2, and 3 were observed in 88 (27.4%), 145 (45.2%), 54 (16.8%), and 34 (10.6%), respectively. During 5.2 ± 2.1 years, 117 (36.4%) patients died. AAC was associated with all-cause mortality (p < .001), and the death rates in AAC grade 0, 1, 2, and 3 were 19.3%, 35.2%, 46.3%, and 70.6%, respectively. In multivariate analysis, grade 3 AAC, age, ischemic heart disease and C-reactive protein were independent risk factors for all-cause mortality. The major causes of death were CVD (39.3%), infection (20.5%), and malignant tumor (15.4%) in the entire cohort. In AAC grade 3, death from infection (29.2%) and malnutrition (16.7%) increased and the combined death from these 2 reasons outweighed CVD death (33.3%).Conclusions: Although AAC was associated with all-cause and CVD mortality, the causes of death in patients on HD much differ among different AAC severities. Attention should be paid to CVD, infection, and malnutrition in patients on HD with severe AAC.

Heritability of Cardiothoracic Ratio and Aortic Arch Calcification in Twins

Background and Objectives: Aortic arch calcification (AoAC) is associated with a variety of cardiovascular complications. The measurement and grading of AoAC using posteroanterior (PA) chest X-rays are well established. The cardiothoracic ratio (CTR) can be simultaneously measured with PA chest X-rays and used as an index of cardiomegaly. The genetic and environmental contributions to the degree of the AoAC and CTR are not well understood. The purpose of this study was to investigate the effect of genetics and environmental factors on the AoAC and CTR. Materials and Methods: A total of 684 twins from the South Korean twin registry (261 monozygotic, MZ and 81 dizygotic, DZ pairs; mean age 38.6 ± 7.9 years, male/female = 264/420) underwent PA chest X-rays. Cardiovascular risk factors and anthropometric data were also collected. The AoAC and CTR were measured and graded using a standardized method. A structural equation method was used to calculate the proportion of variance explained by genetic and environmental factors behind AoAC and CTR. Results: The within-pair differences were low regarding the grade of AoAC, with only a few twin pairs showing large intra-pair differences. We found that the thoracic width showed high heritability (0.67, 95% CI: 0.59–0.73, p = 1). Moderate heritability was detected regarding cardiac width (0.54, 95% CI: 0.45–0.62, p = 0.572) and CTR (0.54, 95% CI: 0.44–0.62, p = 0.701). Conclusions: The heritable component was significant regarding thoracic width, cardiac width, and the CTR.