Dafni Charisopoulou

Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors

BACKGROUND Ethnic differences in prevalence and severity of coronary artery disease are well established and are usually attributed to risk factors variation. This study investigates the differences in coronary artery narrowing and coronary calcification between two age- and gender-matched cohorts of South Asian and Caucasian symptomatic angina patients. METHODS We identified 101 symptomatic angina patients of South Asian origin who had undergone CT angiography and calcium scoring, and compared them with 101 age and gender matched Caucasian patients. RESULTS South Asians had a greater mean number of arterial segments with both obstructive and non-obstructive plaque than Caucasians (p=0.006 and p=0.0003, respectively) and higher prevalence of triple-vessel disease (p=0.0004). Similarly, South Asians had a higher mean CAC score (p<0.0001) and the percentage of South Asians with CAC>0 and in all categories of CAC score 100-1000 were also higher, as was the number of arterial segments with calcified and non-calcified plaque. These results were more marked in patients aged >50 but in those ≤ 50, Caucasians showed a higher mean number of diseased segments (p=0.019), with non-obstructive plaque (p=0.02), possibly suggesting that Caucasians are likely to have more diffuse atherosclerosis at an earlier age. CAC prevalence and severity in this age-group were not significantly different between South Asians and Caucasians. CONCLUSION Despite similar conventional risk factors for CAD, symptomatic South Asians seem to have more aggressive and diffuse arterial calcification compared to Caucasians. These differences are more profound above the age of 50, suggesting potential genetic or other risk factors yet to be determined.

Coronary Artery Calcification Progression in Asymptomatic Individuals With Initial Score of Zero

The aim of this study is to determine the progression of coronary artery calcification (CAC) using electron beam computed tomography (CT) when the initial CAC score (CACS) is zero and to determine the best interval to repeat a CAC scan. We studied 388 individuals with zero CACS (308 males; mean age: 48.8 ± 8.26 years) who underwent 2 consecutive CT scans in a period of at least 12 months apart. The interscan period was 2.99 ± 1.35 years (range: 1-6 years). Three-quarters of the individuals (75%) did not develop any CAC progression, 20.87% presented CAC progression of 1 to 10, 3.6% had 11 to 50, whereas only 0.51% had >50. The average time of new CAC development was 4.2 ± 1.1 years. Individuals with CAC progression presented higher incidence of hypertension, diabetes mellitus, hypercholesterolaemia and higer frequency of male gender than those with without CAC changes (p<0.02). No cardiac events occurred during the follow-up period.

Prevalence of Noncalcified Coronary Plaque in Patients With Calcium Score of 0 : The Silent Enemy

Noncalcified coronary artery plaques (NCAPs) are susceptible to rupture, resulting in coronary artery thrombosis. Using computer tomography coronary angiography (CTCA), we evaluated the prevalence and degree of stenosis caused by NCAP in patients without coronary artery calcification (CAC). A retrospective analysis of 447 symptomatic patients with 0 CAC score revealed negative CTCA in 400 (89.5%). Noncalcified coronary artery plaques were demonstrated in 47 (10.5%), with 4 presenting stenosis >50%. Patients with positive CTCA, compared to those with normal CTCA, had significantly higher mean age (56.2 years vs 50.6 years, P < .004) and higher pretest coronary artery disease (CAD) probability (26% vs 34%, P < .0001). Noncalcified coronary artery plaque was predominantly developed in the proximal segment of the left anterior descending artery. Noncalcified coronary artery plaque is present in up to 10% of patients with a CAC score of 0. Computer tomography coronary angiography could be of diagnostic value in symptomatic patients with multiple risk factors for CAD, even in the absence of CAC.

Differences in clinical profile of individuals with severe and markedly elevated coronary artery calcification detected by electron beam computed tomography.

Although several studies have demonstrated the association between coronary artery calcification (CAC) and coronary artery disease events, the underlying mechanism has not been fully elucidated. Furthermore, extensive CAC still remains a poorly understood phenomenon. The objective of this study is to determine the clinical characteristics and differences between 831 asymptomatic individuals with very high CAC scores (CACS ≥1000) and 497 asymptomatic individuals with CAC scores of 400 to 999. Individuals with CACS ≥1000 were more likely to have hypertension ([HTN]; P = .0004), hypercholesterolemia (P = .0001), diabetes mellitus ([DM] P = .005), and high body mass index ([BMI]; P = .03) compared with individuals with CACS = 400-999. On multivariable analysis, age (P < .0001) and BMI (P = .01) were found to be significant risk factors for the presence of very high CAC. While for males, age (P < .0001), hypercholesterolemia (P = .001), DM (P = .002), and obesity (P = .003) were independent risk factors; in females only HTN (P = .04) was independent risk factor.

Coronary artery calcification is not related to coronary heart disease isolated family history

Coronary artery calcification is not related to coronary heart disease isolated family history

Abnormal ventricular repolarization in long QT syndrome carriers is related to short left ventricular filling time and attenuated stroke volume response during exercise

Long QT syndrome (LQTS) carriers are characterized by abnormal ventricular repolarization, prolonged systole, and mechanical dispersion. Prolonged left ventricular (LV) systole has been shown to result in disproportionate shortening of LV filling in other conditions. The aim of this study was to assess LV filling, diastolic function, and stroke volume (SV) response to dynamic exercise, in a group of LQTS carriers.

35 Right Heart (RH) 2D-Strain Analysis may help to Identify Left Ventricular Assist Device (LVAD) Cadidates at Risk of Developing Postoperative RV Failure

Purpose Right Ventricular Failure (RVF) after LVAD implantation is associated with increased morbidity and mortality. We analyse right (RH) mechanics by 2D echo, strain and haemodynamic indices in an effort to define patters which may predispose to RVF during LVAD support. Methods 70 LV failure patients (47 ± 12 yrs, 59 male, ischaemic: 21%, LV EF: 23%±10) received continuous-flow LVAD as bridge to transplantation within 18 months. Patients were divided into those who developed RVF during LVAD therapy (RVF group) and those who did not (non-RVF). We compared haemodynamic, echo and strain data between the groups. Results 21 patients (30%) developed post-LVAD implantation RVF resulting in lower survival duration (RVF: 372 days ± 345 vs 650 ± 369, p = 0.03), while 14 patients of the RVF group required subsequent right VAD support. There were no significant differences in age, sex, HR or rhythm, LVEF, cardiac index or in RV stroke work index, mean or systolic pulmonary artery pressure, pulmonary vascular resistance index, TAPSE, RV fractional change area, tricuspid regurgitation grade or TDI systolic and diastolic parameters (p > 0.2). However, RVF group had higher RV end-diastolic pressure (RVEDP, 25 ± 7 mmHg vs 15 ± 6, p = 0.02) and higher mean RA pressure (mRAP, 25 ± 6 mmHg vs 15 ± 7, p = 0.03). Additionaly, there was lower RA peak strain (RAPS: 11 ± 1 vs 33 ± 8%, p = 0.01), lower and later-occurring RV global peak strain (RVGS: 8 ± 2.8% vs 9.2 ± 2.5, p = 0.03, time to RVGS: 57% ±10 vs 47 ± 17, p = 0.03), lower and later-occurring RV free wall peak strain (RVFWS: 8.6 ± 2.7% vs 14.8 ± 2.9, p = 0.01, time to RVFWS: 56% ±19 vs 45 ± 17, p = 0.04), lowerRVFW peak systolic strain rate (RVFWSR: 0.94 ± 0.47s-1 vs 1.1 ± 0.3, p = 0.05) occurring earlier in systole (17% ± 10 vs 0.29 ± 0.13, p = 0.04) and higher late RVFW diastolic strain rate (0.43 ± 0,2s-1 vs 0.28 ± 0.21, p = 0.01). RV contraction after PV closure was more frequently seen in the RVF group (30% vs 20%, p = 0.03). There was also greater time delay between RVFW and septal peak strain (RVD, 147 ± 52 ms vs 53 ± 38, p = 0.03) and between RVFWS and LVFWS (136 ± 55 vs 78 ± 40 ms, p = 0.03). LV strain indices were similar for both groups. Independent predictors of RVF were higher mRAP (OR: 6, 95% CI:0.686–0.976, p = 0.03), lower RAPS (OR: 1.2, CI:1.083–1.716, p = 0.003), lower RVFWS (OR: 1.4, CI: 1.012–2.347, p = 0.04) and greater RVD (OR: 1.028, CI:1.008–1.034, p = 0.01). Higher predictive value was shown for RVD (AUC:0.84), mRAP (AUC: 0.82) and RAPS (AUC: 0.795) Conclusion LVAD recipients, who developed post-operative RVF, exhibited lower RAPS and RVFWS and greater RVD, indicating decreased RH compliance and dyssynchronous RV function. RH strain analysis may add incremental value to 2D echo assessment of LVAD candidates and improve decision making before VAD implantation.

Assessment of Coronary Artery Calcification in Elderly Adults

Background : Early identification of atherosclerosis in older adults is paramount due to high cardiovascular morbidity and mortality. Our aim was to investigate CAC in a population of adults ≥55 years without previous history of cardiovascular heart disease (CHD) and its association with cardiovascular risk factors. Methods : This was a retrospective analysis of 6,573 individuals with a mean age of 61.8 years (range 55-85; 68.2% males) who underwent Electron Beam Computed Tomography for CAC score (CACS) assessment. Results : CAC was present in 70.5% of the overall cohort (78.8% of males and 52.7% of females). Twenty six per cent (26%) of those with CAC did not have any CHD risk factors. CACS ranged from 0 to 7,908 (mean 223.3±512.9); males presented a higher mean CACS (284.57 ± 571.1), compared to females (mean CACS 92.2 ± 324.8), p <0.0001. The mean CACS in males increased from 154.2 for ages 55-59 years to 760.2 in those aged 80 to 84 whilst in females mean CACS increased from 39.5 to 224.4, for corresponding age groups. The mean CACS appears to increase with age irrespective of gender. In each gender, age and hypercholesterolemia were associated with higher CACS. Furthermore, in males family history and DM were positively associated with CACS while in females, smoking status and hypertension were positively associated with CACS. Conclusion : A broad distribution of CACS was seen in older subjects. Assessment of CACS may place patients into a higher risk group for future events, and lead to more aggressive treatment with preventative therapies.

The prevalence of non-calcified plaques in symptomatic patients with zero calcium score

Introduction Atheromatous plaque rupture is the most common cause of coronary artery thrombosis. Non-calcified plaques, with thin fibrous cap and large thrombogenic lipid core, are predominantly the most susceptible to rupture. Aims To investigate, with a 640-slice, 320-row CT scanner, the non-calcified coronary artery plaques (NCAP) prevalence and the degree of caused obstruction, in a cohort of symptomatic subjects, without coronary calcification. Methods and Results Out of 1806 patients, who underwent coronary CT angiography (CTCA), we retrospectively identified 447 symptomatic patients with coronary artery calcification (CAC) score of 0. Standard cardiovascular risk factors were assessed prior to the CTCA study. From the 447 subjects, 400 (89.48%) had a negative CTCA, while in 47 (10.51%) NCAP were depicted on CTCA. Four of these (4/47) had stenosis more than 50%. Mean age of patients with positive CTCA was 56.21 years, significantly higher than those of patients with negative CTCA (50.6 years, p<0.004). Additionally, when compared to patients with normal CTCA, those with NCAP were in higher risk of developing CAD, as derived from the pre CTCA assessment (26% vs 34.04%, p<0.0001). The Left Anterior Descending artery (LAD), and especially the proximal segment, was the predominant location for the development of NCAP. Conclusion Absence of coronary calcification does not exclude the presence of atherosclerosis; NCAP is present in up to 10% of patients with CAC score of 0. Symptomatic patients, who older in age, with multiple factors and high probability of CAD, would benefit from CTCA even in the absence of CAC.