Yasutaka Itani

Pericardial fat accumulation in men as a risk factor for coronary artery disease

An increment of abdominal visceral fat accumulation has been reported to be a coronary risk factor. We determined the predictive power of pericardial fat (Pfat) accumulation as intra-thoracic visceral fat, in the diagnosis of coronary artery disease (CAD). Among 251 (181 non-obese [body mass index<25], 70 obese [body mass index> or =25]) Japanese male patients who underwent computed tomography (CT), 128 (90 non-obese, 38 obese) patients were suffering from CAD. Pfat volume was determined by the sum of cross-sectional images 1cm thick from the atrial appendage to the apex over the diaphragm. Abdominal visceral fat (Vfat) and subcutaneous fat (Sfat) areas were measured by a single scan at the L4-L5 region. Pfat was most associated with Vfat in body fat distribution. In non-obese patients, Pfat was most associated with CAD among the various risk factors including body fat distribution. Moreover, Pfat was the strongest independent variable for the severity of CAD, determined by coronary angiogram. This result showed that pericardial fat accumulation was a stronger coronary risk factor than the other body fat distributions in non-obese men.

Aortic Calcification Detected in a Mass Chest Screening Program Using a Mobile Helical Computed Tomography Unit

BACKGROUND There is a significant relationship between calcification of the aortic arch (Arch) detected by chest X-ray examination and coronary artery disease (CAD), but the relationship between risk factors, CAD and aortic calcification detected during a mass screening program using a mobile helical computed tomography (CT) unit remains unknown. METHODS AND RESULTS In total 2,623 subjects (1,347 men, and 1,276 women; mean age, 52.9+/-13.8) underwent an examination for lung cancer and tuberculosis using a mobile helical CT unit. The frequency of calcification was 19.6% in the Arch, 2.7% in the ascending aorta, and 10.1% in the descending aorta, values that were positively associated with age in both genders. Hypertension and smoking were significantly related to calcification of the thoracic aorta. There was a significant relationship between CAD and aortic calcification. The odds ratio of aortic calcification for patients with CAD increased as the number of calcified segments increased. CONCLUSIONS These results suggest that detection of calcification in the thoracic aorta during a mass chest screening using a mobile helical CT unit can be used to evaluate the risk of CAD.

Coronary artery calcification detected by a mobile helical computed tomography unit and future cardiovascular death: 4-year follow-up of 6120 asymptomatic Japanese

In the present study, we performed a prospective follow-up study in a population which underwent chest computed tomography (CT) screening. A total of 6 120 participants underwent a chest CT medical examination for lung cancer and tuberculosis in Nagano Prefecture, Japan, between 1996 and 1997. Computed tomography scanning was performed from the apex of the lung to the diaphragm at a tube voltage of 120 kV and a tube current of 50 mA. We measured the CT density of the coronary arteries in 5–7 slices where coronary arteries were detected. The CT density threshold for determining coronary artery calcification (CAC) was above +110 HU. In 2000, we investigated the number of deaths due to cardiac and noncardiac disease among the participants. Of the 6120 participants, 14 died of cardiac disease (9, myocardial infarction; 4, heart failure; and 1, angina pectoris) and 64 died of other diseases. Coronary artery calcification was detected in 10 of the patients who died of cardiac disease, and in 31 of those who died of other diseases. The prevalence of CAC was higher in the former than in the latter (71.4% vs 48.4%, P = 0.084). The relative risk of CAC for cardiac death was 2.66 (95% confidence interval: 0.76, 9.37). The findings of this study suggested that CAC detected in a mass chest CT screening by a mobile helical CT unit was predictive of future cardiovascular death.

Measurement of aortic diameters and detection of asymptomatic aortic aneurysms in a mass screening program using a mobile helical computed tomography unit.

Abstract In a mass chest computed tomography (CT) screening using a mobile helical CT unit, we measured the aortic diameter at three segments to confirm standard values and also attempted to detect any asymptomatic aortic aneurysms. The population screened in the present study consisted of 6 971 subjects (3 847 men and 3 124 women, mean age 60.3 ± 12.1 years). They underwent a plain chest CT to screen for lung cancer and tuberculosis. The diameters of the ascending and descending aorta were measured at the level of the pulmonary artery bifurcation. The abdominal aorta was measured at the level of the celiac bifurcation, and the mean values for each measurement were calculated. In addition, we attempted to determine whether any correlation exists among aortic diameter, age, and indices of body size and investigated the frequency of asymptomatic aortic aneurysms among the general population. The mean aortic diameter of all three segments was significantly larger in men than in women and increased with age. It also correlated significantly with indices of body size (P < 0.01). A total of 11 subjects (0.16%) had asymptomatic aortic aneurysms (3 ascending, 4 descending, and 4 thoracoabdominal). The aortic diameter in each individual case was greater than the mean aortic diameter +3 standard deviations in each age group. Chest CT screening for lung cancer can thus detect asymptomatic aneurysms through simultaneous aortic measurement.

A case report of intravenous leiomyomatosis extending into the heart.

Abstract The patient was a 47-year-old woman who underwent total hysterectomy for uterine leiomyoma in 1994. Two years later, intracaval and intravenous tumors were found by ultrasonic cardiography, magnetic resonance imaging, enhanced chest computed tomography, and venography. The patient underwent total removal of these tumors. Pathological findings indicated that these tumors were leiomyomas. After comparing the present findings with those of similar cases in the literature, we concluded that our patient had intravenous leiomyomatosis extending into the heart.