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Matthew J Budoff - One of the best experts on this subject based on the ideXlab platform.

  • thoracic aorta calcification detected by Electron Beam Tomography predicts all cause mortality
    Atherosclerosis, 2010
    Co-Authors: Raul D Santos, Matthew J Budoff, Khurram Nasir, Paolo Raggi, Daniel S Berman, John A Rumberger, Leslee J Shaw, Sarwar H Orakzai, Roger S Blumenthal
    Abstract:

    Abstract Background The presence of coronary artery calcium (CAC) is an independent marker of increased risk of cardiovascular disease (CVD) events and mortality. However, the predictive value of thoracic aorta calcification (TAC), which can be additionally identified without further scanning during assessment of CAC, is unknown. Methods We followed a cohort of 8401 asymptomatic individuals (mean age: 53±10 years, 69% men) undergoing cardiac risk factor evaluation and TAC and CAC testing with Electron Beam computed Tomography. Multivariable Cox proportional hazards models were developed to predict all-cause mortality based on the presence of TAC. Results During a median follow-up period of 5 years, 124 (1.5%) deaths were observed. Overall survival was 96.9% and 98.9% for those with and without detectable TAC, respectively ( p p p =0.015). Likelihood ratio χ 2 statistics demonstrated that the addition of TAC contributed significantly in predicting mortality to traditional risk factors alone ( χ 2 =13.62, p =0.002) as well as risk factors+CAC ( χ 2 =5.84, p =0.02) models. Conclusion In conclusion, the presence of TAC was associated with all-cause mortality in our study; this relationship was independent of conventional CVD risk factors as well as the presence of CAC.

  • absence of coronary artery calcification and all cause mortality
    Jacc-cardiovascular Imaging, 2009
    Co-Authors: Michael J Blaha, Matthew J Budoff, Paolo Raggi, Tracy Q Callister, Daniel S Berman, John A Rumberger, Leslee J Shaw, Roger S Blumenthal, Faisal Khosa, Khurram Nasir
    Abstract:

    Objectives We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). Background There is increasing interest in the absence of CAC as a “negative” cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. Methods Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 ± 2.6 years (range 1 to 13 years). Results A total of 19,898 patients (45%) had no CAC on screening Electron Beam Tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. Conclusions In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.

  • reproducibility of coronary artery calcified plaque with cardiac 64 mdct the multi ethnic study of atherosclerosis
    American Journal of Roentgenology, 2009
    Co-Authors: Matthew J Budoff, Nathan D Wong, Roger S Blumenthal, Robyn L Mcclelland, Hyoju Chung, Jeffrey J Carr, Michael Mcnitt Gray, Robert Detrano
    Abstract:

    OBJECTIVE. The Multi-Ethnic Study of Atherosclerosis is a longitudinal study evaluating determinants of future cardiac events and progression of atherosclerosis. Emerging data are showing that coronary artery calcification (CAC) is a robust independent predictor of future cardiac events and that measurement of progression depends on reproducibility of the measure. Reproducibility previously was reported on baseline scans obtained with both Electron-Beam Tomography (EBT) and MDCT. The aim of this study was to compare the interscan variability for both Agatston and volume scores derived with newer (16- and 64-MDCT) scanners with that derived with older scanners in the Multi-Ethnic Study of Atherosclerosis.SUBJECTS AND METHODS. The participants in this study were 4,054 persons who underwent dual scanning with EBT (n = 1,716), 4-MDCT (n = 370), 16-MDCT (n = 1,245), or 64-MDCT (n = 723). Agreement on the presence or absence of CAC was assessed with logistic regression models adjusted for age, sex, body mass in...

  • mortality incidence and the severity of coronary atherosclerosis assessed by computed Tomography angiography
    Journal of the American College of Cardiology, 2008
    Co-Authors: Matthew P Ostrom, Ambarish Gopal, Naser Ahmadi, Khurram Nasir, Eric H Yang, Ioannis A Kakadiaris, Ferdinand Flores, Song S Mao, Matthew J Budoff
    Abstract:

    Objectives This study investigated whether cardiac computed Tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent Electron Beam Tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed Tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by Electron Beam Tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (≥50% luminal narrowing), mild CAD ( Results During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p Conclusions The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.

  • the interscan variation of ct coronary artery calcification score analysis of the calcium acetate renagel comparison care 2 study
    Academic Radiology, 2008
    Co-Authors: Matthew J Budoff, Paul D Kessler, Yan L Gao, Wajeh Y Qunibi, Moustafa Moustafa, Song S Mao
    Abstract:

    Rationale and Objectives In the Calcium Acetate Renagel Evaluation (CARE)-2 study, the effects of calcium acetate plus atorvastatin (Lipitor) on the progression of coronary artery calcifications (CACs) are evaluated versus those of Renagel, monitored using dual Electron Beam Tomography (EBT) scans (two scans at study initiation and two at follow up). The aim of this study is to estimate the interscan variation for the Agatston score and for the volume score determined in patients with end-stage renal disease (ESRD) in the CARE-2 study. Materials and Methods CAC score and volume were measured at study initiation in 463 ESRD subjects (mean age: 59.4 ± 12.5 years, 48.3% female). All patients underwent dual scanning using an EBT, as first scan of two needed to measure the progression of CAC when treated with sevelamer (Renagel) compared with calcium acetate with or without atorvastatin. All scans in all participants were completed by using an EBT system (GE Imatron, South San Francisco, CA). Interscan variability was defined by the following formula: abs (scan A − scan B) ÷ (0.5 × scan A + 0.5 × scan B) × 100%, where A and B denote the first and second scan, respectively, of the dual scan procedure performed before treatment. We evaluated the reproducibility of the cutpoints commonly used for calcium scores clinically, namely 1–30, 31–100, 101–400, and >400. Results The CAC interscan variability was 11.8% using the Agatston score and 10.3% using the volume score. The reproducibility was then assessed using cutpoints 1–30, 31–100, 101–400, and >400. Agatston score variability for the four subgroups was 61.3%, 23%, 16.1%, and 8.2%, respectively (mean variability, 11.8%). Volume score variability was 60.0%, 14.4%, 14.6%, and 7.7%, respectively (mean variability, 10.3%). The correlation coefficient for scan A to scan B goes up significantly with increasing calcium scores and reaches 0.99 for scores greater than 400 ( P Conclusion Interscan variability was sufficiently small for patients with calcium scores greater than 30. Our study thus demonstrates a sufficient reproducibility of the calcium score using EBT. This score allows for accurate serial assessment of these patients and for comparing different therapies.

Khurram Nasir - One of the best experts on this subject based on the ideXlab platform.

  • thoracic aorta calcification detected by Electron Beam Tomography predicts all cause mortality
    Atherosclerosis, 2010
    Co-Authors: Raul D Santos, Matthew J Budoff, Khurram Nasir, Paolo Raggi, Daniel S Berman, John A Rumberger, Leslee J Shaw, Sarwar H Orakzai, Roger S Blumenthal
    Abstract:

    Abstract Background The presence of coronary artery calcium (CAC) is an independent marker of increased risk of cardiovascular disease (CVD) events and mortality. However, the predictive value of thoracic aorta calcification (TAC), which can be additionally identified without further scanning during assessment of CAC, is unknown. Methods We followed a cohort of 8401 asymptomatic individuals (mean age: 53±10 years, 69% men) undergoing cardiac risk factor evaluation and TAC and CAC testing with Electron Beam computed Tomography. Multivariable Cox proportional hazards models were developed to predict all-cause mortality based on the presence of TAC. Results During a median follow-up period of 5 years, 124 (1.5%) deaths were observed. Overall survival was 96.9% and 98.9% for those with and without detectable TAC, respectively ( p p p =0.015). Likelihood ratio χ 2 statistics demonstrated that the addition of TAC contributed significantly in predicting mortality to traditional risk factors alone ( χ 2 =13.62, p =0.002) as well as risk factors+CAC ( χ 2 =5.84, p =0.02) models. Conclusion In conclusion, the presence of TAC was associated with all-cause mortality in our study; this relationship was independent of conventional CVD risk factors as well as the presence of CAC.

  • absence of coronary artery calcification and all cause mortality
    Jacc-cardiovascular Imaging, 2009
    Co-Authors: Michael J Blaha, Matthew J Budoff, Paolo Raggi, Tracy Q Callister, Daniel S Berman, John A Rumberger, Leslee J Shaw, Roger S Blumenthal, Faisal Khosa, Khurram Nasir
    Abstract:

    Objectives We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). Background There is increasing interest in the absence of CAC as a “negative” cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. Methods Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 ± 2.6 years (range 1 to 13 years). Results A total of 19,898 patients (45%) had no CAC on screening Electron Beam Tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. Conclusions In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.

  • mortality incidence and the severity of coronary atherosclerosis assessed by computed Tomography angiography
    Journal of the American College of Cardiology, 2008
    Co-Authors: Matthew P Ostrom, Ambarish Gopal, Naser Ahmadi, Khurram Nasir, Eric H Yang, Ioannis A Kakadiaris, Ferdinand Flores, Song S Mao, Matthew J Budoff
    Abstract:

    Objectives This study investigated whether cardiac computed Tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. Background Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent Electron Beam Tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed Tomography studies. Methods In all, 2,538 consecutive patients who underwent CTA by Electron Beam Tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (≥50% luminal narrowing), mild CAD ( Results During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p Conclusions The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.

  • coronary calcium progression rates with a zero initial score by Electron Beam Tomography
    International Journal of Cardiology, 2007
    Co-Authors: Ambarish Gopal, Khurram Nasir, Ferdinand Flores, Sandy T Liu, Lynn Chen, Matthew J Budoff
    Abstract:

    Abstract Background A review of existing literature shows that for individuals with initial coronary calcium scores (CCS) of zero it would be reasonable to consider follow-up scanning no sooner than 3 years from the initial evaluation, however the data is very limited. In this study, we sought to determine the rate of new calcifications in patients initially presenting with a zero initial score on Electron Beam Tomography (EBT). Methods and results We evaluated 710 physician-referred participants (253 women and 448 men, mean age=56±9 years [range=29 to 93]) with no coronary artery calcium (CAC) at baseline Electron Beam Tomography (EBT) scan. The participants underwent a follow-up scan at least 12 months apart. In our study, 248 (35%) were followed for 1–3 years, 256 (36%) for 3–5 years and 204 (29%) for >5 years, respectively. Overall, more than half of the individuals (62%) did not develop any CAC (score remained zero) in the interim period, whereas only 2% had CAC progression >50 during the follow-up. The overall median (interquartile range) and mean±S.D. change/year in these individuals was 0 (0–0.8) and 1±3, respectively. Only 11 (2%) had CAC progression/year of 11–50, whereas 3 (1%) had CAC change/year >50. It is interesting to note that even among individuals with long-term follow-up (>5 years), very few individuals (2%) had CAC progression >50. Individuals with follow-up 3–5 years did not have a significantly higher odds ratio for CAC change >10 ( p =0.17) as compared to the reference group (follow-up of 1–3 years). All the other individuals who had a longer follow-up (>5 years) had a significantly higher likelihood of CAC progression >10 (OR=6.6, 95% CI=2.6–16.9, p Conclusion In individuals with no detectable coronary calcium on an initial EBT scan, a repeat scan can be recommended no sooner than 5 years.

  • relation of uric acid levels to presence of coronary artery calcium detected by Electron Beam Tomography in men free of symptomatic myocardial ischemia with versus without the metabolic syndrome
    American Journal of Cardiology, 2007
    Co-Authors: Khurram Nasir, Raul D Santos, Raza H Orakzai, Romeu S Meneghelo, Jose A M Carvalho, Roger S Blumenthal
    Abstract:

    The objective of this study was to evaluate whether uric acid (UA) levels were associated with coronary artery calcium (CAC) in white men asymptomatic for coronary heart disease. We also evaluated whether this relation was dependent or not on the presence of the metabolic syndrome (MS). The study population consisted of 371 asymptomatic Brazilian men (48 ± 7 years of age) who underwent a routine evaluation. The average 10-year total risk of coronary heart disease calculated by Framingham risk score was 10.8 ± 7.8%. The age-adjusted prevalence of CAC in patients with a high UA level (fourth quartile ≥7.1 mg/dl, n = 91) was significantly higher than that in those with a normal UA level (58% vs 44%, p = 0.02). With respect to age, smoking, physical activity, and components of MS-adjusted analyses, a high UA level was independently associated with the presence of CAC (p = 0.043) and with increasing levels of CAC (p = 0.028). Prevalence of MS showed a graded increase according to serum UA values. In patients with the MS, after adjusting for age, smoking, physical activity, and white blood cell count, high levels of UA were strongly associated with the presence of any CAC (odds ratio 3.47, 95% confidence interval 1.26 to 9.53, p = 0.01) and with increasing levels of CAC (odds ratio 2.74, 95% confidence interval 1.15 to 6.50, p = 0.02). Conversely, there was no significant association of high UA levels in patients without the MS. However, the interaction between high UA level and the MS did not achieve statistical significance for the presence of CAC (p = 0.11) or higher levels of CAC (p = 0.16). In conclusion, our study suggests that, among asymptomatic moderate-risk men, high UA levels were independently associated with CAC in subjects with the MS.

Roger S Blumenthal - One of the best experts on this subject based on the ideXlab platform.

  • thoracic aorta calcification detected by Electron Beam Tomography predicts all cause mortality
    Atherosclerosis, 2010
    Co-Authors: Raul D Santos, Matthew J Budoff, Khurram Nasir, Paolo Raggi, Daniel S Berman, John A Rumberger, Leslee J Shaw, Sarwar H Orakzai, Roger S Blumenthal
    Abstract:

    Abstract Background The presence of coronary artery calcium (CAC) is an independent marker of increased risk of cardiovascular disease (CVD) events and mortality. However, the predictive value of thoracic aorta calcification (TAC), which can be additionally identified without further scanning during assessment of CAC, is unknown. Methods We followed a cohort of 8401 asymptomatic individuals (mean age: 53±10 years, 69% men) undergoing cardiac risk factor evaluation and TAC and CAC testing with Electron Beam computed Tomography. Multivariable Cox proportional hazards models were developed to predict all-cause mortality based on the presence of TAC. Results During a median follow-up period of 5 years, 124 (1.5%) deaths were observed. Overall survival was 96.9% and 98.9% for those with and without detectable TAC, respectively ( p p p =0.015). Likelihood ratio χ 2 statistics demonstrated that the addition of TAC contributed significantly in predicting mortality to traditional risk factors alone ( χ 2 =13.62, p =0.002) as well as risk factors+CAC ( χ 2 =5.84, p =0.02) models. Conclusion In conclusion, the presence of TAC was associated with all-cause mortality in our study; this relationship was independent of conventional CVD risk factors as well as the presence of CAC.

  • absence of coronary artery calcification and all cause mortality
    Jacc-cardiovascular Imaging, 2009
    Co-Authors: Michael J Blaha, Matthew J Budoff, Paolo Raggi, Tracy Q Callister, Daniel S Berman, John A Rumberger, Leslee J Shaw, Roger S Blumenthal, Faisal Khosa, Khurram Nasir
    Abstract:

    Objectives We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). Background There is increasing interest in the absence of CAC as a “negative” cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. Methods Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 ± 2.6 years (range 1 to 13 years). Results A total of 19,898 patients (45%) had no CAC on screening Electron Beam Tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. Conclusions In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.

  • reproducibility of coronary artery calcified plaque with cardiac 64 mdct the multi ethnic study of atherosclerosis
    American Journal of Roentgenology, 2009
    Co-Authors: Matthew J Budoff, Nathan D Wong, Roger S Blumenthal, Robyn L Mcclelland, Hyoju Chung, Jeffrey J Carr, Michael Mcnitt Gray, Robert Detrano
    Abstract:

    OBJECTIVE. The Multi-Ethnic Study of Atherosclerosis is a longitudinal study evaluating determinants of future cardiac events and progression of atherosclerosis. Emerging data are showing that coronary artery calcification (CAC) is a robust independent predictor of future cardiac events and that measurement of progression depends on reproducibility of the measure. Reproducibility previously was reported on baseline scans obtained with both Electron-Beam Tomography (EBT) and MDCT. The aim of this study was to compare the interscan variability for both Agatston and volume scores derived with newer (16- and 64-MDCT) scanners with that derived with older scanners in the Multi-Ethnic Study of Atherosclerosis.SUBJECTS AND METHODS. The participants in this study were 4,054 persons who underwent dual scanning with EBT (n = 1,716), 4-MDCT (n = 370), 16-MDCT (n = 1,245), or 64-MDCT (n = 723). Agreement on the presence or absence of CAC was assessed with logistic regression models adjusted for age, sex, body mass in...

  • relation of uric acid levels to presence of coronary artery calcium detected by Electron Beam Tomography in men free of symptomatic myocardial ischemia with versus without the metabolic syndrome
    American Journal of Cardiology, 2007
    Co-Authors: Khurram Nasir, Raul D Santos, Raza H Orakzai, Romeu S Meneghelo, Jose A M Carvalho, Roger S Blumenthal
    Abstract:

    The objective of this study was to evaluate whether uric acid (UA) levels were associated with coronary artery calcium (CAC) in white men asymptomatic for coronary heart disease. We also evaluated whether this relation was dependent or not on the presence of the metabolic syndrome (MS). The study population consisted of 371 asymptomatic Brazilian men (48 ± 7 years of age) who underwent a routine evaluation. The average 10-year total risk of coronary heart disease calculated by Framingham risk score was 10.8 ± 7.8%. The age-adjusted prevalence of CAC in patients with a high UA level (fourth quartile ≥7.1 mg/dl, n = 91) was significantly higher than that in those with a normal UA level (58% vs 44%, p = 0.02). With respect to age, smoking, physical activity, and components of MS-adjusted analyses, a high UA level was independently associated with the presence of CAC (p = 0.043) and with increasing levels of CAC (p = 0.028). Prevalence of MS showed a graded increase according to serum UA values. In patients with the MS, after adjusting for age, smoking, physical activity, and white blood cell count, high levels of UA were strongly associated with the presence of any CAC (odds ratio 3.47, 95% confidence interval 1.26 to 9.53, p = 0.01) and with increasing levels of CAC (odds ratio 2.74, 95% confidence interval 1.15 to 6.50, p = 0.02). Conversely, there was no significant association of high UA levels in patients without the MS. However, the interaction between high UA level and the MS did not achieve statistical significance for the presence of CAC (p = 0.11) or higher levels of CAC (p = 0.16). In conclusion, our study suggests that, among asymptomatic moderate-risk men, high UA levels were independently associated with CAC in subjects with the MS.

  • detection of high risk young adults and women by coronary calcium and national cholesterol education program panel iii guidelines
    Journal of the American College of Cardiology, 2005
    Co-Authors: Khurram Nasir, Roger S Blumenthal, Erin D Michos, Paolo Raggi
    Abstract:

    Objectives The purpose of this study was to investigate the classification of cardiovascular risk in young individuals and women according to the National Cholesterol Education Program (NCEP) guidelines across a continuum of coronary calcium scores (CCS). Background Current NCEP guidelines might underestimate cardiovascular risk in young individuals and women. Methods The study population consisted of 1,611 asymptomatic individuals (67% men, mean age: 53 ± 10 years) who presented to a single Electron Beam Tomography facility for coronary artery calcium screening. Participants were categorized into low-risk (n = 738, 46%), intermediate-risk (n = 583, 36%), moderately high-risk (n = 263, 16%), and high-risk (n = 27, 2%) according to the NCEP Panel III guidelines. Results Absence of calcium, CCS of 0 to 99 (mild), 100 to 399 (moderate), and ≥400 (severe), was observed in 572 (35%), 707 (44%), 192 (12%), and 140 (9%) of the patients, respectively. A high CCS percentile (≥75th percentile) was present in 426 (26%) individuals. Overall, 59% and 78% of participants with CCS ≥400 and CCS ≥75th percentile were not identified as high risk and candidates for pharmacotherapy on the basis of NCEP categories. Furthermore, women as well as young individuals were less likely to be considered candidates for pharmacotherapy compared with men and older individuals in each CCS category. Conclusions The NCEP guidelines seem to underestimate cardiovascular risk in young asymptomatic individuals and women. For these individuals, assessment of plaque burden might provide incremental value to global risk assessment.

Stephan Achenbach - One of the best experts on this subject based on the ideXlab platform.

  • clinical utility of computed Tomography and magnetic resonance techniques for noninvasive coronary angiography
    Journal of the American College of Cardiology, 2003
    Co-Authors: Matthew J Budoff, Stephan Achenbach, Andre J Duerinckx
    Abstract:

    Abstract Objectives The purpose of this study was to provide a comprehensive review of the literature relating to Electron Beam angiography (EBA), magnetic resonance angiography, and spiral computed Tomography, currently the three most promising noninvasive methods to visualize obstructions in the coronary tree. Background Given the high costs and invasiveness of coronary angiography, there is increased interest in noninvasive coronary angiography, which has made great strides to become a clinically useful tool to augment conventional coronary angiography (CCA). Methods MEDLINE searches were performed to include all articles related to noninvasive angiography utilizing either magnetic resonance imaging (MRI), multi-row detector spiral computed Tomography (MDCT), and Electron Beam Tomography (EBT). Weighted analysis was performed to define the published sensitivity and specificity for each technique. Results Electron Beam angiography (EBA) provides an overall sensitivity of 87% and specificity of 91% for the detection of obstructive coronary artery disease (CAD). Four-level MDCT data demonstrated an overall sensitivity of 59% and specificity of 89%, with higher accuracy in two recent studies of 16-level detector devices. Magnetic resonance angiography demonstrated sensitivity for detection of obstructive CAD of 77% and specificity of 71%. Conclusions Noninvasive coronary angiography is a rapidly developing technique and currently not an alternative to CCA in all cases. All three methods are currently used clinically in certain centers with appropriate expertise. Selective use should prove both cost-effective and provide a safer, less-invasive method for patients to determine the need for medical versus revascularization therapy.

  • comparison of image quality in contrast enhanced coronary artery visualization by Electron Beam Tomography and retrospectively electrocardiogram gated multislice spiral computed Tomography
    Investigative Radiology, 2003
    Co-Authors: Stephan Achenbach, M. Kachelriess, T. Giesler, Dieter Ropers, Stefan Ulzheimer, Hans Derlien, Evelyn Wenkel, Katharina Anders, Karsten Pohle, W.a. Kalender
    Abstract:

    Achenbach S, Giesler T, Ropers D, et al. Comparison of image quality in contrast-enhanced coronary-artery visualization by Electron Beam Tomography and retrospectively electrocardiogram-gated multislice spiral computed Tomography. Invest Radiol 2003;38:119–128.Rationale and Objectives.To compare the

  • influence of lipid lowering therapy on the progression of coronary artery calcification a prospective evaluation
    Circulation, 2002
    Co-Authors: Stephan Achenbach, Dieter Ropers, Karsten Pohle, Magda Kusus, Alexander W Leber, C Thilo, Andreas Knez, Theresa Menendez, Ralph Maeffert, M Regenfus
    Abstract:

    Background— Coronary calcification measured by fast computed Tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification. Methods and Results— In 66 patients with coronary calcifications in Electron Beam Tomography (EBT), LDL cholesterol >130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.3 mg/d). After 12 months of treatment, a third EBT scan was performed. Coronary calcifications were quantified using a volumetric score. Cerivastatin therapy lowered the mean LDL cholesterol level from 164±30 to 107±21 mg/dL. The median calcified volume was 155 mm3 (range, 15 to 1849) at baseline, 201 mm3 (19 to 2486) after 14 months without treatment, and 203 mm3 (15 to 2569) after 12 months of cerivastatin treatment. T...

  • influence of lipid lowering therapy on the progression of coronary artery calcification a prospective evaluation
    Circulation, 2002
    Co-Authors: Stephan Achenbach, Dieter Ropers, Karsten Pohle, Magda Kusus, Alexander W Leber, C Thilo, Andreas Knez, Theresa Menendez, Ralph Maeffert, M Regenfus
    Abstract:

    BACKGROUND: Coronary calcification measured by fast computed Tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification. METHODS AND RESULTS: In 66 patients with coronary calcifications in Electron Beam Tomography (EBT), LDL cholesterol >130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.3 mg/d). After 12 months of treatment, a third EBT scan was performed. Coronary calcifications were quantified using a volumetric score. Cerivastatin therapy lowered the mean LDL cholesterol level from 164+/-30 to 107+/-21 mg/dL. The median calcified volume was 155 mm3 (range, 15 to 1849) at baseline, 201 mm3 (19 to 2486) after 14 months without treatment, and 203 mm3 (15 to 2569) after 12 months of cerivastatin treatment. The median annualized absolute increase in coronary calcium was 25 mm3 during the untreated versus 11 mm3 during the treatment period (P=0.01). The median annual relative increase in coronary calcium was 25% during the untreated versus 8.8% during the treatment period (P 130 mg/dL.

  • a direct comparison of noninvasive coronary angiography by Electron Beam Tomography and navigator echo based magnetic resonance imaging for the detection of restenosis following coronary angioplasty
    Investigative Radiology, 2002
    Co-Authors: Dieter Ropers, W. Moshage, M Regenfus, Werner G. Daniel, Nikolaos I Stilianakis, Susanne Birke, Winfried Kessler, Gerhard Laub, Stephan Achenbach
    Abstract:

    Ropers D, Regenfus M, Stilianakis N, et al. A direct comparison of noninvasive coronary angiography by Electron Beam Tomography and navigator-echo-based magnetic resonance imaging for the detection of restenosis following coronary angioplasty. Invest Radiol 2002;37:386–392.rationale and objectives.

Paolo Raggi - One of the best experts on this subject based on the ideXlab platform.

  • thoracic aorta calcification detected by Electron Beam Tomography predicts all cause mortality
    Atherosclerosis, 2010
    Co-Authors: Raul D Santos, Matthew J Budoff, Khurram Nasir, Paolo Raggi, Daniel S Berman, John A Rumberger, Leslee J Shaw, Sarwar H Orakzai, Roger S Blumenthal
    Abstract:

    Abstract Background The presence of coronary artery calcium (CAC) is an independent marker of increased risk of cardiovascular disease (CVD) events and mortality. However, the predictive value of thoracic aorta calcification (TAC), which can be additionally identified without further scanning during assessment of CAC, is unknown. Methods We followed a cohort of 8401 asymptomatic individuals (mean age: 53±10 years, 69% men) undergoing cardiac risk factor evaluation and TAC and CAC testing with Electron Beam computed Tomography. Multivariable Cox proportional hazards models were developed to predict all-cause mortality based on the presence of TAC. Results During a median follow-up period of 5 years, 124 (1.5%) deaths were observed. Overall survival was 96.9% and 98.9% for those with and without detectable TAC, respectively ( p p p =0.015). Likelihood ratio χ 2 statistics demonstrated that the addition of TAC contributed significantly in predicting mortality to traditional risk factors alone ( χ 2 =13.62, p =0.002) as well as risk factors+CAC ( χ 2 =5.84, p =0.02) models. Conclusion In conclusion, the presence of TAC was associated with all-cause mortality in our study; this relationship was independent of conventional CVD risk factors as well as the presence of CAC.

  • absence of coronary artery calcification and all cause mortality
    Jacc-cardiovascular Imaging, 2009
    Co-Authors: Michael J Blaha, Matthew J Budoff, Paolo Raggi, Tracy Q Callister, Daniel S Berman, John A Rumberger, Leslee J Shaw, Roger S Blumenthal, Faisal Khosa, Khurram Nasir
    Abstract:

    Objectives We sought to quantify the mortality rates associated with absent and low positive (CAC 1 to 10) coronary artery calcium (CAC). Background There is increasing interest in the absence of CAC as a “negative” cardiovascular risk factor. However, published event rates for individuals with no CAC vary, likely owing to differences in baseline risk, follow-up period, and outcome ascertainment. The prognostic significance of low CAC (CAC 1 to 10) is not well described. Methods Annualized all-cause mortality rates were assessed in 44,052 consecutive asymptomatic patients referred for CAC testing. Mean follow-up of the cohort was 5.6 ± 2.6 years (range 1 to 13 years). Results A total of 19,898 patients (45%) had no CAC on screening Electron Beam Tomography, whereas 5,388 (12%) had low levels of CAC (CAC 1 to 10), and 18,766 (43%) had CAC >10. There were 104 deaths in those with no CAC (0.52%), 58 deaths in those with CAC 1 to 10 (1.06%), and 739 deaths in those with CAC >10 (3.96%). Annualized all-cause mortality rates for CAC = 0, CAC 1 to 10, and CAC >10 were 0.87, 1.92, and 7.48 deaths/1,000 person-years, respectively. The hazard ratio (HR) for all-cause mortality among CAC 1 to 10 versus CAC = 0 after adjustment for traditional risk factors was 1.99 (95% confidence interval [CI]: 1.44 to 2.75). Smoking (HR: 3.97, 95% CI: 2.75 to 5.41) and diabetes mellitus (HR: 3.36, 95% CI: 2.09 to 5.41) were associated with few events observed in CAC = 0 group. Conclusions In appropriately selected asymptomatic patients, the absence of CAC predicts excellent survival with 10-year event rates of approximately 1%. A finding of 0 CAC might be used as a rationale to emphasize lifestyle therapies rather than pharmacotherapy and to forgo repeated imaging studies. Individuals with low CAC score (CAC 1 to 10) are at increased risk above individuals with a 0 score and could be considered a distinct risk group by physicians and investigators.

  • long term prognosis associated with coronary calcification observations from a registry of 25 253 patients
    Journal of the American College of Cardiology, 2007
    Co-Authors: Matthew J Udoff, Ferdinand Flores, Paolo Raggi, Sandy T Liu, Leslee J Shaw, Steve R Weinstei, Philip H Tseng, Tracy Q Calliste, Daniel S Erma, Triste P Mosle
    Abstract:

    Objectives The purpose of this study was to develop risk-adjusted multivariable models that include risk factors and coronary artery calcium (CAC) scores measured with Electron-Beam Tomography in asymptomatic patients for the prediction of all-cause mortality. Background Several smaller studies have documented the efficacy of CAC testing for assessment of cardiovascular risk. Larger studies with longer follow-up will lend strength to the hypothesis that CAC testing will improve outcomes, cost-effectiveness, and safety of primary prevention efforts. Methods We used an observational outcome study of a cohort of 25,253 consecutive, asymptomatic individuals referred by their primary physician for CAC scanning to assess cardiovascular risk. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and CAC scores. Results The frequency of CAC scores was 44%, 14%, 20%, 13%, 6%, and 4% for scores of 0, 1 to 10, 11 to 100, 101 to 400, 401 to 1,000, and >1,000, respectively. During a mean follow-up of 6.8 ± 3 years, the death rate was 2% (510 deaths). The CAC was an independent predictor of mortality in a multivariable model controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2,017, p 1,000, respectively (p 1,000 (p Conclusions This large observational data series shows that CAC provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality.

  • juice powder concentrate and systemic blood pressure progression of coronary artery calcium and antioxidant status in hypertensive subjects a pilot study
    Evidence-based Complementary and Alternative Medicine, 2007
    Co-Authors: Mark C Housto, Uce Cooil, Jarki J Olafsso, Paolo Raggi
    Abstract:

    Because micronutrients from plants may have beneficial cardiovascular effects, the hypothesis that an encapsulated juice powder concentrate might affect several measures of vascular health was tested in free living adults at low cardiovascular risk. Blood pressure, vascular compliance, lipid and antioxidant markers, and serial Electron Beam Tomography (to calculate a coronary artery calcium score as a measure of atherosclerosis burden), were monitored in 51 prehypertensive and hypertensive subjects over 2 years. By the end of follow-up, systolic and diastolic blood pressure decreased significantly (� 2.4 � 1.0 mmHg, P50.05 and � 2.2 � 0.6 mmHg, P50.001), and large artery compliance improved significantly (1.9 � 0.6 ml mmHg � 1 � 100, P50.01). The progression of coronary artery calcium score was smaller than expected compared with a historical database (P50.001). Laboratory testing showed a significant decrease in homocysteine (P ¼ 0.05), HDL cholesterol (P ¼ 0.025) and Apo A( P ¼ 0.004), as well as a significant increase in b-carotene, folate, Co-Q10 and a-tocopherol (all P50.001). The phytonutrient concentrate we utilized induced several favorable modifications of markers of vascular health in the subjects. This study supports the notion that plant nutrients are important components of a heart healthy diet.

  • detection of high risk young adults and women by coronary calcium and national cholesterol education program panel iii guidelines
    Journal of the American College of Cardiology, 2005
    Co-Authors: Khurram Nasir, Roger S Blumenthal, Erin D Michos, Paolo Raggi
    Abstract:

    Objectives The purpose of this study was to investigate the classification of cardiovascular risk in young individuals and women according to the National Cholesterol Education Program (NCEP) guidelines across a continuum of coronary calcium scores (CCS). Background Current NCEP guidelines might underestimate cardiovascular risk in young individuals and women. Methods The study population consisted of 1,611 asymptomatic individuals (67% men, mean age: 53 ± 10 years) who presented to a single Electron Beam Tomography facility for coronary artery calcium screening. Participants were categorized into low-risk (n = 738, 46%), intermediate-risk (n = 583, 36%), moderately high-risk (n = 263, 16%), and high-risk (n = 27, 2%) according to the NCEP Panel III guidelines. Results Absence of calcium, CCS of 0 to 99 (mild), 100 to 399 (moderate), and ≥400 (severe), was observed in 572 (35%), 707 (44%), 192 (12%), and 140 (9%) of the patients, respectively. A high CCS percentile (≥75th percentile) was present in 426 (26%) individuals. Overall, 59% and 78% of participants with CCS ≥400 and CCS ≥75th percentile were not identified as high risk and candidates for pharmacotherapy on the basis of NCEP categories. Furthermore, women as well as young individuals were less likely to be considered candidates for pharmacotherapy compared with men and older individuals in each CCS category. Conclusions The NCEP guidelines seem to underestimate cardiovascular risk in young asymptomatic individuals and women. For these individuals, assessment of plaque burden might provide incremental value to global risk assessment.