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Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events.

ABSTRACT: Aims:Little is known regarding the risk of atherosclerotic cardiovascular disease (ASCVD) conferred by changes in the volume and density of ascending thoracic aorta calcium (ATAC) over time. We evaluated changes in ATAC volume and density scores and incident ASCVD events. Methods and results:The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study of individuals without baseline clinical ASCVD. Ascending thoracic aorta calcium was measured from baseline and follow-up (mean interval 2.4?years) cardiac computed tomography (CT). Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) per standard deviation for events after the follow-up exam adjusted for ASCVD risk factors, baseline ATAC and coronary artery calcium (CAC) volume and density, and changes in CAC volume and density. Among 5887 participants, 296 (5.0%) had detectable ATAC at baseline, follow-up, or both exams. A total of 403 events occurred over 9.5?years. An increase in ATAC volume was associated with coronary heart disease (CHD) (HR 1.90, 95% CI 1.14-3.16), ASCVD (HR 1.93, 95% CI 1.26-2.94), and ischaemic stroke (HR 2.14, CI 1.21-3.78). An increase in ATAC density was inversely associated with CHD (HR 0.29, 95% CI 0.14-0.60) and ASCVD (HR 0.42, 95% CI 0.23-0.76), but not stroke (HR 0.61, CI 0.23-1.61). Conclusion:Ascending thoracic aorta calcium is uncommon on serial cardiac CT. However, changes in ATAC volume and density are both associated with incident ASCVD events, but in opposite directions. Serial assessments in those with baseline ATAC may provide insight into an individual's trajectory of ASCVD risk.

SUBMITTER: Thomas IC

PROVIDER: S-EPMC6247661 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events.

Thomas Isac C IC McClelland Robyn L RL Allison Matthew A MA Ix Joachim H JH Michos Erin D ED Forbang Nketi I NI Post Wendy S WS Wong Nathan D ND Budoff Matthew J MJ Criqui Michael H MH

European heart journal. Cardiovascular Imaging 20181201 12

<h4>Aims</h4>Little is known regarding the risk of atherosclerotic cardiovascular disease (ASCVD) conferred by changes in the volume and density of ascending thoracic aorta calcium (ATAC) over time. We evaluated changes in ATAC volume and density scores and incident ASCVD events.<h4>Methods and results</h4>The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study of individuals without baseline clinical ASCVD. Ascending thoracic aorta calcium was measured from baseline and follow-u ...[more]

PMID: 29415207

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Project description:Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67?year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30?mm Gelweave Vascutek graft but represented 6?months later with development of a penetrating ulcer which ruptured into a huge 14?cm pseudoaneurysm. This was repaired with a 28?mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6?weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2?days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3?weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6?months later which further ruptured into a larger 14?cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

Project description:IntroductionIn patients with ascending aortic (AA) aneurysms, prosthetic graft replacement yields benefit but risk for complications in the descending aorta persists. Longitudinal impact of AA grafts on native descending aortic physiology is poorly understood.MethodsTransthoracic echocardiograms (echo) in patients undergoing AA elective surgical grafting were analyzed: Descending aortic deformation indices included global circumferential strain (GCS), time to peak (TTP) strain, and fractional area change (FAC). Computed tomography (CT) was used to assess aortic wall thickness and calcification.Results46 patients undergoing AA grafting were studied; 65% had congenital or genetically-associated AA (30% bicuspid valve, 22% Marfan, 13% other): After grafting (6.4±7.5 months), native descending aortic distension increased, irrespective of whether assessed based on circumferential strain or area-based methods (both p<0.001). Increased distensibility paralleled altered kinetics, as evidenced by decreased time to peak strain (p = 0.01) and increased velocity (p = 0.002). Augmented distensibility and flow velocity occurred despite similar pre- and post-graft blood pressure and medications (all p = NS), and was independent of pre-surgical aortic regurgitation or change in left ventricular stroke volume (both p = NS). Magnitude of change in GCS and FAC was 5-10 fold greater among patients with congenital or genetically associated AA vs. degenerative AA (p<0.001), paralleling larger descending aortic size, greater wall thickness, and higher prevalence of calcific atherosclerotic plaque in the degenerative group (all p<0.05). In multivariate analysis, congenital/genetically associated AA etiology conferred a 4-fold increment in magnitude of augmented native descending aortic strain after proximal grafting (B = 4.19 [CI 1.6, 6.8]; p = 0.002) independent of age and descending aortic size.ConclusionsProsthetic graft replacement of the ascending aorta increases magnitude and rapidity of distal aortic distension. Graft effects are greatest with congenital or genetically associated AA, providing a potential mechanism for increased energy transmission to the native descending aorta and adverse post-surgical aortic remodeling.

Project description:Previous studies suggested that pu-erh tea aqueous extract could lower blood pressure and ameliorate hypertension symptoms. However, the antihypertension mechanisms of pu-erh tea remain unclear. In this work, the direct effects of pu-erh tea on vessels and cells were investigated by detecting isometric tension and intracellular calcium ([Ca2+]i), respectively. Additionally, to identify the main active components, the aqueous extract of pu-erh was separated by organic solvents to obtain various fractions, and the effects of these fractions on arteries were assessed. The results showed that pu-erh aqueous extract vasodilated rat thoracic aortas preconstricted by phenylephrine or KCl. These vasodilation effects were not significantly affected by the removal of the endothelium or by preincubation with potassium channel blockers (tetraethylammonium, glibenclamide, aminopyridine, or barium chloride). Moreover, pu-erh aqueous extract could reduce the vessel contractibility induced by CaCl2 and phenylephrine under KCl-depolarizing or Ca2+-free buffer conditions, respectively. Furthermore, pu-erh aqueous extract attenuated the KCl-induced increase in [Ca2+]i in cultured rat aortic smooth muscle A7r5 cells. In addition, the chloroform precipitate of pu-erh aqueous extract produced the most potent vasodilation. Theabrownins (the characteristic components of pu-erh tea) accounted for 41.91 ± 1.09 % of the chloroform precipitate and vasodilated arteries in an endothelium-independent manner. In addition, the vasodilation effect of caffeine was verified. In conclusion, theabrownins and caffeine should be the two main active components in pu-erh tea. Pu-erh aqueous extract vasodilated arteries in an endothelium-independent manner, which might partly be attributed to the decrease in extracellular Ca2+ influx. Moreover, our study provided data on the potential mechanism of the hypotensive actions of pu-erh tea, which might improve our understanding of the effect of pu-erh tea on the prevention and treatment of hypertension.

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Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events.

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Progression of calcium density in the ascending thoracic aorta is inversely associated with incident cardiovascular disease events.

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