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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Cardiac calcifications in hemodialysis patients assessed with spiral computed tomography
1Department of Nephrology, S. Giovanni Addolorata Hospital, Rome, Italy. micaela.manni@tin.it
Insights
Uremic patients show significantly higher cardiac calcium scores than non-uremic patients. Multislice computed tomography (MSCT) can identify high-risk individuals, emphasizing mineral and lipid control for preventing arterial calcification.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Cardiac disease is a leading cause of mortality in patients with uremia.
- Uremia is associated with increased cardiovascular risk.
- Accurate assessment of cardiac calcification is crucial for risk stratification.
Purpose of the Study:
- To evaluate cardiac calcium content in uremic patients using multislice computed tomography (MSCT).
- To identify predictors of cardiac calcification in uremic patients.
Main Methods:
- A study involving 120 uremic and 28 non-uremic patients with cardiovascular disease.
- Measurement of serum calcium, phosphorus, calcium-phosphate product, intact parathyroid hormone (iPTH), and lipid profiles.
- Quantification of cardiac calcification using MSCT, reported as Agatson scores.
Main Results:
- Uremic patients had average Agatson scores 10 times higher than non-uremic patients (3389 vs. 328).
- Cardiac calcification scores correlated significantly with age, hemodialysis vintage, serum calcium, and iPTH.
- Multivariable analysis identified age, hemodialysis vintage, serum cholesterol, triglycerides, HDL, and non-HDL cholesterol as predictors of cardiac score.
Conclusions:
- MSCT is a valuable tool for identifying and stratifying uremic patients at high risk for cardiac calcification.
- Controlling mineral metabolism and lipid levels is essential for preventing arterial calcification in uremic patients.
- Early identification and intervention can improve outcomes in uremic patients with cardiovascular disease.
Aim:
Cardiac disease is a major cause of mortality in uremic patients. The aim of this paper was to evaluate cardiac calcium content in uremic patients with multislice computed tomography (MSCT).
Methods:
The study has been carried out on 120 uremic and 28 nonuremic patients affected by cardiovascular disease. Serum calcium, phosphorus, calcium-phosphate product, intact PTH were assayed. Several lipidic and nutritional parameters were measured. Calcification values obtained with the MSCT were reported in terms of Agatson scores.
Results:
We found that the average score values in cohort on uremic was 10 times higher than in nonuremic patients (score values 3.389 vs 328). Cardiac calcification score was found to be correlated significantly to age (P=0.006), HD age (P=0.010), serum calcium (P=0.006), iPTH (P=0.004). Multiregression analysis (MRA) with the cardiac score as dependent variable selected the following variables (R(2) 0.612): age (P=0.002), HD age (P=0.010), serum cholesterol (P<0.000), triglycerides (P=0.001) and inversely HDL cholesterol (P=0.001) and non-HDL cholesterol (P=0.001) as predictive variables for cardiac score. By comparing patients with scores lower and higher than 400, the group with score <400 showed a significantly lower age (P=0.0001), HD vintage (P=0.01) and a significantly higher serum cholesterol (P=0.009), HDL cholesterol (P=0.05) and non-HDL cholesterol (P=0.05).
Conclusions:
The MSCT could help in identifying and stratifying high-risk patients to implement preventive strategies. The control of mineral metabolism and of lipid levels is important in prevention of arterial calcification in uremic patients.
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