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Association Between Myocardial Work and Coronary Artery Calcium Score in Patients With Chronic Kidney Disease
Flemming Javier Olsen1,2, Nino Emanuel Landler1,2, Jacob Christensen1,2
1Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
Insights
Myocardial work measures show potential for diagnosing coronary artery disease (CAD) in chronic kidney disease (CKD) patients. Territorial work index (TWI) was linked to high coronary artery calcium scores in specific arteries, unlike global work index (GWI).
Area of Science:
- Cardiology
- Nephrology
- Biomedical Engineering
Background:
- Myocardial work is a novel diagnostic measure for coronary artery disease (CAD).
- Patients with chronic kidney disease (CKD) present unique challenges in CAD diagnosis.
- Assessing CAD in CKD patients may benefit from innovative diagnostic tools.
Purpose of the Study:
- To investigate the utility of myocardial work indices in diagnosing CAD among patients with CKD.
- To determine the association between global work index (GWI) and territorial work index (TWI) with coronary artery calcium score (CACS) in CKD patients.
Main Methods:
- Cross-sectional study involving 455 non-dialysis-dependent CKD patients (G1-5).
- Cardiac computed tomography (CT) used to quantify coronary artery calcium score (CACS).
- Pressure-strain loop analysis performed to derive GWI and TWI; logistic regression used to assess associations with high CACS (>400).
Main Results:
- No significant difference in GWI was found between patients with high versus non-high CACS.
- TWI was significantly reduced in patients with high CACS in the LAD (p=0.003) and Cx (p=0.001) arteries.
- TWI association with high CACS in LAD and Cx remained significant after multivariable regression in patients without prior CAD, but not in the RCA.
Conclusions:
- Global work index (GWI) is not associated with overall high coronary artery calcium scores in CKD patients.
- Territorial work index (TWI) shows an association with high CACS in specific coronary arteries (LAD, Cx) in CKD patients.
- The association of TWI with high CACS in CKD patients is artery-specific and requires further investigation.
Background:
Myocardial work is a novel measure of potential value for diagnosing coronary artery disease (CAD). It may therefore be useful in patients with chronic kidney disease (CKD), in whom the diagnostic work-up can be challenging.
Methods:
This was a cross-sectional study of patients with CKD (G1-5, nondialysis-dependent). Cardiac computed tomography was performed to quantify coronary artery calcium score (CACS). Pressure-strain loop analysis was performed to obtain global and territorial work index (GWI and TWI, respectively). Logistic regression was applied to investigate the association between work measures and high CACS (>400).
Results:
We included 455 patients (age: 57 years, 60% men, 8% with previous CAD, and eGFR of 43 mL/min/1.73 m2). High CACS across all coronary arteries was observed in 77 (17%), with 53 (12%) in the left anterior descending (LAD) artery, 28 (6%) in the right coronary artery (RCA), and 17 (4%) in the circumflex (Cx) artery. No difference in GWI was observed for overall high versus non-high CACS (1861 vs. 1937 mmHg%, p = 0.14). TWI was reduced in patients with high versus non-high CACS in the LAD (1772 vs. 1956 mmHg%, p = 0.003) and in the Cx (1556 vs. 1934 mmHg%, p = 0.001), but not in the RCA (p = 0.68). After multivariable regression, TWI remained significantly associated with high CACS in the LAD and Cx in patients with no history of CAD, but not in the RCA.
Conclusion:
In patients with CKD, GWI was not associated with an overall high CACS. TWI was, however, associated with a high CACS in specific coronary arteries, although the findings were inconsistent.
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