| 1. |
- Bacsovics Brolin, Elin
(author)
-
Coronary computed tomography in patients with myocardial infarction and non-obstructed coronary arteries
- 2015
-
Doctoral thesis (other academic/artistic)abstract
- Cardiovascular disease (CVD) is the number one cause of death worldwide. In Sweden, almost 30 000 people suffer an acute myocardial infarction (AMI) each year and, despite the greatly improved survival after AMI, CVD remains the leading cause of death among women and men. During the last decade, there has been increasing awareness of the significant minority of patients with acute myocardial infarction, for whom invasive coronary angiography (ICA) does not show any coronary artery stenoses. This condition is called myocardial infarction and non-obstructed coronary arteries (MINOCA) and is still incompletely understood. Another condition that has gained increasing attention is Takotsubo syndrome (TS), also known as stress-induced cardiomyopathy or the broken heart syndrome. Patients with TS may be considered a sub-group of MINOCA. Important advances in coronary computed tomography angiography (CTA) technology have enabled safe and accurate non-invasive imaging of the coronary arteries. In contrast to ICA, coronary CTA allows for detection of non-obstructive as well as obstructive coronary artery disease (CAD). Coronary CTA is also useful for assessment of plaque characteristics and detection of myocardial bridging (MB). In order to improve CVD risk prediction, numerous risk markers have emerged, among them carotid artery intima-media thickness (IMT), endothelial function determined by digital reactive hyperemia peripheral arterial tonometry (RH-PAT) and different categories of circulating biomarkers. Coronary CTA plaque burden has a prognostic value in CVD risk assessment, but its association with other risk markers is incompletely studied. There were two major aims of this thesis. The first aim was to investigate the underlying mechanisms of MINOCA (study I and III). The second aim was to examine the association between coronary CTA plaque burden and other risk markers of CVD (study II and IV). In study I we compared coronary CTA plaque burden in MINOCA patients and controls, matched by age and gender. We found that coronary CTA plaque burden was similar in the two groups and that a large proportion of MINOCA patients (42%) had no signs of CAD at coronary CTA. Non-obstructive CAD is most likely not a frequent cause of MINOCA. In study II, 58 volunteers, free from clinical CVD, underwent testing for IMT and RH-PAT as well as coronary CTA. More than half of the study group had evidence of subclinical CAD at coronary CTA. There was no association between IMT or RH-PAT and presence or extent of CAD. Neither evaluation of IMT nor RH-PAT can reliably be used to predict coronary CTA plaque burden in clinically healthy subjects. In study III the prevalence of MB, determined by coronary CTA, was compared for MINOCA patients, including a subgroup with TS, and matched controls. The MB depiction rate of coronary CTA and ICA was compared. MB was frequent, with a similar prevalence in MINOCA patients, patients with TS and controls, suggesting MB is not a frequent cause of MINOCA or TS. Coronary CTA detects significantly more MB than ICA. In study IV, 115 subjects with predominantly low-to-intermediate CVD risk and normal or mildly reduced kidney function, underwent coronary CTA and laboratory testing. The groups without and with CAD differed with regard to levels of adiponectin, lipoprotein(a) and cystatin C. However, in a multivariable logistic regression model, only male sex and levels of cystatin C were independently associated with non-obstructive CAD at coronary CTA. In conclusion, non-obstructive CAD is not a frequent cause of MINOCA in patients with angiographically normal or near-normal coronary arteries. MINOCA should probably not be considered a definitive diagnosis, but rather a working diagnosis, warranting additional diagnostic evaluation. TS, which is one of the possible underlying causes of MINOCA, is most likely not caused by MB. For TS, future consensus on the diagnostic criteria will facilitate research on pathophysiological mechanisms, diagnosis, prognosis and patient management. Circulating cystatin C was associated with non-obstructive CAD and may thus have a potential to serve as a screening test for subclinical CAD. However, CVD risk assessment is complex and large-scale studies are necessary to investigate which combination of imaging parameters and other risk markers yields the most accurate individual risk prediction.
|
|
| 2. |
- Bergström, Göran, 1964, et al.
(author)
-
Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS.
- 2023
-
In: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 373, s. 46-54
-
Journal article (peer-reviewed)abstract
- Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS).The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p<0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.
|
|
| 3. |
- Sederholm Lawesson, Sofia, 1973-, et al.
(author)
-
Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography.
- 2023
-
In: JAMA. - : American Medical Association (AMA). - 1538-3598 .- 0098-7484. ; 329:5, s. 393-404
-
Journal article (peer-reviewed)abstract
- Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown.To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening.Cross-sectional study of a population-based cohort of women in Sweden (n=10528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected.Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures.Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100.A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk.Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.
|
|
