| 1. |
- Erlandsson, Helen, et al.
(författare)
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Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation
- 2022
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 291:6, s. 813-823
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Tidskriftsartikel (refereegranskat)abstract
- Background Progression of vascular calcification causes cardiovascular disease, which is the most common cause of death in chronic kidney failure and after kidney transplantation (KT). The prognostic impact of the extent of medial vascular calcification at KT is unknown. Methods In this prospective cohort study, we investigated the impact of medial calcification compared to a mix of intimal and medial calcification represented by coronary artery calcification (CAC score) and aortic valve calcification in 342 patients starting on kidney failure replacement therapy. The primary outcomes were cardiovascular events (CVE) and death. The median follow-up time was 6.4 years (interquartile range 3.7-9.6 years). Exposure was CAC score and arteria epigastrica medial calcification scored as none, mild, moderate, or severe by a pathologist at time of KT (n = 200). We divided the patients according to kidney failure replacement therapy during follow-up, that is, living donor KT, deceased donor KT, or dialysis. Results Moderate to severe medial calcification in the arteria epigastrica was associated with higher mortality (p = 0.001), and the hazard ratio for CVE was 3.1 (95% confidence interval [CI] 1.12-9.02, p < 0.05) compared to no or mild medial calcification. The hazard ratio for 10-year mortality in the dialysis group was 33.6 (95% CI, 10.0-113.0, p < 0.001) compared to living donor recipients, independent of Framingham risk score and prevalent CAC. Conclusion Scoring of medial calcification in the arteria epigastrica identified living donor recipients as having 3.1 times higher risk of CVE, independent of traditional risk factors. The medial calcification score could be a reliable method to identify patients with high and low risk of CVE and mortality following KT.
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| 2. |
- Golembiewska, Edyta, et al.
(författare)
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Copeptin is independently associated with vascular calcification in chronic kidney disease stage 5
- 2020
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Ingår i: BMC Nephrology. - Stockholm : Karolinska Institutet, Dept of Clinical Science, Intervention and Technology. - 1471-2369.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vascular calcification (VC) is an independent predictor of cardiovascular disease (CVD) present in 30– 70% of patients with chronic kidney disease (CKD). Copeptin is a sensitive surrogate marker of arginine vasopressin (AVP), which is involved in many pathophysiologic processes in CKD. The aim of the present study was to explore the association of copeptin with VC in CKD stage 5. Methods: Copeptin was investigated in conjunction with living donor kidney transplantation in 149 clinically stable CKD stage 5 patients (CKD5), including 53 non-dialyzed (CKD5-ND) and 96 dialysis patients treated by peritoneal dialysis (PD) (n = 43) or hemodialysis (HD) (n = 53). We analyzed the association of copeptin with presence and extent of VC ascertained both histologically in biopsies from the inferior epigastric artery (n = 137) and by coronary artery calcification (CAC) score measured by computed tomography. Results: Patients with higher copeptin were older, had higher systolic blood pressure, higher prevalence of CVD and their preceding time on chronic dialysis was longer. In Spearman’s rank correlations (Rho), copeptin concentrations were significantly associated with CAC score (Rho = 0.27; p = 0.003) and presence of medial VC (Rho = 0.21; p = 0.016). Multivariate logistic regression analysis showed that 1-SD higher age, male gender, diabetes and 1-SD higher copeptin were significantly associated with the presence of moderate-extensive VC. Conclusions: High circulating levels of copeptin in CKD5 patients are independently associated with the degree of medial calcification ascertained by histology of arterial biopsies. Thus, plasma copeptin may serve as a marker of the uremic calcification process.
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| 3. |
- Laucyte-Cibulskiene, Agne, et al.
(författare)
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Role of GDF-15, YKL-40 and MMP 9 in patients with end-stage kidney disease : focus on sex-specific associations with vascular outcomes and all-cause mortality
- 2021
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Ingår i: Biology of Sex Differences. - : Springer Science and Business Media LLC. - 2042-6410. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sex differences are underappreciated in the current understanding of cardiovascular disease (CVD) in association with chronic kidney disease (CKD). A hallmark of CKD is vascular aging that is characterised, amongst others, by; systemic inflammation, microbiota disbalance, oxidative stress, and vascular calcification—features linked to atherosclerosis/arteriosclerosis development. Thus, it is the necessary to introduce novel biomarkers related to athero-/arteriosclerotic damage for better assessment of vascular ageing in patients CKD. However, little is known about the relationship between uraemia and novel CVD biomarkers, such as growth differentiation factor-15 (GDF-15), cartilage glycoprotein-39 (YKL-40) and matrix metalloproteinase-9 (MMP-9). Therefore, we hypothesise that there are sex-specific relationships between GDF-15, YKL-40, MMP-9 levels in end-stage kidney disease (ESKD) patients in relation to gut microbiota, vascular calcification, inflammation, comorbidities, and all-cause mortality. Methods: ESKD patients, males (n = 151) and females (n = 79), not receiving renal replacement therapy were selected from two ongoing prospective ESKD cohorts. GDF-15, YKL-40 and MMP9 were analysed using enzyme-linked immunosorbent assay kits. Biomarker levels were analysed in the context of gut microbiota-derived trimethylamine N-oxide (TMAO), vascular calcification, inflammatory response, oxidative stress, comorbidities, and all-cause mortality. Results: Increased GDF-15 correlated with higher TMAO in females only, and with higher coronary artery calcification and IL-6. In females, diabetes was associated with elevated GDF-15 and MMP-9, whilst males with diabetes only had elevated GDF-15. No associations were found between biomarkers and CVD comorbidity. Deceased males and females had higher GDF-15 concentrations (p = 0.01 and p < 0.001, respectively), meanwhile only YKL-40 was increased in deceased males (p = 0.02). Conclusions: In conclusion, in males GDF-15 and YKL-40 were related to vascular calcification, inflammation, and oxidative stress, whilst in females GDF-15 was related to TMAO. Increased levels of YKL-40 and GDF-15 in males, and only GDF-15 in females, were associated with all-cause mortality. Our findings suggest that sex-specific associations of novel CVD biomarkers have a potential to affect development of cardiovascular complications in patients with ESKD.
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| 4. |
- Mårtensson, Mattias, et al.
(författare)
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Assessment of left ventricular volumes using simplified 3-D echocardiography and computed tomography - a phantom and clinical study
- 2008
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To compare the accuracy of simplified 3-dimensional (3-D) echocardiography vs. multi-slice computed tomography (MSCT) software for the quantification of left ventricular (LV) volumes. Design: Three-D echocardiography (3-planes approach) and MSCT-CardIQ software were calibrated by measuring known volumes of 10 phantoms designed to closely mimic blood-endocardium interface. Subsequently, LV volumes were measured with both the methods in 9 patients referred routinely for coronary angiography and the agreement between the measurements was evaluated. Results: Simplified 3D-echocardiography provided higher degree of agreement between the measured and true phantom volumes (mean difference 0 +/- 1 ml, variation range + 4 to -4 ml) than MSCT software (mean difference 6 +/- 5 ml; variation range + 22 to -10 ml). The agreement between LV measurements in the patients was considerably poorer, with significantly larger volumes produced by MSCT (mean difference - 23 +/- 40 ml, variation between + 93 and -138 ml). Conclusion: Simplified 3-D echocardiography provides more accurate assessment of phantom volumes than MSCT-CardIQ software. The discrepancy between the results of LV measurements with the two methods is even greater and does not warrant their interchangeable diagnostic use.
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| 5. |
- Nordenfur, Tim, et al.
(författare)
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Algorithm Comparison for Cardiac Image Fusion of Coronary Computed Tomography Angiography and 3D Echocardiography
- 2015
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Ingår i: 2015 IEEE INTERNATIONAL ULTRASONICS SYMPOSIUM (IUS). - : IEEE. - 9781479981823
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Konferensbidrag (refereegranskat)abstract
- Treatment decision for coronary artery disease (CAD) is based on both morphological and functional information. Image fusion of coronary computed tomography angiography (CCTA) and three-dimensional echocardiography (3DE) could combine morphology and function into a single image to facilitate diagnosis. Three semi-automatic feature-based algorithms for CCTA/3DE registration were implemented and applied on CAD patients. Algorithms were verified and compared using landmarks manually identified by a cardiologist. All algorithms were found feasible for CCTA/3DE fusion.
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| 6. |
- Nordenfur, Tim, 1990-, et al.
(författare)
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Cardiac fusion imaging of 3D echocardiography and coronary computed tomography angiography
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background. The choice of treatment strategy for coronary artery disease is often based on: 1) anatomical information on stenosis locations, and 2) functional information on their haemodynamic relevance, e.g. myocardial deformation or perfusion. Inspecting a single fused image containing both anatomical and functional information, as opposed to viewing separate images side-by-side, facilitates this treatment choice. The aim of this study is to develop a novel cardiac fusion imaging technique to combine 3D+time echocardiography (3DE) (functional information) with coronary computed tomography angiography (CCTA) (anatomical information).Method. 3DE and CCTA data sets were obtained from 20 patients with suspected coronary artery disease. The coronary artery tree was segmented from the CCTA images. A semi-automatic fusion algorithm was developed to perform the following steps: The left ventricle (LV) 3D surfaces were segmented in the CCTA image and 3DE images and used to align the two data sets. The moving 3DE LV was then visualized along with the CCTA coronary arteries. Myocardial strain was estimated and visualized on the LV surface.Results. Preliminary fusion results from images of one patient have been obtained. The figure shows the CCTA coronary artery tree aligned with a) 3DE LV endocardium in end-systole, b) 3DE LV endocardium in end-diastole, and c) 3DE LV with colour-coded instantaneous longitudinal strain.Discussion. Preliminary results show that fusion of CCTA and 3DE images is feasible. However, the algorithm needs to be further developed to increase automation and include other functional parameters, such as myocardial perfusion. Moreover, a validation study to assess algorithm performance and diagnostic value in multiple patients will be performed.
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| 7. |
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| 8. |
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| 9. |
- Ripsweden, Jonaz
(författare)
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Computed tomography of the coronary arteries
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Non-invasive coronary computed tomography angiography (CCTA) has become an important tool for visualisation of coronary arteries since the introduction of 64-channel detector CCTA in 2004. It has been proved to be especially beneficial for ruling out coronary artery disease (CAD) in selected patient populations, due to the high negative predictive value (NPV). The aim of this thesis was to study some aspects of the introduction, establishment and development of a new method, retrospectively ECG-gated CCTA with 64-channel detector, to evaluate coronary arteries. In study I the diagnostic capacity and limitation of CCTA was compared to that of invasive coronary angiography (ICA) in a newly established CCTA team. CCTA had a very high NPV but the number of non-diagnostic scans was also high. The main limitations were motion artifacts and vessel calcifications, while short experience in reading CCTA did not affect image interpretation. Study II described the learning-curve effect of the interpretation of 100 CCTA and also compared the diagnostic accuracy of both radiologists and radiographers, after a common introduction. The review time for novices was approximately halved during the first 100 cases, with maintained diagnostic accuracy. There was a learning-curve effect in positive predictive value (PPV) for radiologists, but not for the radiographers. However, the diagnostic accuracy of dedicated radiographers indicated that they might be considered as part of the evaluation team. Study III compared the radiation exposure in retrospectively ECG-gated CCTA and ICA in the same population. Both mean estimated effective dose (ED) and organ doses (skin, breast, lung and oesophagus) were higher in CCTA when compared to ICA. The relatively high radiation dose to breast indicates that bismuth shielding should be used in women when performing CCTA. When using the updated tissue weighting factors provided in ICRP 103 the calculated ED from CCTA were significantly higher than those obtained using outdated ICRP 60. In study IV the image quality and radiation doses were compared when decreasing X-ray tube peak kilovoltage (kVp) from 120 to 100 kVp in patients undergoing CCTA. By reduction of tube voltage the radiation dose was almost halved while the diagnostic image quality was kept at a clinically acceptable level. In conclusion, CCTA is increasingly available throughout the world as an alternative to gold standard ICA, especially due to the excellent capability to rule out CAD. Still, retrospectively ECG-gated 64-channel detector CCTA has limitations such as motion artifacts and vessel calcifications. Another limitation is the high radiation doses required for CCTA compared to ICA. By lowering the kVp from traditionally 120 kVp to 100 kVp the radiation dose is halved while retaining diagnostic accuracy. There is a learning curve effect (regarded PPV and review time) of the interpretation of CCTA. However, more than 100 reviewed CCTA cases are necessary to reach a diagnostic accuracy that is acceptable.
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| 10. |
- Ripsweden, Jonaz, et al.
(författare)
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Impact on image quality and radiation exposure in coronary CT angiography: 100 kVp versus 120 kVp
- 2010
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Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 51:8, s. 903-909
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of radiation-induced cancer has become a major concern with the increasing use of computed tomography (CT). Purpose: To compare image quality and radiation doses when decreasing X-ray tube peak kilovoltage (kVp) from 120 to 100 kVp in patients undergoing coronary CT angiography (CCTA). Material and Methods: Patients referred for evaluation of suspected coronary artery disease (CAD) underwent 64-channel detector CCTA using a tube voltage of either 120 kVp (n = 46) or 100 kVp (n = 82). The individual volume CT dose index (CTDIvol) and dose length product (DLP) were recorded and effective radiation dose was estimated on the basis of DLP. Subjective image quality was assessed by two radiologists on per-patient based consensus. Vascular density and image noise were quantified in the left main coronary artery (LMCA) and proximal ascending aorta (AA). Mean density in the adjacent perivascular tissue was also quantified. Contrast-to-noise ratio (CNR) was calculated. Corresponding invasive coronary angiography (ICA) was performed, which constituted the gold standard. Results: Mean values in the 100120 kVp cohorts regarding CNR in the LMCA were 12.716.0 (P < 0.0001)) and in the AA 13.217.2 (P < 0.0001), CTDIvol 34.457.4 mGy (a 40% reduction, P < 0.0001), DLP 5781125 mGy X cm (P < 0.0001), and estimated effective dose 9.620.2 mSv (P < 0.0001). There was no statistically significant difference in subjective image quality between the two cohorts. The sensitivity to detect significant coronary stenoses was 88% (120 kVp) and 84% (100 kVp) and the specificity was 71% (120 kVp) and 74% (100 kVp), respectively. Conclusion: By reduction of tube voltage from 120 to 100 kVp at CCTA, while keeping all other scanning parameters unchanged, the radiation dose to the patient can be almost halved while keeping the diagnostic image quality at a clinically acceptable level.
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| 11. |
- Ward, Liam J., et al.
(författare)
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Coronary artery calcification and aortic valve calcification in patients with kidney failure : a sex-disaggregated study
- 2023
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Ingår i: Biology of Sex Differences. - 2042-6410. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic kidney disease (CKD) is linked to an increased cardiovascular disease (CVD) burden. Albeit underappreciated, sex differences are evident in CKD with females being more prone to CKD development, but males progressing more rapidly to kidney failure (KF). Cardiovascular remodelling is a hallmark of CKD with increased arterial and valvular calcification contributing to CKD. However, little is known regarding sex differences in calcific cardiovascular remodelling in KF patients. Thus, we hypothesise that sex differences are present in coronary artery calcification (CAC) and aortic valve calcification (AVC) in patients with KF. Methods: KF patients, males (n = 214) and females (n = 107), that had undergone computer tomography (CT) assessment for CAC and AVC were selected from three CKD cohorts. All patients underwent non-contrast multi-detector cardiac CT scanning, with CAC and AVC scoring based on the Agatston method. Baseline biochemical measurements were retrieved from cohort databases, including plasma analyses for inflammation markers (IL-6, TNF, hsCRP) and oxidative stress by skin autofluorescence measuring advanced glycation end-products (AGE), amongst other variables. Results: Sex-disaggregated analyses revealed that CAC score was associated with age in both males and females (both p < 0.001). Age-adjusted analyses revealed that in males CAC was associated with diabetes mellitus (DM) (p = 0.018) and CVD (p = 0.011). Additionally, for females CAC associated with IL-6 (p = 0.005) and TNF (p = 0.004). In both females and males CAC associated with AGE (p = 0.042 and p = 0.05, respectively). CAC was associated with mortality for females (p = 0.015) independent of age. AVC in females was not reviewed due to low AVC-positive samples (n = 14). In males, in multivariable regression AVC was associated with age (p < 0.001) and inflammation, as measured by IL-6 (p = 0.010). Conclusions: In female KF patients inflammatory burden and oxidative stress were associated with CAC. Whereas in male KF patients oxidative stress and inflammation were associated with CAC and AVC, respectively. Our findings suggest a sex-specific biomarker signature for cardiovascular calcification that may affect the development of cardiovascular complications in males and females with KF.
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