Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients

Muntner, Paul; Ferramosca, Emiliana; Bellasi, Antonio; Block, Geoffrey A.; Raggi, Paolo

doi:10.1093/ndt/gfl609

Cited by 26 publications

(21 citation statements)

References 37 publications

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“…24 Munter et al combined MVC, AVC, and abdominal aortic calcification along with age and history of dialysis to create a “cardiovascular calcification index”, which was significantly predictive of CAC. 25 Tison et al reported that a multisite thoracic ECC score, consisting of TAC, MVC, MVC, ARC, can improve risk prediction for CHD events, CHD mortality, and all-cause mortality when combined with traditional risk factors. However, when CAC was added to the model, thoracic ECC significantly predicted all-cause mortality, but not CHD events or CHD mortality.…”

Section: Discussionmentioning

confidence: 99%

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

et al. 2017

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Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6,805 participants (mean age 62.1±10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p<0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n=184), total stroke (n=235), and TIA (n=85), but not hemorrhagic stroke (n=32) and stroke mortality (n=42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p>0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.

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Section: Discussionmentioning

confidence: 99%

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

et al. 2017

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“…This stepped strategy would recognize patients with CAC in advance and allow early therapeutic choice before coronary heart disease become symptomatic (24,26). In ESRD patients, standard radiographs, echocardiography, and pulse pressure have been found to be suitable procedures for predicting the presence of CAC (15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…In ESRD patients, several studies have evaluated the relationship between pulse pressure and vascular calcifications, with contrasting results (17,22,30,31). In one study, significant positive association was observed between increasing values of pulse pressure and the number of calcified peripheral arteries assessed by a high-resolution B-mode echo-tracking system.…”

Section: Discussionmentioning

confidence: 99%

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Pulse Pressure and Presence of Coronary Artery Calcification

Russo

Morrone

Brancaccio

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background: Coronary calcification (CAC) is found in early stages of CKD. Pulse pressure (PP) predicts CAC in dialysis patients. This study evaluates the accuracy of PP in predicting CAC in patients not yet on dialysis (CKD patients).Methods: CKD patients (n ‫؍‬ 388) underwent coronary calcium score (CAC score) and abdominal x-ray (n ‫؍‬ 128) for estimating aorta calcification (AAC). Biochemistry and PP were measured every 3 and 6 months in patients with stage 4 to 5 and 2 to 3 CKD, respectively. The accuracy of PP and AAC was assessed by receiver operating characteristics analysis.Results: PP correlated with CAC score in the whole cohort and in patients with stages 2 to 3 and stages 4 to 5 CKD. PP >60 mmHg predicted CAC score >0 (OR: 2.14; P < 0.001), >100 (OR: 2.92; P < 0.001), >400 (OR: 6.17; P < 0.001) after multivariable adjustment. Area under the curve (AUC) was 0.626 for CAC score >0, 0.676 for score >100, and 0.746 for score >400. PP >60 mmHg reduced the rate of event-free survival. AAC was found in 58% of patients and correlated with CAC score. AUC was 0.628 for CAC score >0, 0.652 for score >100, 0.831 for score >400.Conclusion: PP may identify CKD patients with subclinical CAC who need further evaluation. Accuracy of PP and AAC is nearly similar in predicting CAC. High PP indicates vessel wall alterations leading to adverse outcome.

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“…[22] As the most common and routine x-ray examination in outpatient hemodialysis clinics is the posterior-anterior plain chest x-ray, a method that uses plain chest x-ray films would enable the greatest number of patients to be assessed. Previous studies have reported methods that use plain chest x-ray films to estimate vascular calcification: Fabbian et al reported that aortic arch calcification on standard chest x-ray radiographs is related to age, duration of renal replacement therapy, the Ca×P product, systolic blood pressure, and peripheral vascular disease in hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Switching from Calcium Carbonate to Sevelamer Hydrochloride Has Suppressive Effects on the Progression of Aortic Calcificationin Hemodialysis Patients: Assessment Using Plain Chest X-Ray Films

Izumi¹,

Morita²,

Nishian³

et al. 2008

Renal Failure

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Sevelamer hydrochloride, a non-aluminum-and non-calciumcontaining hydrogel, is an effective phosphate binder in dialysis patients. The suppressive effect of the switching from calcium carbonate to sevelamer hydrochloride on the progression of vascular calcification was examined by measuring areas of calcification on routine chest X-rays using image-analyzing software. The data of 69 maintenance hemodialysis patients were analyzed retrospectively. Over a period of 18 months, 19 patients took only sevelamer hydrochloride as a phosphate binder, while the other 50 patients took only calcium carbonate. The area of calcification increased in the calcium carbonate group, but did not change significantly in the sevelamer group. While the usefulness of computed tomography in detecting vascular calcification in hemodialysis patients has been reported previously, the suppressive effects of switching from calcium carbonate to sevelamer hydrochloride on the progression of aortic calcification can be observed without computed tomography by using the plain chest X-ray films that are routinely performed in hemodialysis clinics.

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Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients

Cited by 26 publications

References 37 publications

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

Pulse Pressure and Presence of Coronary Artery Calcification

Switching from Calcium Carbonate to Sevelamer Hydrochloride Has Suppressive Effects on the Progression of Aortic Calcificationin Hemodialysis Patients: Assessment Using Plain Chest X-Ray Films

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