Multimodality Imaging of Subclinical Aortic Atherosclerosis

Abstract

Aortic stiffness, an important predictor of cardiovascular events, may relate to aortic calcification rather than noncalcified atherosclerotic plaque. The aim of this study was to determine the relation of aortic stiffness to aortic plaque and aortic calcification in asymptomatic postmenopausal women. One hundred female twins (mean age±standard deviation 64±7 years) underwent computed tomography and magnetic resonance imaging (black-blood sequence) of the aorta. The topographical relation of plaque on magnetic resonance images and calcification on computed tomography images was assessed on magnetic resonance/computed tomography fused images. Carotid-femoral pulse wave velocity was used as a measure of aortic stiffness. Aortic plaque was identified in 87% and calcification in 65% of subjects, both increased with age and were higher in the abdominal compared with thoracic aorta (P<0.0001). Plaque correlated with calcification (R=0.68; P<0.0001), but was also detected in 58% of women who had no calcification. Pulse wave velocity (adjusted for age and blood pressure) increased across quartiles of calcification (P<0.01) but not plaque score (P=0.56). Shared genetic factors accounted for >99% of the correlation (0.35) between PWV and calcification. In conclusion, there is a high prevalence of subclinical atherosclerosis within the aorta in asymptomatic middle-aged women. Aortic stiffening relates to aortic calcification, but not to atherosclerotic plaque burden, and the association of aortic stiffness with calcification is driven by common genes.

Arterial Stiffness Is Associated With Carotid Intraplaque Hemorrhage in the General Population

“…40 Previous studies found inconsistent associations between arterial stiffness and plaque calcification. 25,41 A previous cross-sectional study within the Rotterdam Study found an independent association of arterial stiffness, measured as carotid-femoral PWV and carotid distensibility coefficient, with carotid calcification. 42 In contrast to our study, calcification was measured using computed tomography and quantified according to the Agatston score.…”

Molecular Mechanisms of Arterial Stiffening

“…When measured by aortic pulse wave velocity (aPWV), it is highly predictive of clinical cardiovascular disease events independent of blood pressure, both in the general population and in groups with additional risk factors [5,6]. Formerly thought to be simply a marker of atherosclerosis [7], the pathology of aortic stiffening may differ, at least in part, from that of atherosclerosis [8,9,10]. Thus, in primate models of atherosclerosis, aPWV is reduced compared to non-atherosclerotic controls, at least in the early stages of atherosclerosis [10].…”

“…Thus, in primate models of atherosclerosis, aPWV is reduced compared to non-atherosclerotic controls, at least in the early stages of atherosclerosis [10]. In humans, aPWV is largely independent of risk factors other than age and blood pressure [11] and is not elevated in the presence of non-calcified atheromatous plaque [8,9]. The prognostic importance of arterial stiffening and the fact that it may be driven by a specific pathology distinct from atherosclerosis makes it an appealing target to prevent cardiovascular disease events.…”

“…However, animal models show that medial calcification (in the absence of atherosclerosis) increases arterial stiffness, suggesting a direct causal relation between calcification and stiffening [14]. Using combined computed tomography and magnetic resonance imaging to measure calcification and atheroma in the Twins UK population, we have shown that even though calcification often colocalises with atherosclerotic plaque, the association of stiffness with calcification is not explained by coexistent atheromatous plaque [8]. Furthermore, the correlation between calcification and stiffness is explained by shared genetic factors distinct from those responsible for atherosclerosis [8,9].…”

486 The implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism

“…[14][15][16] Arterial stiffness and atherosclerosis are related to aortic calcification, which is a risk factor for cardiovascular disease (CVD). 17,18 PA patients have a greater risk of developing CVD than essential patients with hypertension. 19 Aortic calcification can be quantitatively measured by abdominal computed tomography (CT) on the aortic calcification index (ACI).…”