جستجوی مقالات مرتبط با کلیدواژه « Calcium Score » در نشریات گروه « پزشکی »

Adjuvant radiation therapy (RT) improves the prognosis of breast cancer (BC); nevertheless, causes post-RT complications. One of the most life-threatening complications of RT in BC patients is atherosclerotic coronary artery disease (CAD). Compared with old two-dimensional RT (2D-RT), newer three-dimensional conformal radiotherapy (3D-CRT) protects normal tissues including the heart from irradiation. Early detection of plaques using coronary artery calcium score (CACS) could improve the post-RT BC survivors’ outcomes. This study assessed CACS in BC patients who underwent 3D-CRT to find whether there is any significant difference between their CACS and those of non-BC patients. Patients and Methods: CACS of fifty BC patients with different intervals from RT - case - and fifty women with no history of BC or RT - control - using 64-slice ECG-gated CT scan were assessed as Agatston score (AS). The risk factors of CAD, the Framingham’s 10-year risk score, and the age-matched CACS percentiles were evaluated. No AS difference between the case and control was found. No correlation between AS and RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P < 0.001). No significant difference in CACS was found in BC patients treated by 3D-CRT in comparison with those of non-BC individuals or BC patients who treated by 2D-RT. This finding may be the result of either the non-calcified nature of radiation-induced CAD plaques or reduced cardiac radiation in 3D-CRT, leading to myocardial microvascular disease rather than senile calcified atherosclerotic plaques. CACS may not be an appropriate screening test to detect early CAD in these patients.

Breast cancer (BC) mortality rate has significantly decreased during the past decades by introducing adjuvant chemotherapy and/or radiotherapy (RT) in addition to surgery. However, as an emerging phenomenon, the corresponding therapeutic side effects caused non-malignant morbidity and mortality. Coronary artery disease (CAD) is the leading non-malignant cause of death in BC patients. It is established that chest RT has a role in atherosclerotic plaque formation in the coronary arteries. Newer techniques of RT like three-dimensional conformal radiotherapy (3D-CRT) use technical methods in which less radiation doses are given to the non-cancerous tissues. Non-invasive technique of coronary artery calcium score (CACS) can detect atherosclerotic plaques long before the plaques become symptomatic, helping to treat them in early stages, so improve BC patients’ outcome. The aim of this study is to assess and compare CACS in BC patients with a history of 3D-RT and non-BC women in the same age range with no history of RT.
CACS of fifty BC patients (age range: 34 - 70 years) with different time intervals from RT (range: 3-9 years) and CACS of fifty age-matched control group of non-BC women with no history of chest RT, using 64-slice ECG-gated CT scan were calculated and presented as the quantitative value of Agatston score (AS). The risk factors contributing to CAD (hypertension, hyperlipidemia, diabetes mellitus, smoking), and the Framingham’s 10-year risk score, as well as the age-matched CACS percentiles, were evaluated.
No correlation between AS and history of RT, RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P No difference between CACS was noted between BC patients with a history of 3D-CRT and the non-BC women without a history of RT. Although cardiac radiation dose reduction in 3D-CRT technique can justify the findings, as multiple studies have shown increase of CAD in BC patients with history of old RT techniques, but some studies show no difference in CACS between new and old RT techniques, other reason would be non-calcified atherosclerotic plaques after RT or myocardial microvascular disease due to reduced cardiac doses after 3D-CRT rather than calcified atherosclerotic plaques seen naturally by aging.

Coronary artery calcium score (CACS) is a quantitative assessment of calcifications and an established predictor of cardiovascular events..
In this study, we evaluated the diagnostic accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity and sensitivity of CACS less than 100 in predicting significant coronary artery stenosis in patients with risk of coronary artery disease (CAD) in a vessel-based analysis..
Patients and A cross sectional study was carried out on a study population of 2527 consecutive stable patients with symptoms suggestive of CAD who were referred for coronary computed tomographic angiography (CCTA). We performed 1343 studies with 256 slice machine in Shahid Rajaee hospital and the other studies were carried out with 64 slice machine in Imam Khomeini hospital and the calcium score was quantified according to the Agatston method..
At the cutoff point of 100 for coronary calcium scoring, there was high specificity (87%), high sensitivity (79%), high efficiency (84%), high PPV (79%), and high NPV (87%) in the diagnosis of significant stenosis in the whole heart. The frequency of zero calcium scoring was 59% in normal or nonsignificant stenosis and 7.6% in significant stenosis in the whole heart. Calcium scoring increased with greater severity of the arterial stenosis (P values We conclude that coronary calcium scoring provided useful information in the management of patients. In CACS less than 100, it has a NPV of 87% in excluding significant stenosis in patients with the risk of CAD but it does not have enough diagnostic accuracy for surely excluding coronary stenosis, so we should perform a combination of CACS and coronary CT angiography for patients..

Coronary artery calcification (CAC) is a specific indicator of and a sensitive marker for the atherosclerotic disease process. However, calcium scoring may miss noncalcified plaques with clinical importance. The present study aimed to identify the presence and extent of coronary plaques in computed tomography coronary angiography (CTCA) in patients with a zero CAC score and the secondary endpoint was to evaluate the association between coronary risk factors and the presence of noncalcified plaques.

In a retrospective descriptive‑analytic study, a total of 2000 consecutive patients who undergone CTCA between September 2012 and September 2014 at Alzahra Hospital in Isfahan, Iran were analyzed. Three hundred and eighty‑five patients with a zero calcium score were included in the study. The demographic information and coronary artery disease (CAD), risk factors including diabetes mellitus (DM), hypertension, hyperlipidemia, smoking, and family history of CAD, were obtained from the questionnaire. Furthermore, the presence of plaques and extent of stenosis were evaluated in patients with zero CAC score.

Of the 385 patients with a zero calcium score, 16 (4.2%) had atherosclerotic plaques. Among them, 6 (1.6%) had significant (>50%) coronary stenosis, and 10 (2.6%) had no significant (<50%) coronary stenosis. Hyperlipidemia, DM, and smoking were significantly associated with obstructive CAD. Furthermore, in patients with zero calcium score, DM, hyperlipidemia, and smoking had odds ratios of 5.9, 14, and 32.5 for the development of coronary artery plaques, respectively.

Although, CAC scoring is a noninvasive and valuable method to evaluate CAD; but zero CAC score does not absolutely exclude the CAD, especially in the presence of risk factors such as diabetes, hyperlipidemia, and smoking.

Osteoprotegerin (OPG) could be a marker of vascular calcification extent. The purpose of this study was to evaluate relationships between OPG and coronary artery calcification (CAC) extent in an Iranian population.
A total of 151 patients with chest pain [107 males/44 females, mean age: 57.23 (30-85)] were enrolled, excluding patients with previously established coronary artery diseases. All underwent chest multidetector computed tomography (MDCT) for CAC scoring. Blood samples were collected for measurement of OPG. A potential relationship between CAC, OPG, age and number of involved coronary arteries was investigated, and a receiver-operating characteristic (ROC) curve was designed thereafter to identify a cut-off value of OPG that best predicted the presence of CAC.
A total of 93 patients did not have CAC, who were younger than others. The mean age of patients with a different number of involved arteries was significantly different and is significantly correlated with a number of involved coronary arteries. The mean level of OPG differed by the number of calcified coronary arteries and is significantly correlated with the number of involved coronary arteries. The level of OPG had a weak but positive correlation with Ca score. ROC curve analysis showed that plasma OPG level had a fair prediction of CAC score, with an area under ROC curve of 0.62. The cut-off value best predicting CAC score was 59.1 pg/ml.
This study suggests that a serum level of OPG can fairly predict extent of coronary retry calcification in symptomatic population.

The objective of our study was to assess early post operative patency and anatomy of CABGs using retrospectively ECG gated MDCT and correlation between the amount of calcium scoring and early coronary graft occlusion and also retrospective correlation between Calcium scoring and coronary artery disease. 65 patients (43 men, 12 women) who underwent CABG in Shahid Rajaii heart hospital were included in this study. The time interval between the CABG surgery and imaging protocol was less than l month.We used ECG gated 10 detector CTA (slice thickness 0.6 mm, rotation 500ms), for detection the relation between coronary calcium score and early SVG graft occlusion. The threshold of 130 Hounsfield units was set to identify calcifications by Agatston method.Results and The sensitivity and the specificity of calcification for severe stenosis (>75%) were 85% and 40%, respectively. we did not find any correlation between coronary calcium scoring and early SVG graft occlusion(pv=0.6).