Dangas George D, Maehara Akiko, Evrard Solene M, Sartori Samantha, Li Jennifer R, Chirumamilla Amala P, Nomura-Kitabayashi Aya, Gukathasan Nilusha, Hassanin Ahmed, Baber Usman, Fahy Martin, Fuster Valentin, Mintz Gary S, Kovacic Jason C
Cardiovascular Research Foundation, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2014 Feb;15(2):201-9. doi: 10.1093/ehjci/jet139. Epub 2013 Jul 31.
Emerging data have indicated unexpected complexity in the regulation of vascular and bone calcification. In particular, several recent studies have challenged the concept of a universally positive relationship between body morphology [weight, height, body mass index (BMI), body surface area (BSA)] and the extent of vascular calcification. We sought to clarify these discrepancies and investigated the relationship between index lesion coronary artery calcification (CAC) and body morphology in patients undergoing percutaneous coronary intervention (PCI) using three-dimensional intravascular ultrasound (IVUS).
We analysed CAC in patients who underwent PCI with pre-intervention IVUS imaging. The main outcome measure was the calcium index (CalcIndex); a three-dimensional IVUS-derived measure of total calcification per obstructive coronary lesion. A total of 346 patients (65.3 ± 10.6 years; 29.5% females) underwent PCI with IVUS-based CAC assessment. CalcIndex was categorized as zero-low (0-0.1399; n = 152) or intermediate-high (0.1400-1.2541; n = 194). All measures of body morphology were lower in patients with intermediate-high CalcIndex (height, P = 0.024; weight, P = 0.008; BMI, P = 0.064; BSA, P = 0.005). In adjusted multivariable models, weight and BSA were independent inverse predictors of intermediate-high CalcIndex [weight: odds ratio (OR) 0.986, P = 0.017; BSA: OR 0.323, P = 0.012] while CalcIndex also trended towards an inverse association with both height (P = 0.068) and BMI (P = 0.064). These independent inverse associations were consistent across multiple clinical subgroups, including stratification by age, race, gender, diabetes, and renal impairment.
Using three-dimensional IVUS to assess vascular calcification, these data confirm an independent, inverse relationship between body size and index lesion CAC in patients with obstructive coronary artery disease.
新出现的数据表明，血管钙化和骨钙化的调节存在意想不到的复杂性。特别是，最近的几项研究对身体形态[体重、身高、体重指数（BMI）、体表面积（BSA）]与血管钙化程度之间普遍存在的正相关概念提出了挑战。我们试图澄清这些差异，并使用三维血管内超声（IVUS）研究接受经皮冠状动脉介入治疗（PCI）患者的冠状动脉钙化指数病变（CAC）与身体形态之间的关系。
我们分析了接受PCI并进行术前IVUS成像患者的CAC情况。主要结局指标是钙指数（CalcIndex）；这是一种基于三维IVUS得出的每个阻塞性冠状动脉病变总钙化量的测量指标。共有346例患者（65.3±10.6岁；29.5%为女性）接受了基于IVUS的CAC评估的PCI治疗。CalcIndex被分为零低（0 - 0.1399；n = 152）或中高（0.1400 - 1.2541；n = 194）。中高CalcIndex患者的所有身体形态指标均较低（身高，P = 0.024；体重，P = 0.008；BMI，P = 0.064；BSA，P = 0.005）。在调整后的多变量模型中，体重和BSA是中高CalcIndex的独立反向预测因素[体重：比值比（OR）0.986，P = 0.017；BSA：OR 0.323，P = 0.012]，而CalcIndex也趋向于与身高（P = 0.068）和BMI（P = 0.064）呈负相关。这些独立的反向关联在多个临床亚组中都是一致的，包括按年龄、种族、性别、糖尿病和肾功能损害进行分层。
使用三维IVUS评估血管钙化，这些数据证实了在患有阻塞性冠状动脉疾病的患者中，体型与指数病变CAC之间存在独立的负相关关系。
