Craiem Damian, Alsac Jean-Marc, Casciaro Mariano E, El Batti Salma, Mousseaux Elie, Sirieix Marie-Emmanuelle, Simon Alain
Facultad de Ingeniería Ciencias Exactas y Naturales, Universidad Favaloro, CONICET, Buenos Aires, Argentina; Centre de Médecine Préventive Cardiovasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France.
INSERM U970, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France; Service de Chirurgie Cardiaque et Vasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France.
Rev Esp Cardiol (Engl Ed). 2016 Sep;69(9):827-35. doi: 10.1016/j.rec.2016.01.031. Epub 2016 May 4.
Thoracic aorta calcium detection is known to improve cardiovascular risk prediction for cardiac and noncardiac events beyond traditional risk factors. We investigated the influence of thoracic aorta morphometry on the presence and extent of aortic calcifications.
Nonenhanced computed tomography heart scans were performed in 970 asymptomatic participants at increased cardiovascular risk. An automated algorithm estimated the geometry of the entire thoracic aorta and quantified the aortic calcium Agatston score. A nonparametric model was used to analyze the percentiles of calcium score by age. Logistic regression models were calculated to identify anatomical associations with calcium levels.
Calcifications were concentrated in the aortic arch and descending portions. Higher amounts of calcium were associated with an enlarged, unfolded, less tapered and more tortuous aorta. The size of the ascending aorta was not correlated with aortic calcium score, whereas enlargement of the descending aorta had the strongest association: the risk of having a global calcium score > 90th percentile was 3.62 times higher (confidence interval, 2.30-5.91; P < .001) for each 2.5-mm increase in descending aorta diameter. Vessel taper, tortuosity, unfolding and aortic arch and descending volumes were also correlated with higher amounts of calcium.
Thoracic aorta calcium was predominantly found at the arch and descending aorta and was positively associated with the size of the descending aorta and the aortic arch, but not with the size of the ascending aorta. These findings suggest that aortic dilatation may have different mechanisms and may consequently require different preventive strategies according to the considered segments.
已知胸主动脉钙化检测可改善对心脏和非心脏事件的心血管风险预测，超出传统风险因素。我们研究了胸主动脉形态学对主动脉钙化的存在和程度的影响。
对970名心血管风险增加的无症状参与者进行了非增强计算机断层扫描心脏检查。一种自动算法估计了整个胸主动脉的几何形状，并对主动脉钙化阿加斯顿评分进行了量化。使用非参数模型按年龄分析钙化评分的百分位数。计算逻辑回归模型以确定与钙水平的解剖学关联。
钙化集中在主动脉弓和降部。较高的钙含量与主动脉扩大、展开、变细程度降低和迂曲度增加有关。升主动脉的大小与主动脉钙化评分无关，而降主动脉的扩大关联最强：降主动脉直径每增加2.5毫米，总体钙化评分>第90百分位数的风险高3.62倍（置信区间，2.30 - 5.91；P <.001）。血管变细、迂曲度、展开情况以及主动脉弓和降部的容积也与较高的钙含量相关。
胸主动脉钙化主要见于主动脉弓和降主动脉，与降主动脉和主动脉弓的大小呈正相关，但与升主动脉的大小无关。这些发现表明，主动脉扩张可能有不同机制，因此根据所考虑的节段可能需要不同的预防策略。
