Coronary computed tomography angiography | TCRM

Coronary computed tomography angiography | TCRM

Advent

Lipoprotein(a) (Lp(a)) is a particle this is structurally very similar to low-density lipoprotein ldl cholesterol (LDL) and comprises apolipoprotein(a) certain to apolipoprotein B100 by way of a disulfide bond.1 Some research have prompt that top concentrations of plasma Lp(a) are related to a excessive chance of aortic valve stenosis2 and coronary artery illness (CAD).3,4 There are a number of hypotheses in regards to the pathophysiology of Lp(a). Very similar to LDL, Lp(a) may also be pro-atherogenic as a result of extra Lp(a) is deposited into the subendothelial arterial area and oxidized.5 As well as, Lp(a) may also be prothrombotic for the reason that construction of apolipoprotein(a) is very similar to plasminogen and would possibly compete with plasminogen, thus resulting in interference with the fibrinolytic gadget.6

Then again, the relationships between Lp(a) and CAC, and between Lp(a) and CAD, are very complicated and feature now not but been exactly established. Many research have proven other relationships between Lp(a) ranges and CAD, in particular in regards to race.7 As an example, in keeping with Virani et al, the Lp(a) ranges of Black topics had been upper than the ones of white topics, and had a more potent sure correlation with heart problems occasions in comparison to that seen in white matter.8 Against this, a big potential cohort find out about in China (n = 3884) discovered that plasma Lp(a) ranges weren’t strongly related to CAD, dying, or stroke.11 As well as, more than a few research have discovered other correlations of Lp(a) with coronary artery calcification. In a community-based find out about, sex-specific associations between Lp(a) and coronary artery calcium (CAC) rating had been supported,12 and every other find out about reported that Lp(a) used to be strongly related to excessive CAC rating in girls with sort 2 diabetes mellitus (DM).13 In the meantime, some research reported detrimental effects.10,14

The aim of this find out about used to be to decide the correlation between Lp(a) stage and CAC rating in Korean sufferers, and to decide the connection between Lp(a) and CAD.

Fabrics and Strategies

Find out about Contributors

This used to be a single-center, cross-sectional, observational find out about. The sufferers consisted of 252 people who visited Kyung Hee College Health center from March 2020 to February 2021 for the analysis of chest ache, CAD chance analysis for non-cardiac surgical treatment, stroke, or healthcare exam. A few of the guests for healthcare exam, those that had cardiac hypertrophy on CXR or excessive CAC rating (>400) or important stenosis on coronary computed tomography angiography (CCTA) had been integrated. The sufferers underwent CCTA and an Lp(a) take a look at in a three-month time-frame. That they had now not in the past been recognized with CAD (outlined as myocardial infarction (MI), coronary revascularization, angiographic important stenosis, or sure tension take a look at), and had been 27 to 89 years previous. Of the 252 eligible sufferers, 81 sufferers underwent coronary revascularization and 171 gained scientific remedy simplest. Coronary angiography used to be carried out in keeping with the doctor’s determination. Coronary revascularization used to be carried out on lesions with stenosis more than 70% and/or FFR <0.8. Coronary revascularization used to be now not carried out on lesions clinically judged to be not possible for PCI or the ones for which it used to be concept that intervention would now not be recommended (eg, distal lesions or too-small vessels).

The exclusion criterion used to be a historical past of coronary illness.

The find out about used to be performed in keeping with the Declaration of Helsinki and licensed by means of the Institutional Evaluation Board of Kyung Hee College Health center (protocol code: KHUH 2021-10-077).

Medical and Laboratory Values

Knowledge at the age, intercourse, DM, high blood pressure (HTN), prior stroke historical past, smoking, and alcohol intake of the sufferers used to be received from their scientific information. Frame mass index used to be received by means of dividing weight (kg) by means of the sq. of top (m2). The creatinine, glucose, general ldl cholesterol, triglyceride, high-density lipoprotein ldl cholesterol, LDLcholesterol, and high-sensitivity C-reactive protein concentrations had been measured the use of an AU-5800 Chemistry Analyzer (Beckman Coulter Inc., Brea, CA, USA). The Lp(a) stage used to be measured by means of an immunoturbidimetry methodology calibrated with the IFCC reference subject matter, the use of the similar analyzer. HbA1c used to be measured the use of an automatic Glycohemoglobin Analyzer HLC-723G8 (Tosoh G8; Tosoh Bioscience, Inc., Japan).

Computed Tomography Scans

Computed tomography (CT) scans had been carried out with a 128-slice scanner (Ingenuity CT cor 128, Philips Scientific Programs, Cleveland, OH, USA), and the usual scanning parameters had been 64 mm × 0.625 mm phase collimation, 400 ms rotation time, 120 kV tube voltage, and 39.5 mAs (395 mA × 0.1 s) tube present below ECG-gated dose modulation. The Agatston rating used to be calculated the use of same old calcium scoring.

Statistical Research

Statistical analyses of the information had been carried out the use of SPSS (model 22.0; IBM Corp., Armonk, NY, USA). Knowledge are reported as imply ± same old deviation for steady variables and as proportions for express variables. The Spearman correlation statistical means used to be used to research the correlations between Lp(a) and the chance elements of CAD and between Lp(a) and CAC rating. Scholar’s t-tests and chi-square checks had been used to check the coronary intervention team and scientific control simplest team, the high and low Lp(a) teams, and the high and low CAC teams.

Effects

Baseline Player Traits

Desk 1 presentations a abstract of the baseline traits. The imply age used to be 68.2 years, and 58.7% of the sufferers had been male. The imply CAC rating used to be 478.4, and the Lp(a) stage used to be 24.8 mg/dL. The selection of sufferers who underwent coronary intervention used to be 81 (32%).

Coronary computed tomography angiography | TCRM

Desk 1 Baseline Player Traits

Analysis of anginal chest ache used to be the commonest reason why for CCTA (n = 161, 64%). Following this, the opposite causes for exam had been chance analysis of non-cardiac surgical treatment (n = 50, 19.8%), coronary analysis of sufferers with stroke (n = 26, 10.3%), and healthcare exam (n = 15, 5.9%).

Associations Between Lp(a) and CAD and More than a few CAD Possibility Elements

Spearman correlations didn’t expose any associations between Lp(a) and different lipid, metabolic, or inflammatory parameters. The evaluation used to be additionally performed by means of dividing the sufferers into the scientific remedy simplest and coronary revascularization teams. Then again, the effects had been nearly the similar between the 2 teams (Desk 2).

Desk 2 Spearman Correlations of Lipid, Metabolic, and Inflammatory Parameters with Plasma Lp(a) Ranges

As many research counsel that Lp(a) ranges above 50 mg/dL be designated as odd,9 we divided the sufferers into two teams in keeping with an Lp(a) stage of fifty mg/dL to decide the variations between the 2 teams. There used to be no distinction between the 2 affected person teams in regards to the lipid, metabolic, or inflammatory parameters. As well as, there have been no important variations within the selection of sufferers who underwent coronary intervention (69 (31.1%) vs 12 (40.0%), p = 0.326) or the CAC rankings (474.2 ± 744.3 vs 509.8 ± 824.2, p = 0.808) between the 2 teams (Desk 3).

Desk 3 Lipid, Metabolic, and Inflammatory Parameters; CAC Rating; and Choice of Sufferers Who Underwent Coronary Revascularization In line with Lp(a) Stage

Associations Between Lp(a) Stage and CAC Rating

Determine 1 presentations biased distributions of Lp(a) stage and CAC rating. All sufferers had been divided into two teams in keeping with a calcium rating of 400, which is a degree typically thought to be to have prognostic worth.10,11 There used to be no important distinction within the Lp(a) stage between the 2 teams (25.4 ± 26.0 vs 23.6 ± 20.0, p = 0.601). Then again, the imply age of the excessive CAC rating team used to be upper than that of the low CAC rating team (70.9 ± 8.9 vs 67.0 ± 10.1, p = 0.003), the percentage of guys used to be upper (49 (62.0%) vs 65 (37.6%), p = 0.004) within the excessive CAC rating team, and the ratio of sufferers who had HTN used to be upper (68 (86.1%) vs 122 (70.5%), p = 0.008) within the excessive CAC rating team. The selection of sufferers who underwent coronary intervention used to be upper within the excessive CAC rating team (40 (50.6%) vs 41 (23.7%), p = 0.000) (Desk 4).

Desk 4 Lipid, Metabolic, and Inflammatory Parameters; Lp(a) Stage; and Choice of Sufferers Who Underwent Coronary Revascularization In line with CAC Rating

Determine 1 (A) Distribution of Lp(a): n=252, imply: 24.75 mg/dL, SD=24.29 mg/dL, median: 18.3 mg/dL, IQR 20.7. (B) Distribution of CAC rating: n=252, imply: 478.4 mg/dL, SD=752.6 mg/dL, median: 185.26 mg/dL, IQR 491.4.

The correlation between Lp(a) and CAC rating may now not be seen in all sufferers by means of the use of the Spearman correlation (Spearman correlation: 0.053, p = 0.403). The consequences had been the similar within the team receiving scientific treatment simplest (Spearman correlation: 0.057, p = 0.46) and within the coronary intervention team (Spearman correlation: 0.002, p = 0.986).

Dialogue

Lp(a) is located in atherosclerotic plaques and is related to vascular clean muscle proliferation and endothelial mobile harm.12 In a up to date large-scale find out about focused on multi-ethnic individuals, Lp(a) used to be associated with CAD independently of CAC rating.13 Then again, different research counsel that the connection between Lp(a) and CAD would possibly seem another way relying on age, intercourse, race, and comorbidities.7,14–16 The result of our find out about confirmed no sturdy courting between Lp(a) and CAD in a Korean cohort, and this discovering may also be defined by means of the result of earlier research.

In our find out about, no correlation used to be discovered between Lp(a) and CAC rankings. There are two fresh research at the correlation between Lp(a) and CAC in Korea. The find out about of Chung et al confirmed that during asymptomatic male sufferers over 45 years of age, the extent of Lp(a) used to be considerably upper for sufferers with CAC rankings more than 0 than the Lp(a) stage of sufferers with CAC rankings of 0 (16.74 ± 20.53 vs 13.97 ± 16.10, p =  0.006).18 Sung et al19 additionally demonstrated a good correlation between Lp(a) stage and CAC rating in a big cohort in Korea. Then again, not like our find out about, those two research had been performed on asymptomatic well being check-up sufferers, and the cut-off of the sufferers’ CAC rankings used to be a lot not up to that during our find out about (0 vs 400). Typically, CAC rating signifies the load of atherosclerosis within the coronary artery,17 and the overall cutoff for expanding CAD chance has been recognized as roughly 350–400; subsequently, it may be mentioned that those research confirmed correlation between preclinical atherosclerosis and Lp(a). Against this, our find out about divided sufferers at the foundation of a CAC of 400, and the scientific importance of our find out about is the comparability of the variations of the particular scientific consequence, this is, whether or not a coronary revascularization used to be carried out.

The selection of sufferers integrated within the provide find out about used to be simplest 252, and this small pattern measurement used to be a drawback of this find out about. Nonetheless, the effects obviously point out relationships between CAD and different well known chance elements for CAD (eg, CAC rating, age, gender, and HTN). This means that the sufferers on this find out about sufficiently mirror the traits of the overall inhabitants. Every other drawback of this find out about used to be the heterogeneity of the sufferers. Then again, the integrated sufferers most commonly had angina, excessive coronary chance within the preoperative analysis, or stroke. Handiest 5.9% of sufferers underwent CT scans for well being examine exam and those sufferers had chance for CAD (eg, cardiac hypertrophy, excessive CAC rating, and/or important stenosis on CCTA). Due to this fact, many of the topics had been at excessive chance of coronary illness. That is supported by means of the truth that the typical CAC rating of the sufferers on this find out about used to be 478.4, which is reasonably excessive.

On this cross-sectional find out about, the evaluation used to be performed by means of dividing the sufferers into one team that gained the intervention and a 2nd team that didn’t. All sufferers who gained the intervention had been solid angina sufferers, and sufferers with acute coronary syndrome weren’t integrated. Due to this fact, follow-up cohort research on endpoints corresponding to survival price, MI, and stroke are important in long run. As well as, as the extent of Lp(a) within the blood is in large part made up our minds by means of the gene, in long run research, it will be significant to behavior Lp(a) genetic find out about, corresponding to Apo(a) measurement polymorphism or SNP evaluation, on Korean cohort and examine the effects with the ones of large-scale global research.20,21

In conclusion, important correlations between Lp(a) stage and CAC rating and between Lp(a) and CAD weren’t seen on this Korean cohort find out about. Then again, a excessive CAC rating used to be considerably correlated with coronary revascularization.

Knowledge Sharing Commentary

The information don’t seem to be publicly to be had as a result of information export used to be now not licensed by means of the Institutional Evaluation Board. The information offered on this find out about are to be had on request from the Institutional Evaluation Board.

Institutional Evaluation Board Commentary

The find out about used to be performed in keeping with the Declaration of Helsinki, and licensed by means of the Institutional Evaluation Board of Kyung Hee College Health center (protocol code: KHUH 2021-10-077 and date of approval: 2021.11.01).

Knowledgeable Consent Commentary

Affected person consent used to be waived as a result of this find out about is a RETROSPECTIVE find out about; consent waiver used to be licensed by means of the Institutional Evaluation Board.

Investment

This paintings used to be supported by means of the Nationwide Analysis Basis of Korea (NRF), funded by means of the Ministry of Training (2020R1F1A1076495).

Disclosure

The authors claim no conflicts of pastime on this paintings.

References

1. Utermann G. The mysteries of lipoprotein(a). Science. 1989;246(4932):904–910. doi:10.1126/science.2530631

2. Thanassoulis G, Campbell CY, Owens DS, et al. Genetic associations with valvular calcification and aortic stenosis. N Engl J Med. 2013;368(6):503–512. doi:10.1056/NEJMoa1109034

3. Kamstrup PR, Tybjærg-Hansen A, Nordestgaard BG. Increased lipoprotein(a) and chance of aortic valve stenosis within the normal inhabitants. J Am Coll Cardiol. 2014;63(5):470–477. doi:10.1016/j.jacc.2013.09.038

4. Nordestgaard BG, Langsted A. Lipoprotein (a) as a explanation for heart problems: insights from epidemiology, genetics, and biology. J Lipid Res. 2016;57(11):1953–1975. doi:10.1194/jlr.R071233

5. Nielsen LB. Atherogenecity of lipoprotein(a) and oxidized low density lipoprotein: perception from in vivo research of arterial wall inflow, degradation and efflux. Atherosclerosis. 1999;143(2):229–243. doi:10.1016/S0021-9150(99)00064-7

6. Berglund L, Ramakrishnan R. Lipoprotein(a): an elusive cardiovascular chance issue. Arterioscler Thromb Vasc Biol. 2004;24(12):2219–2226. doi:10.1161/01.ATV.0000144010.55563.63

7. Sharrett AR, Ballantyne CM, Coady SA, et al. Coronary center illness prediction from lipoprotein levels of cholesterol, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: the Atherosclerosis Possibility in Communities (ARIC) find out about. Stream. 2001;104(10):1108–1113. doi:10.1161/hc3501.095214

8. Virani SS, Brautbar A, Davis BC, et al. Associations between lipoprotein(a) ranges and cardiovascular results in black and white topics: the Atherosclerosis Possibility in Communities (ARIC) find out about. Stream. 2012;125(2):241–249. doi:10.1161/CIRCULATIONAHA.111.045120

9. Nordestgaard BG, Chapman MJ, Ray Ok, et al. Lipoprotein(a) as a cardiovascular chance issue: present standing. Eur Middle J. 2010;31(23):2844–2853. doi:10.1093/eurheartj/ehq386

10. Torngren Ok, Rylance R, Björk J, et al. Affiliation of coronary calcium rating with endothelial disorder and arterial stiffness. Atherosclerosis. 2020;313:70–75. doi:10.1016/j.atherosclerosis.2020.09.022

11. Lo-Kioeng-Shioe MS, Rijlaarsdam-Hermsen D, van Domburg RT, et al. Prognostic worth of coronary artery calcium rating in symptomatic people: a meta-analysis of 34,000 topics. Int J Cardiol. 2020;299:56–62. doi:10.1016/j.ijcard.2019.06.003

12. Cambillau M, Simon A, Amar J, et al. Serum Lp(a) as a discriminant marker of early atherosclerotic plaque at 3 extracoronary websites in hypercholesterolemic males. The PCVMETRA Staff. Arterioscler Thromb. 1992;12(11):1346–1352. doi:10.1161/01.ATV.12.11.1346

13. Mehta A, Vasquez N, Ayers CR, et al. Impartial affiliation of lipoprotein(a) and coronary artery calcification with atherosclerotic cardiovascular chance. J Am Coll Cardiol. 2022;79(8):757–768. doi:10.1016/j.jacc.2021.11.058

14. Shai I, Schulze MB, Manson JE, et al. A potential find out about of lipoprotein(a) and chance of coronary center illness amongst girls with sort 2 diabetes. Diabetologia. 2005;48(8):1469–1476. doi:10.1007/s00125-005-1814-3

15. Frohlich J, Dobiásová M, Adler L, et al. Gender variations in plasma ranges of lipoprotein (a) in sufferers with angiographically confirmed coronary artery illness. Physiol Res. 2004;53(5):481–486.

16. Qasim AN, Martin SS, Mehta NN, et al. Lipoprotein(a) is strongly related to coronary artery calcification in type-2 diabetic girls. Int J Cardiol. 2011;150(1):17–21. doi:10.1016/j.ijcard.2010.02.021

17. Burge MR, Eaton RP, Schade DS. The function of a coronary artery calcium scan in sort 1 diabetes. Diabetes Technol Ther. 2016;18(9):594–603. doi:10.1089/dia.2016.0110

18. Chung YH, Lee B-Ok, Kwon HM, et al. Coronary calcification is related to increased serum lipoprotein (a) ranges in asymptomatic males over the age of 45 years: a cross-sectional find out about of the Korean nationwide well being checkup information. Drugs. 2021;100(9):e24962. doi:10.1097/MD.0000000000024962

19. Sung KC, Wild SH, Byrne CD. Lipoprotein (a), metabolic syndrome and coronary calcium rating in a big occupational cohort. Nutr Metab Cardiovasc Dis. 2013;23(12):1239–1246. doi:10.1016/j.numecd.2013.02.009

20. Enas A, Varkey B, Dharmarajan TS, et al. Lipoprotein(a): an unbiased, genetic, and causal issue for heart problems and acute myocardial infarction. Indian Middle J. 2019;71(2):99–112. doi:10.1016/j.ihj.2019.03.004

21. Nathan O. Coding variation in ANGPTL4, LPL, and SVEP1 and the chance of coronary illness. N Engl J Med. 2016;374(12):1134–1144.

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