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Do Calcium Supplements Lead to an Increase in Coronary Calcification?
S28
Abstracts
Heart, Lung and Circulation 2009;18S:S1–S31
ABSTRACTS
tial mortality and morbidity. Endovascular stent-graft placement has been developed as an effective treatment modality in various diseases of descending thoracic aorta. Aortic arch pathologies have not been suitable for endovascular repair because of involvement of supraaortic vessels. The strategy of extra-anatomic bypass of arch vessels followed by deployment of endovascular stent-graft (Hybrid procedure) to treat aortic arch pathology has recently been reported. Hereby we present our experience of hybrid procedure in management of aortic arch pathologies. Methods: We have performed this procedure in three patients with acute dissection involving the aortic arch in last one year. All patients were at high risk for open repair. The first patient who had previous Bentall procedure, presented with acute type B dissection with retrograde arch extension. The second patient also presented with acute type B dissection on background history of ascending aortic interposition graft. The third patient presented with type B dissection with involvement of distal most ascending aorta. Results: All three patients survived the procedure. There were no neurological complications. One patient developed acute renal failure requiring dialysis. The postoperative course in remaining two was uneventful. During follow-up, one patient developed type 2 endoleak, which was subsequently embolised. Conclusion: Hybrid aortic arch repair is technically challenging but feasible. This novel procedure offers a less invasive approach to management of high risk surgical patients; however long-term data is needed to validate routine application of this procedure in clinical practice. doi:10.1016/j.hlc.2009.04.066 64 SCREENING FOR CARDIOVASCULAR DISEASE USING HAND-CARRIED ECHOCARDIOGRAPHY IN ASYMPTOMATIC PRIMARY CARE PATIENTS WITH TYPE 2 DIABETES MELLITUS JB Somaratne 1,2,∗ , RN Bagg 1,2 , GA Whalley 1 1 The
Doughty 1,2 , KK
Poppe 1 , W
University of Auckland, Auckland, New Zealand City Hospital, Auckland, New Zealand
2 Auckland
Background: Cardiovascular disease (CVD) is the main cause of mortality in patients with type 2 diabetes mellitus (T2DM). LV hypertrophy (LVH) contributes to this risk but current guidelines do not recommend routine CVD screening. Hand-carried echocardiography (HCE), a lowcost, portable alternative to standard echocardiography (SE), may be useful for screening patients with T2DM. We sought to determine the effectiveness of HCE for detecting CVD in primary care. Methods: To simulate a community-based screening setting, a registrar with minimal echocardiography training performed and measured a screening echo with HCE in asymptomatic patients with T2DM and no known CVD. HCE was compared with SE reported by an
experienced (>10 years) echocardiographer. Sensitivity, specificity, positive-predictive value (PPV) and negativepredictive value (NPV) were examined for detection of any CVD by SE: systolic dysfunction, E/e > 15, increased left atrial area (LAA) or LVH by ASE cut-offs. Results: 214 patients were studied: female 51%; mean age 57 years (SD11); mean BMI 32 kg/m2 (SD7); mean BP 134/81 mmHg (SD17/11); median HbA1c 7.0% (IQR 6.3–8.0). By SE, 5% had systolic dysfunction, 58% LVH [mean 51.2 g/m2.7 (SD 15.0)], 8% E/e > 15, 40% increased LAA, and 67% any CVD. Performance of HCE for any CVD: sensitivity 95%; specificity 23%; PPV 71%; NPV 70%. 58% with LVH were on ACEI. Conclusion: Screening with HCE detected most CVD, although the predictive values suggest that screening offers little benefit over SE, primarily because of the high prevalence of CVD in this population. This study may provide rationale for echocardiography in all patients with T2DM irrespective of symptoms, due to the high frequency of structural abnormalities and 40% of those with LVH not being on ACEI. doi:10.1016/j.hlc.2009.04.067 65 DO CALCIUM SUPPLEMENTS LEAD TO INCREASE IN CORONARY CALCIFICATION?
AN
N Van Pelt 1,∗ , P Ruygrok 2 , MJ Bolland 1 , GD Gamble 3 , B Mason 3 , R Ames 3 , IR Reid 3 1 Middlemore
Hospital, Auckland, New Zealand City Hospital, Auckland, New Zealand 3 University of Auckland, Auckland, New Zealand 2 Auckland
Background: Calcium supplements (Ca) are commonly used to increase bone density and reduce fracture risk. However their use has been linked with increased cardiovascular events. A potential mechanism for this is an acceleration of coronary calcification Methods: We performed a calcium score (CAC) scan, using a 64 slice CT scanner, on 163 healthy men who had taken either 1200 mg of supplemental calcium or placebo for 2 years as part of a randomized clinical trial to investigate the effect on bone density. The CAC scan was performed 1.7 years (SD 0.41) after completion of the trial Results: The mean age was 57 years (±10 years). There was no significant difference in the mean CAC between men who had taken Ca (223 Agatston Units) or placebo (238, p = 0.88). The number of men taking Ca compared with those taking placebo who had a zero calcium score was not significantly different (20 vs. 24, p = 0.54). In this study cohort, 3 men suffered a major cardiovascular event (MACE) (myocardial infarction, coronary artery bypass surgery, and percutaneous coronary intervention). The median CAC in the men who had a MACE was 1094 (1094, 2658) compared to 39 for the 160 men taking Ca or placebo with no MACE (p = 0.0063). The CAC was strongly correlated with risk of having a MACE (area under the curve 0.96, p = 0.0068).
Conclusion: Calcium supplementation was not associated with an increase in coronary calcification in healthy men. An increased calcium score was strongly associated with risk of MACE in this study cohort. doi:10.1016/j.hlc.2009.04.068 66 USE OF A MODERN IMAGING PROTOCOL FOR 64SLICE CT CARDIAC ANGIOGRAPHY RESULTS IN A SIGNIFICANT REDUCTION IN THE RADIATION DOSE RECEIVED BY PATIENTS N Van Pelt 1,5,∗ , CJ Ellis 1 , ME Legget 1 , C Edwards 1 , JA Ormiston 1 , J Christiansen 2 , H Winch 1 , M Osborne 3 , G Gamble 4,5 1 Auckland
Heart Group, Auckland, New Zealand Cardiology, Auckland, New Zealand 3 Mercy Radiology, Mercy Hospital, Auckland, New Zealand 4 Dept of Medicine, University of Auckland, New Zealand 5 Middlemore Hospital, Auckland, New Zealand 2 Waitemata
Background: Computed tomography coronary angiography (CTCA) is a powerful technique to detect coronary artery disease. Concerns regarding the total radiation dose of CTCA has led to new protocols designed to lower the dose. Methods: Using a GE Light Speed 64-slice cardiac CT scanner a new strategy to reduce the radiation dose of CTCA was applied from July 2008. In addition to electrocardiographically controlled tube current modulation, tube voltage and tube current were further reduced depending on the body mass index (BMI) of the patient. Total radiation dose was measured as the dose length product (DLP) and converted to the estimated effective radiation dose in milliSeverts (mSv) using a standard conversion factor (k = 0.014). Results: We studied 116 consecutive patients (pts)—41 before and 75 pts after the new strategy. Pts had similar demographics: with median age (52 vs 57, p = 0.030) and body mass index (BMI) (26 vs 26, p = 0.87).
Abstracts
S29 ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S31
Abstracts
Heart, Lung and Circulation 2009;18S:S1–S31
ABSTRACTS
tial mortality and morbidity. Endovascular stent-graft placement has been developed as an effective treatment modality in various diseases of descending thoracic aorta. Aortic arch pathologies have not been suitable for endovascular repair because of involvement of supraaortic vessels. The strategy of extra-anatomic bypass of arch vessels followed by deployment of endovascular stent-graft (Hybrid procedure) to treat aortic arch pathology has recently been reported. Hereby we present our experience of hybrid procedure in management of aortic arch pathologies. Methods: We have performed this procedure in three patients with acute dissection involving the aortic arch in last one year. All patients were at high risk for open repair. The first patient who had previous Bentall procedure, presented with acute type B dissection with retrograde arch extension. The second patient also presented with acute type B dissection on background history of ascending aortic interposition graft. The third patient presented with type B dissection with involvement of distal most ascending aorta. Results: All three patients survived the procedure. There were no neurological complications. One patient developed acute renal failure requiring dialysis. The postoperative course in remaining two was uneventful. During follow-up, one patient developed type 2 endoleak, which was subsequently embolised. Conclusion: Hybrid aortic arch repair is technically challenging but feasible. This novel procedure offers a less invasive approach to management of high risk surgical patients; however long-term data is needed to validate routine application of this procedure in clinical practice. doi:10.1016/j.hlc.2009.04.066 64 SCREENING FOR CARDIOVASCULAR DISEASE USING HAND-CARRIED ECHOCARDIOGRAPHY IN ASYMPTOMATIC PRIMARY CARE PATIENTS WITH TYPE 2 DIABETES MELLITUS JB Somaratne 1,2,∗ , RN Bagg 1,2 , GA Whalley 1 1 The
Doughty 1,2 , KK
Poppe 1 , W
University of Auckland, Auckland, New Zealand City Hospital, Auckland, New Zealand
2 Auckland
Background: Cardiovascular disease (CVD) is the main cause of mortality in patients with type 2 diabetes mellitus (T2DM). LV hypertrophy (LVH) contributes to this risk but current guidelines do not recommend routine CVD screening. Hand-carried echocardiography (HCE), a lowcost, portable alternative to standard echocardiography (SE), may be useful for screening patients with T2DM. We sought to determine the effectiveness of HCE for detecting CVD in primary care. Methods: To simulate a community-based screening setting, a registrar with minimal echocardiography training performed and measured a screening echo with HCE in asymptomatic patients with T2DM and no known CVD. HCE was compared with SE reported by an
experienced (>10 years) echocardiographer. Sensitivity, specificity, positive-predictive value (PPV) and negativepredictive value (NPV) were examined for detection of any CVD by SE: systolic dysfunction, E/e > 15, increased left atrial area (LAA) or LVH by ASE cut-offs. Results: 214 patients were studied: female 51%; mean age 57 years (SD11); mean BMI 32 kg/m2 (SD7); mean BP 134/81 mmHg (SD17/11); median HbA1c 7.0% (IQR 6.3–8.0). By SE, 5% had systolic dysfunction, 58% LVH [mean 51.2 g/m2.7 (SD 15.0)], 8% E/e > 15, 40% increased LAA, and 67% any CVD. Performance of HCE for any CVD: sensitivity 95%; specificity 23%; PPV 71%; NPV 70%. 58% with LVH were on ACEI. Conclusion: Screening with HCE detected most CVD, although the predictive values suggest that screening offers little benefit over SE, primarily because of the high prevalence of CVD in this population. This study may provide rationale for echocardiography in all patients with T2DM irrespective of symptoms, due to the high frequency of structural abnormalities and 40% of those with LVH not being on ACEI. doi:10.1016/j.hlc.2009.04.067 65 DO CALCIUM SUPPLEMENTS LEAD TO INCREASE IN CORONARY CALCIFICATION?
AN
N Van Pelt 1,∗ , P Ruygrok 2 , MJ Bolland 1 , GD Gamble 3 , B Mason 3 , R Ames 3 , IR Reid 3 1 Middlemore
Hospital, Auckland, New Zealand City Hospital, Auckland, New Zealand 3 University of Auckland, Auckland, New Zealand 2 Auckland
Background: Calcium supplements (Ca) are commonly used to increase bone density and reduce fracture risk. However their use has been linked with increased cardiovascular events. A potential mechanism for this is an acceleration of coronary calcification Methods: We performed a calcium score (CAC) scan, using a 64 slice CT scanner, on 163 healthy men who had taken either 1200 mg of supplemental calcium or placebo for 2 years as part of a randomized clinical trial to investigate the effect on bone density. The CAC scan was performed 1.7 years (SD 0.41) after completion of the trial Results: The mean age was 57 years (±10 years). There was no significant difference in the mean CAC between men who had taken Ca (223 Agatston Units) or placebo (238, p = 0.88). The number of men taking Ca compared with those taking placebo who had a zero calcium score was not significantly different (20 vs. 24, p = 0.54). In this study cohort, 3 men suffered a major cardiovascular event (MACE) (myocardial infarction, coronary artery bypass surgery, and percutaneous coronary intervention). The median CAC in the men who had a MACE was 1094 (1094, 2658) compared to 39 for the 160 men taking Ca or placebo with no MACE (p = 0.0063). The CAC was strongly correlated with risk of having a MACE (area under the curve 0.96, p = 0.0068).
Conclusion: Calcium supplementation was not associated with an increase in coronary calcification in healthy men. An increased calcium score was strongly associated with risk of MACE in this study cohort. doi:10.1016/j.hlc.2009.04.068 66 USE OF A MODERN IMAGING PROTOCOL FOR 64SLICE CT CARDIAC ANGIOGRAPHY RESULTS IN A SIGNIFICANT REDUCTION IN THE RADIATION DOSE RECEIVED BY PATIENTS N Van Pelt 1,5,∗ , CJ Ellis 1 , ME Legget 1 , C Edwards 1 , JA Ormiston 1 , J Christiansen 2 , H Winch 1 , M Osborne 3 , G Gamble 4,5 1 Auckland
Heart Group, Auckland, New Zealand Cardiology, Auckland, New Zealand 3 Mercy Radiology, Mercy Hospital, Auckland, New Zealand 4 Dept of Medicine, University of Auckland, New Zealand 5 Middlemore Hospital, Auckland, New Zealand 2 Waitemata
Background: Computed tomography coronary angiography (CTCA) is a powerful technique to detect coronary artery disease. Concerns regarding the total radiation dose of CTCA has led to new protocols designed to lower the dose. Methods: Using a GE Light Speed 64-slice cardiac CT scanner a new strategy to reduce the radiation dose of CTCA was applied from July 2008. In addition to electrocardiographically controlled tube current modulation, tube voltage and tube current were further reduced depending on the body mass index (BMI) of the patient. Total radiation dose was measured as the dose length product (DLP) and converted to the estimated effective radiation dose in milliSeverts (mSv) using a standard conversion factor (k = 0.014). Results: We studied 116 consecutive patients (pts)—41 before and 75 pts after the new strategy. Pts had similar demographics: with median age (52 vs 57, p = 0.030) and body mass index (BMI) (26 vs 26, p = 0.87).
Abstracts
S29 ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S31