Dataset Information

Prognostic value of Toll-like receptor 4 on human monocyte subsets combined with computed tomography-adapted Leaman score assessing coronary artery disease.

ABSTRACT:

Background

Upregulation of Toll-like receptor 4 (TLR-4) is associated with coronary plaque vulnerability assessed by coronary computed tomography angiography (CCTA). Computed tomography-adapted Leaman score (CT-LeSc) is an independent long-term predictor of cardiac events. The relationship between the TLR-4 expression of CD14 ++ CD16 + monocytes and future cardiac events is unknown. We investigated this relationship using CT-LeSc in patients with coronary artery disease (CAD).

Methods

We analyzed 61 patients with CAD who underwent CCTA. Three monocyte subsets (CD14 ++ CD16 - , CD14 ++ CD16 + , and CD14 + CD16 + ) and the expression of TLR-4 were measured by flow cytometry. We divided the patients into two groups according to the best cutoff value of the TLR-4 expression on CD14 + CD16 + which could predict future cardiac events.

Results

CT-LeSc was significantly greater in the high TLR-4 group than the low TLR-4 group [9.61 (6.70-13.67) vs. 6.34 (4.27-9.09), P < 0.01]. The expression of TLR-4 on CD14 ++ CD16 + monocytes was significantly correlated with CT-LeSc ( R2 = 0.13, P < 0.01). The expression of TLR-4 on CD14 ++ CD16 + monocytes was significantly higher in patients who had future cardiac events than in those who did not [6.8 (4.5-9.1) % vs. 4.2 (2.4-7.6) %, P = 0.04]. High TLR-4 expression on CD14 ++ CD16 + monocytes was an independent predictor for future cardiac events ( P = 0.01).

Conclusion

An increase in the TLR-4 expression on CD14 ++ CD16 + monocytes is related to the development of future cardiac events.

SUBMITTER: Ozaki Y

PROVIDER: S-EPMC10309091 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Prognostic value of Toll-like receptor 4 on human monocyte subsets combined with computed tomography-adapted Leaman score assessing coronary artery disease.

Ozaki Yuichi Y Kashiwagi Manabu M Imanishi Toshio T Katayama Yosuke Y Taruya Akira A Nishiguchi Tsuyoshi T Shiono Yasutsugu Y Kuroi Akio A Yamano Takashi T Tanimoto Takashi T Kitabata Hironori H Tanaka Atsushi A

Coronary artery disease 20230524 5

<h4>Background</h4>Upregulation of Toll-like receptor 4 (TLR-4) is associated with coronary plaque vulnerability assessed by coronary computed tomography angiography (CCTA). Computed tomography-adapted Leaman score (CT-LeSc) is an independent long-term predictor of cardiac events. The relationship between the TLR-4 expression of CD14 ++ CD16 + monocytes and future cardiac events is unknown. We investigated this relationship using CT-LeSc in patients with coronary artery disease (CAD).<h4>Methods ...[more]

PMID: 37222220

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Project description:BackgroundCoronary computed tomographic angiography (CCTA) facilitates comprehensive evaluation of coronary artery disease (CAD), including plaque characterization, and can provide additive diagnostic value to single-photon emission computed tomography (SPECT). However, data regarding the incremental prognostic value of CCTA to SPECT remain sparse. We evaluated the independent and incremental prognostic value of CCTA, as compared with clinical risk factors and SPECT.Materials and methodsA total of 1,077 patients with suspected CAD who underwent both SPECT and cardiac CT between 2004 and 2012 were enrolled retrospectively. Presence of reversible or fixed perfusion defect (PD) and summed stress score were evaluated on SPECT. Presence, extent of coronary atherosclerosis and diameter stenosis (DS) were evaluated on CCTA. Plaque composition was categorized as non-calcified, mixed, or calcified according to the volume of calcified component (>130 Hounsfield Units). Patients were followed up for the occurrence of adverse cardiac events including cardiac death, non-fatal myocardial infarction, unstable angina, and late revascularization (>90 days after imaging studies).ResultsDuring follow-up (median 23 months), adverse cardiac events were observed in 71 patients (6.6%). When adjusted for clinical risk factors and SPECT findings, the presence of any coronary plaque, any plaque in ≥3 segments, coronary artery calcium score (CACS) ≥400, a plaque ≥50% DS, presence of non-calcified plaque (NCP) or mixed plaque (MP), and NCP/MP in ≥2 segments were independent predictors of adverse cardiac events; however, the presence of calcified plaque (CP) was not. Conventional CCTA findings, including CACS ≥400 and a plaque ≥50% DS, demonstrated incremental prognostic value over clinical risk factors and SPECT (χ² 54.19 to 101.03; p <0.001). Addition of NCP/MP in ≥2 segments resulted in further significantly improved prediction (χ² 101.03 to 113.29; p <0.001).ConclusionComprehensive CCTA evaluation of coronary atherosclerosis provides independent and incremental prognostic value in relation to SPECT evaluation of myocardial ischemia. Specifically, segmentally-analyzed plaque composition with CCTA provides further risk stratification in addition to CACS and DS.

Project description:The current standard for measuring coronary artery calcification to determine the extent of atherosclerosis is by calculating the Agatston score from computed tomography (CT). However, the Agatston score disregards pixel values less than 130 Hounsfield Units (HU) and calcium regions less than 1 mm2. Due to this thresholding, the score is not sensitive to small, weakly attenuating regions of calcium deposition and may not detect nascent micro-calcification. A recently proposed metric called the spatially weighted calcium score (SWCS) also utilizes CT but does not include a threshold for HU and does not require elevated signals in contiguous pixels. Thus, the SWCS is sensitive to weakly attenuating, smaller calcium deposits and may improve the measurement of coronary heart disease risk. Currently, the SWCS is underutilized owing to the added computational complexity. To promote translation of the SWCS into clinical research and reliable, repeatable computation of the score, the aim of this study was to develop a semi-automatic graphical tool that calculates both the SWCS and the Agatston score. The program requires gated cardiac CT scans with a calcium hydroxyapatite phantom in the field of view. The phantom allows for deriving a weighting function, from which each pixel's weight is adjusted, allowing for the mitigation of signal variations and variability between scans. With all three anatomical views visible simultaneously, the user traces the course of the four main coronary arteries by placing points or regions of interest. Features such as scroll-to-zoom, double-click to delete, and brightness/contrast adjustment, along with written guidance at every step, make the program user-friendly and easy to use. Once tracing the arteries is complete, the program generates reports, which include the scores and snapshots of any visible calcium. The SWCS may reveal the presence of subclinical disease, which may be used for early intervention and lifestyle changes.

Project description:PurposeAn important aspect in the prevention and treatment of coronary artery disease is the functional evaluation of narrowed blood vessels. Medical image-based Computational Fluid Dynamic methods are currently increasingly being used in the clinical setting for flow studies of cardio vascular system. The aim of our study was to confirm the feasibility and functionality of a non-invasive computational method providing information about hemodynamic significance of coronary stenosis.MethodsA comparative method was used to simulate the flow energy losses in real (stenotic) and reconstructed models without (reference) stenosis of the coronary arteries under stress test conditions, i.e. for maximum blood flow and minimal, constant vascular resistance. In addition to the absolute pressure drop in the stenotic arteries (FFRsten) and in the reconstructed arteries (FFRrec), a new energy flow reference index (EFR) was also defined, which expresses the total pressure changes caused by stenosis in relation to the pressure changes in normal coronary arteries, which also allows a separate assessment of the haemodynamic significance of the atherosclerotic lesion itself. The article presents the results obtained from flow simulations in coronary arteries, reconstructed on the basis of 3D segmentation of cardiac CT images of 25 patients from retrospective data collection, with different degrees of stenoses and different areas of their occurrence.ResultsThe greater the degree of narrowing of the vessel, the greater drop of flow energy. Each parameter introduces an additional diagnostic value. In contrast to FFRsten, the EFR indices that are calculated on the basis of a comparison of stenosed and reconstructed models, are associated directly with localization, shape and geometry of stenosis only. Both FFRsten and EFR showed very significant positive correlation (P < 0.0001) with coronary CT angiography-derived FFR, with a correlation coefficient of 0.8805 and 0.9011 respectively.ConclusionThe study presented promising results of non-invasive, comparative test to support of prevention of coronary disease and functional evaluation of stenosed vessels.

Project description:BackgroundIt is unclear whether the parameters derived from coronary computed tomography angiography (CCTA) can identify the impairments of coronary arteries and if they are associated with major adverse cardiovascular events (MACEs) in patients with thoracic malignancies receiving chemotherapy or chemoradiotherapy. This study aimed to investigate the longitudinal changes in coronary arteries using CCTA and to determine their association with MACEs in patients with thoracic malignancies receiving chemotherapy or chemoradiotherapy.MethodsThis cross-sectional study included consecutive patients with thoracic malignancies who received chemotherapy or chemoradiotherapy and who underwent CCTA between June 2013 and May 2019 at Chongqing University Cancer Hospital. The pericoronary fat attenuation index (FAI) of three main coronary arteries before and after chemotherapy or chemoradiotherapy were assessed. The association between CCTA parameters and MACEs was evaluated via the Cox proportional hazards model. Kaplan-Meier survival curves were drawn to compare the MACE-free survival rates.ResultsA total of 1,543 patients were enrolled, 232 of whom developed MACEs. Among the patients, 41.3% were male, and the median age was 67.00 years (interquartile range 56.00-72.00 years). The FAI values were significantly increased after chemotherapy or chemoradiotherapy (all P values <0.05). After treatment, the FAI values were higher in the chemoradiotherapy group than in the chemotherapy group. MACEs were associated with the FAI values before chemotherapy in the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) [LAD: hazard ratio (HR) =3.745, 95% confidence interval (CI): 1.193-11.756, P=0.023; LCX: HR =3.460, 95% CI: 1.092-10.832, P=0.031; RCA: HR =4.175, 95% CI: 1.375-12.673, P=0.011] and chemoradiotherapy (LAD: HR =2.856, 95% CI: 1.210-6.742, P=0.016; LCX: HR =2.385, 95% CI: 1.037-5.487; P=0.040; RCA: HR =2.029, 95% CI: 1.074-3.834, P=0.029).ConclusionsThe FAI derived from CCTA, as an imaging biomarker of coronary arterial inflammation, was able to characterize coronary arterial impairment, and the FAI at baseline was associated with MACEs in patients with thoracic malignancies receiving chemotherapy or chemoradiotherapy.

Project description:BackgroundDue to the increasing incidence of ischaemic cerebrovascular diseases, the accurate assessment of internal carotid artery (ICA) stenosis is crucial for the development of treatment plans. This systematic review and meta-analysis aimed to evaluate the diagnostic value of computed tomography angiography (CTA) for severe ICAstenosis, thereby providing support for clinical decision-making and promoting diagnostic updates.MethodsThe PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals (VIP), and Chinese Biomedical Literature (CBM) electronic databases were searched from inception to March 21, 2024, to identify publicly available research literature on the use of CTA to diagnose severe ICA stenosis. Literature screening, data extraction, and quality assessment were conducted based on the inclusion and exclusion criteria as well as the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) standards. Data analysis was performed using Stata 17.0 and Meta-Disc 1.4 software. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies were calculated using Stata 17.0 software, and forest plots and summary receiver operating characteristic (SROC) curves were generated. The area under the curve (AUC) was calculated, and funnel plots were constructed to assess publication bias.ResultsA total of 16 studies with 2368 vascular segments were included. The meta-analysis revealed that the combined sensitivity and specificity of CTA for severe ICA stenosis were 0.93 (95% CI: 0.88 ~ 0.96) and 0.99 (95% CI: 0.96 ~ 1.00), respectively. The combined positive likelihood ratio and negative likelihood ratio were 92.0 (95% CI: 24.2 ~ 349.6) and 0.07 (95% CI: 0.04 ~ 0.13), respectively. The diagnostic odds ratio was 1302 (95% CI: 257 ~ 6606), and the AUC of the SROC curve was 0.98. The Deeks funnel plot suggested no publication bias among the included studies.ConclusionCTA demonstrated high sensitivity and specificity for diagnosing severe ICA stenosis. Therefore, this study provided important evidence for the accurate diagnosis and treatment of severe ICA stenosis. However, there was considerable heterogeneity among the included studies, thus indicating the need for additional high-quality prospective studies to confirm the clinical applicability of CTA.

Dataset Information

Prognostic value of Toll-like receptor 4 on human monocyte subsets combined with computed tomography-adapted Leaman score assessing coronary artery disease.

Background

Methods

Results

Conclusion

Publications

Prognostic value of Toll-like receptor 4 on human monocyte subsets combined with computed tomography-adapted Leaman score assessing coronary artery disease.

Similar Datasets

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