Kostní metabolismus u chronického onemocnění ledvin (CKD) je dán kombinací renální osteodystrofie a změn ve smyslu sekundární osteoporózy. Souhrnně je označován jako minerálová a kostní choroba (MBD-CKD), která je definována přítomností alespoň jednoho ze tří kritérií: abnormálním metabolismem kalcia, fosforu, iPTH a vitamínu D, renální osteopatií a/nebo výskytem cévních kalcifikací. Samotné chronické onemocnění ledvin je spojeno s vysokou kardiovaskulární úmrtností mnohonásobně převyšující mortalitu populace bez renálního postižení, kterou nelze vysvětlit pouhou přítomností klasických komorbidit a rizikových faktorů. Hlavní součásti léčby MBD-CKD zasahují nejen do jednotlivých složek této poruchy, ale i do jednotlivých patogenetických mechanismů a aktuálně se mění podle stupně poruchy renální funkce.

Bone metabolism in chronic renal failure (CKD) is characterized by a combination of renal osteodystrophy and changes in secondary osteoporosis, which is collectively referred to as mineral and bone disease (MBD-CKD) and is defined by the presence of at least one of the three criteria: abnormal calcium, phosphorus, iPTH and vitamin D metabolism, renal osteopathy and / or vascular calcifications. Chronic kidney disease alone is associated with high cardiovascular mortality, many times greater than the mortality of the population without renal impairment, which cannot be explained by the mere presence of classical comorbidities and risk factors. The main components of MBD-CKD treatment affect not only the individual components of this disorder, but also the individual pathogenetic mechanisms and currently vary according to the degree of renal dysfunction.

• MeSH
• Renal Insufficiency, Chronic complications   physiopathology   MeSH
• Fibroblast Growth Factors MeSH
• Bone and Bones * anatomy & histology   cytology   metabolism   physiopathology   MeSH
• Humans MeSH
• RANK Ligand MeSH
• Bone Diseases, Metabolic etiology   physiopathology   MeSH
• Chronic Kidney Disease-Mineral and Bone Disorder * diagnosis   drug therapy   complications   pathology   therapy   MeSH
• Osteoporosis etiology   MeSH
• Parathyroid Hormone physiology   MeSH
• Heart Disease Risk Factors MeSH
• Vascular Calcification diagnostic imaging   etiology   pathology   MeSH
• Vitamin D therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

OBJECTIVE: The aim of the study was to test the potential role of breast arterial calcification (BAC) in the prediction of coronary artery disease (CAD) in women. The criterion standard for CAD diagnostics was coronary angiography. METHODS: This retrospective study enrolled 163 consecutive women, who underwent digital mammography and coronary angiography in our hospital. We assessed the presence and severity of BAC, and tested whether the presence and/or extent of BAC could be a predictor for CAD, quantified by Gensini score. RESULTS: BAC was presented in 34 patients (21%). Neither the presence of CAD (17 patients, 50%, vs 55 42.6%, P = 0.44), nor the Gensini score (20.5 ± 29.7 vs 15.4 ± 24.1, P = 0.3) differed significantly between BAC-present and BAC-absent patients.A finding of triple-vessel disease, however, more frequently occurred in the BAC-present (seven patients, 20.6%) than in the BAC-absent (nine patients, 7%) group, odds ratio (OR) 3.1, 95% CI 1-9.5, P = 0.049. The presence of BAC did not significantly increase the odds for the presence of CAD (OR = 1.29, P = 0.54). Among the subgroup of patients with CAD, BAC presence was associated with triple vessel disease (OR = 3.34, P = 0.049). CONCLUSIONS: We did not confirm BAC as a predictor of CAD. However, BAC showed association with more severe forms of coronary atherosclerosis (triple vessel disease).

• MeSH
• Early Detection of Cancer MeSH
• Coronary Angiography MeSH
• Humans MeSH
• Mammography MeSH
• Breast Neoplasms * diagnostic imaging   MeSH
• Coronary Artery Disease * diagnostic imaging   MeSH
• Predictive Value of Tests MeSH
• Breast diagnostic imaging   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Vascular Calcification * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Management of calcified coronary lesions remains challenging, with frequent stent underexpansion and suboptimal results, which lead to early and late stent failure. Appropriate lesion preparation and optimal stent expansion are the keys to prevent stent failure. We present an unusual case of extensive sever right coronary artery calcified stenosis, in which both rotational atherectomy (RA) and non-compliant balloons failed to dilate the lesion and finally the Shockwave lithotripsy balloon offered optimal lesion dilation and successful stent deployment. Furthermore, optical coherence tomography provided mechanistic insight into the differential effect of Shockwave balloon versus RA for extensively calcified lesions.

• MeSH
• Atherectomy, Coronary * MeSH
• Humans MeSH
• Lithotripsy * MeSH
• Coronary Artery Disease * diagnosis   surgery   MeSH
• Tomography, Optical Coherence MeSH
• Vascular Calcification * diagnostic imaging   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Transcatheter aortic valve implantation (TAVI) is a well-established management option for symptomatic patients with severe aortic stenosis. The minimally invasive transfemoral approach is considered to be superior to non-transfemoral accesses; however, its use is often limited by concomitant peripheral artery disease (PAD). Percutaneous transluminal angioplasty with stent implantation (PTA) is a gold-standard therapy for symptomatic PAD. We present 2 cases from our cohort of patients with severe aortic stenosis and PAD previously contraindicated for TAVI because of poor peripheral vascular access. However, the patients were eventually treated either by staged PTA and TAVI through an endothelialized stent or PTA and TAVI though a newly implanted peripheral stent during one procedure. We provide recommendations based on our experience of how to select the optimal patients for such a combined minimally invasive transfemoral approach (Fig. 2, Ref. 9).

• MeSH
• Angiography MeSH
• Angioplasty methods   MeSH
• Aortic Valve Stenosis surgery   MeSH
• Angioplasty, Balloon methods   MeSH
• Humans MeSH
• Peripheral Arterial Disease * surgery   diagnostic imaging   MeSH
• Tomography, X-Ray Computed MeSH
• Aged MeSH
• Stents MeSH
• Transcatheter Aortic Valve Replacement * methods   MeSH
• Vascular Calcification diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: Coronary arterial plaques in patients with end-stage renal disease (ESRD) are assumed to have increased calcification due to underlying renal disease or initiation of dialysis. This relationship may be confounded by comorbid type 2 diabetes mellitus (DM). METHODS: From a single-center OCT registry, 60 patients were analyzed. Twenty patients with ESRD and diabetes (ESRD-DM) were compared to 2 groups of non-ESRD patients: 20 with and 20 without diabetes. In each patient, one 20 mm segment within the culprit vessel was analyzed. RESULTS: ESRD-DM patients exhibited similar calcium burden, arc, and area compared to patients with diabetes alone. When compared to patients without diabetes, patients with diabetes exhibited a greater summed area of calcium (DM: Median 9.0, IQR [5.3-28] mm2 vs Non-DM: 3.5 [0.1-14] mm2, p = 0.04) and larger calcium deposits by arc (DM: Mean 45 ± SE 6.2° vs Non-DM: 21 ± 6.2°, p = 0.01) and area (DM: 0.58 ± 0.10 mm2 vs Non-DM: 0.26 ± 0.10 mm2, p = 0.03). Calcification deposits in ESRD-DM patients (0.14 ± 0.02 mm) and patients with diabetes (0.14 ± 0.02 mm) were more superficially located relative to patients without diabetes (0.21 ± 0.02 mm), p = 0.01 for both. CONCLUSIONS: Coronary calcification in DM and ESRD-DM groups exhibited similar burden, deposit size, and depth within the arterial wall. The increase in coronary calcification and cardiovascular disease events seen in ESRD-DM patients may not be secondary to ESRD and dialysis, but instead due to a combination of declining renal function and diabetes.

• MeSH
• Plaque, Atherosclerotic * MeSH
• Kidney Failure, Chronic complications   diagnosis   therapy   MeSH
• Diabetes Mellitus, Type 2 complications   diagnosis   MeSH
• Renal Dialysis MeSH
• Middle Aged MeSH
• Humans MeSH
• Coronary Artery Disease diagnostic imaging   etiology   MeSH
• Tomography, Optical Coherence * MeSH
• Predictive Value of Tests MeSH
• Registries MeSH
• Retrospective Studies MeSH
• Heart Disease Risk Factors MeSH
• Aged MeSH
• Vascular Calcification diagnostic imaging   etiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Comparative Study MeSH

BACKGROUND Determination of prognosis based on ischemia detection, using single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), can be challenging in patients with multiple affected coronary arteries. AIMS The aim of the study was to examine the outcomes of SPECT-MPI combined with the coronary artery calcium score (CACS) to identify predictors of adverse cardiac events (ACEs) in patients for whom ischemia detection may be difficult using SPECT-MPI. METHODS The study group included 195 patients with a history of chronic kidney disease, suspected ischemic cardiomyopathy, or left bundle branch block. All patients underwent SPECT-MPI and CACS evaluation. During the follow-up, ACEs were recorded. Perfusion and functional parameters as well as the CACS were analyzed to find the predictors of ACEs. RESULTS The ACEs were recorded in 58 individuals (29.7%) and were significantly associated with ischemia (P <0.001), abnormal functional parameters (P = 0.04), and higher CACSs (P <0.001). The optimal cutoff value of the CACS to predict an ACE was 530. Cox proportional hazards models revealed that age, mild and severe ischemia, functional abnormalities, and a CACS of 530 or higher were significant predictors of ACEs. In the subgroup of individuals without ischemia, a CACS of 530 or higher was significantly associated with poor outcome, while we recorded only 3 ACEs in these patients when the CACS was lower than 530. CONCLUSIONS The addition of the CACS to SPECT-MPI improves the identification of patients at higher risk for ACEs, even in individuals for whom SPECT-MPI is challenging.

• MeSH
• Kidney Failure, Chronic complications   MeSH
• Myocardial Ischemia complications   diagnosis   diagnostic imaging   MeSH
• Tomography, Emission-Computed, Single-Photon MeSH
• Coronary Vessels diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Multidetector Computed Tomography * MeSH
• Prognosis MeSH
• Proportional Hazards Models MeSH
• Aged MeSH
• Vascular Calcification complications   diagnosis   diagnostic imaging   MeSH
• Myocardial Perfusion Imaging * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Calcium deposits in the aortic valve and mitral annulus have been associated with cardiovascular events and mortality. However, there is no accepted standard method for scoring such cardiac calcifications, and most existing methods are simplistic. The aim of this study was to test the hypothesis that a semiquantitative score, one that accounts for all visible calcium on echocardiography, could predict all-cause mortality and stroke in a graded fashion. METHODS: This was a retrospective study of 443 unselected subjects derived from a general echocardiography database. A global cardiac calcium score (GCCS) was applied that assigned points for calcification in the aortic root and valve, mitral annulus and valve, and submitral apparatus, and points for restricted leaflet mobility. The primary outcome was all-cause mortality, and the secondary outcome was stroke. RESULTS: Over a mean 3.8 ± 1.7 years of follow-up, there were 116 deaths and 34 strokes. Crude mortality increased in a graded fashion with increasing GCCS. In unadjusted proportional hazard analysis, the GCCS was significantly associated with total mortality (hazard ratio, 1.26; 95% CI, 1.17-1.35; P < .0001) and stroke (hazard ratio, 1.23; 95% CI, 1.07-1.40; P = .003). After adjusting for demographic and clinical factors (age, gender, body mass index, diabetes, hypertension, dyslipidemia, smoking, family history of coronary disease, chronic kidney disease, history of atrial fibrillation, and history of stroke), these associations remained significant. CONCLUSIONS: The GCCS is easily applied to routinely acquired echocardiograms and has clinically significant associations with total mortality and stroke.

• MeSH
• Stroke diagnostic imaging   mortality   MeSH
• Echocardiography methods   statistics & numerical data   MeSH
• Incidence MeSH
• Cardiomyopathies diagnostic imaging   mortality   MeSH
• Causality MeSH
• Comorbidity MeSH
• Middle Aged MeSH
• Humans MeSH
• Survival Rate MeSH
• Observer Variation MeSH
• Reproducibility of Results MeSH
• Risk Factors MeSH
• Sex Distribution MeSH
• Sensitivity and Specificity MeSH
• Vascular Calcification diagnostic imaging   mortality   MeSH
• Age Distribution MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Pennsylvania epidemiology   MeSH