Search PubMed⌕ Search

Biomedical subjects

R Detrano

Publications and source records attributed to R Detrano.

At least 19 recordsLinked to original sources
PubMed2004

Validation of thoracic quantitative computed tomography as a method to measure bone mineral density.

The purpose of this study was to measure precision of thoracic quantitative computed tomography (QCT) bone mineral density (BMD) and correlation to lumbar spine QCT bone density. We measured the reproducibility of thoracic QCT; two consecutive thoracic QCT scans of the T9, T10, and T11 vertebrae were performed on 95 subjects (49 females, 46 males; mean age, 62.5 years) undergoing coronary scanning. In order to correlate the thoracic to standard lumbar measurement, the subjects also underwent a lumbar QCT scan of the L1, L2, and L3 vertebrae as part of an abdominal aortic scanning study. The variation of thoracic BMD was assessed in different ethnic subgroups. Consecutive thoracic QCT measurements showed good agreement (r=0.98; RMS CV=5.78%). Thoracic bone density was significantly higher than lumbar bone density results (paired t-test, P=0.003), but the two methods correlated well (r=0.86). The regression equation for the relationship between lumbar (X) and thoracic (Y) QCT was Y=0.87X + 22.97. The standard error of estimate was 19.0 mg/cm3. Thoracic QCT from coronary calcium thoracic scans is able to measure BMD with rescan precision and regression errors that are small compared to the biologic variability in the population. Given the relatively small precision error and the reasonable correlation to lumbar BMD, an ancillary assessment of thoracic BMD in a cardiac scan is likely to be a useful assessment of bone mineral status in the general population.

Bone Density↗
PubMed1997

Active serum vitamin D levels are inversely correlated with coronary calcification.

BACKGROUND: Arterial calcification is a common feature of atherosclerosis, occurring in >90% of angiographically significant lesions. Recent evidence from this and other studies suggests that development of atherosclerotic calcification is similar to osteogenesis; thus, we undertook the current investigation on the potential role of osteoregulatory factors in arterial calcification. METHODS AND RESULTS: We studied two human populations (173 subjects) at high and moderate risk for coronary heart disease and assessed them for associations between vascular calcification and serum levels of the osteoregulatory molecules osteocalcin, parathyroid hormone, and 1alpha,25-dihydroxyvitamin D3 (1,25-vitamin D). Our results revealed that 1,25-vitamin D levels are inversely correlated with the extent of vascular calcification in both groups. No correlations were found between extent of calcification and levels of osteocalcin or parathyroid hormone. CONCLUSIONS: These data suggest a possible role for vitamin D in the development of vascular calcification. Vitamin D is also known to be important in bone mineralization; thus, 1,25-vitamin D may be one factor to explain the long observed association between osteoporosis and vascular calcification.

Adult↗
PubMed1997

Electron beam computed tomographic coronary calcium as a predictor of coronary events: comparison of two protocols.

BACKGROUND: We assessed the accuracy of two electron beam computed tomography (EBCT) protocols for predicting coronary events. METHODS AND RESULTS: In 1994, 24 months after enrollment in a longitudinal study, 326 high-risk adults underwent both 3- and 6-mm image-slice thickness EBCT scanning and were followed up for 32.0+/-4.0 additional months. Events were defined as either coronary death, myocardial infarction, or revascularization. We monitored these subjects for the 32-month postscanning period with yearly phone calls and acquisition of records for all hospital admissions. At the time of scanning, 11 subjects (3%) had already suffered 12 events (5 infarctions and 7 revascularizations) during the 24-month prescanning period. During the postscanning period, 18 subjects (6%) suffered 23 events (5 coronary deaths, 6 infarctions, and 12 revascularizations). Thus, 28 subjects (9%) suffered 35 events. Calcium quantities calculated for both protocols, performed on the same subjects, were sorted in ascending order and divided into equal quartiles. When revascularizations were included, there was a significant trend toward higher frequencies of events with increasing calcium quantity (P<.01). However, coronary death and infarction were not significantly more frequent in higher quartiles. These relationships were preserved in the subjects without prior events at the time of scanning. CONCLUSIONS: Calcium quantities from the 3-mm and the more reproducible 6-mm scanning are equally accurate for predicting events. Coronary calcium amount appears to be a weak predictor of coronary death and infarction. Its predictive accuracy is superior for predicting revascularization.

Aged↗
PubMed1996

Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography.

OBJECTIVES: This investigation sought to determine the relative prognostic value of coronary calcific deposits and coronary angiographic findings for predicting coronary heart disease-related events in patients referred for angiography. BACKGROUND: The relation among coronary calcification, coronary stenoses and coronary heart disease-related events is of interest on a clinical as well as a pathophysiologic basis. METHODS: Four hundred ninety-one symptomatic patients underwent coronary angiography and electron beam computed tomography at five different centers between April 1989 and December 1993. The electron beam computed tomograms were interpreted by a cardiologist with no knowledge of the coronary angiographic and clinical data. Receiver operating characteristic (ROC) curves were constructed to determine the relation between electron beam computed tomographic and coronary angiographic findings. A follow-up telephone survey was completed in 86% of patients. The records for all patients who died or were admitted to the hospital for chest pain or suspected myocardial infarction were reviewed by three other cardiologists with no knowledge of the coronary angiographic and electron beam computed tomographic study results. RESULTS: The mean (+/- SE) area under the ROC curve was 0.75 +/- 0.02 for the coronary calcium score, indicating moderate discriminatory power for this score for predicting angiographic findings. Thirteen coronary heart disease-related deaths and eight nonfatal acute infarctions occurred over 30 +/- 13 months. Scores were sorted in ascending order and divided into quartiles of equal size. One patient in the first quartile had a fatal myocardial infarction (coronary calcium score range 0 to 2.1); 2 in the second quartile (range 2.1 to 75.3), 8 in the third quartile (range 75.3 to 397.1) and 10 in the fourth quartile (> 397.1) had a coronary heart disease-related event. Application of bivariate logistic regression showed that log score but not number of angiographically diseased vessels significantly predicted the probability of a coronary heart disease-related event occurring during follow-up. CONCLUSIONS: Electron beam computed tomographic calcium scores correlate moderately well with angiographic findings. These scores predict coronary heart disease-related events in patients undergoing angiography as well as do the number of angiographically affected arteries.

Calcinosis↗
PubMed1996

In vitro atherosclerotic plaque and calcium quantitation by intravascular ultrasound and electron-beam computed tomography.

The purpose of this investigation was to compare the accuracy of intravascular ultrasound (IVUS) and electron-beam computed tomography (EBCT) in quantitating human atherosclerotic plaque and calcium. In experiment 1, 12 human atherosclerotic arterial segments were obtained at autopsy and imaged by using IVUS and EBCT. The plaque from each arterial segment was dissected and a volume measurement of the dissected plaque was obtained by water displacement. The plaque from each arterial segment was ashed at 700 degrees F, and the weight of the remaining ashes was used as an estimate of the calcium mass. In experiment II, 11 calcified arterial segments were obtained at autopsy and imaged by using IVUS at one site along the artery. A corresponding histologic cross section stained with Masson's trichrome was prepared. In experiment I, the mean plaque volume measured by water displacement was 165.3 +/- 118.4 microliters. The mean plaque volume calculated by IVUS was 166.1 +/- 114.4 microliters and correlated closely with that by water displacement (r = 0.98, p < 0.0001). The mean calcium mass measured by ashing was 19.4 +/- 15.8 mg. The mean calculated calcium mass by EBCT was 19.9 mg and correlated closely with that by ashing (r=0.98, p<0.001). The mean calculated calcium volume by IVUS was 18.6 +/- 11.2 microliters and correlated linearly with the calcium mass by ashing (r = 0.87, p < 0.0003). In experiment II, the mean cross-sectional area of the calcified matrix was 1.71 +/- 0.66 mm2 by histologic examination compared with 1.44 +/- 0.66 mm2 by IVUS. There was a good correlation between the calcified cross-sectional area by histologic examination and IVUS (r = 0.76, p < 0.007); however, IVUS may underestimate the amount of calcium present depending on the intralesional calcium morphologic characteristics. In conclusion, IVUS accurately quantitates atherosclerotic plaque volume as well as the cross-sectional area and volume of intralesional calcium, especially if the calcium is localized at the base of the plaque. IVUS underestimates the amount of calcium present because of signal drop-off when the calcium is too thick for the ultrasound to completely penetrate. In comparison, EBCT accurately quantitates calcium mass regardless of the intralesional calcium morphologic characteristics; however, EBCT does not accurately quantitate plaque volume and will miss noncalcified atherosclerotic lesions.

Adolescent↗
PubMed1995

Incremental value of exercise electrocardiography and thallium-201 testing in men and women for the presence and extent of coronary artery disease.

Our goal was to assess the incremental value of exercise testing in men and women for the diagnosis and extent of coronary artery disease. With data from one center, incremental logistic algorithms were developed and evaluated in a separate set of 865 patients from four centers. Variables included were pretest (age, sex, symptoms, diabetes, smoking, and cholesterol concentration); exercise electrocardiogram (ECG) (ST-segment depression [millimeters], ST-segment slope, peak heart rate, and change in systolic blood pressure); and thallium-201 scintigram (defect presence, reversibility, and intensity of hypoperfusion). End points were coronary disease presence (50% diameter stenosis) and extent (multivessel disease). Accuracy and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. Incremental ROC curve areas for disease presence were pretest 0.75 +/- 0.02, post-exercise ECG 0.82 +/- 0.01, and post-thallium scintigram 0.85 +/- 0.01 and for disease extent were pretest 0.71 +/- 0.02, post-exercise ECG 0.76 +/- 0.02, and post-thallium scintigram 0.78 +/- 0.02 (p < 0.005 for all increments). Incremental increases in accuracy were similar for men and women. We conclude that when multivariable algorithms derived from one center were applied to a separate group, there was a significant incremental increase in accuracy associated with exercise testing for the presence and extent of coronary disease. This increase in accuracy was similar for men and women.

Adult↗
PubMed1995

Accurate coronary calcium phosphate mass measurements from electron beam computed tomograms.

Precipitates of calcium phosphate in coronary arteries always indicate the presence of atherosclerosis. The mass of these precipitates is related to the severity of atherosclerosis. To determine the accuracy of electron beam computed tomographic (CT) mass estimates, we imaged 21 human hearts inside an anthropomorphic chest phantom using an Imatron C-100 electron beam CT scanner (Imatron, San Francisco, CA). We then incinerated the 63 imaged coronary arteries and weighed the mineral ash. We calculated the mass estimates from the images using an algorithm derived from a model that assumes simple radiographic properties of the coronary arteries. We also calculated the currently used coronary calcium score for each artery. Although both the mass estimates and the scores correlated with the actual mass of the incinerated specimens (r = .97 and r = .93), the correlation with the mass estimates was better (P = .02; William's test). The regression equation relating the actual mass to the mass estimates was y = 1.37 x + 14, indicating that the CT mass estimates consistently underestimate actual coronary calcium phosphate mass. We conclude that relative mass estimates using electron beam CT scanning are accurate and that both these and the currently employed calcium scores reflect the actual mass of precipitated calcium phosphate in diseased coronary arteries.

Algorithms↗
PubMed1995

Offline assessment of atherosclerotic coronary calcium from electron beam tomograms.

Coronary calcium screening using electron beam computed tomography (EBCT) is being applied clinically and for research purposes. We compared the accuracy of a specialized image analysis system with the standard proprietary software in the scanner's host computer. Sixty-seven symptomatic patients underwent coronary angiography and EBCT. Tomograms were analyzed using the proprietary software included in the scanner and with a specialized coronary calcium scoring work station. Sensitivities, specificities, and receiver operating characteristic curve areas were calculated for the proprietary software and the specialized system using the angiographic definition of disease of at least one stenosis causing greater than 50% luminal narrowing. There were no significant differences between the proprietary and the specialized software's accuracy. Receiver operating characteristic curve areas were 0.84 and 0.82 for proprietary software, respectively. During a 50 minute analysis session, the average number of studies analyzed were 12.6 +/- 1.7 using the proprietary software and 23.2 +/- 5.7 using the specialized software (P = .02).Image analysis was thus found to be more rapid using the specialized software. The specialized coronary calcium analysis system is as accurate as the proprietary software for scoring EBCT for coronary calcium. The reduction in analysis time makes the specialized system the preferable method.

Adult↗
PubMed1994

Quantitation of in vitro coronary artery calcium using ultrafast computed tomography.

Ultrafast computed tomography (UFCT) has the potential to quantify coronary hydroxyapatite (HAP). However, no definitive studies validating this technique are available. We constructed a human chest phantom model with coronary arteries represented by cylindrical holes containing: (1) calcium chloride solutions, (2) a block of HAP immersed in paraffin (without partial volume effect), and (3) HAP granules embedded in a gelatin matrix (with partial volume effect). We scanned this model to determine the relationship between measured CT number per voxel and density of the calcium per voxel. The relationships between CT number and concentration of calcium chloride was linear (r = 0.992 to 0.999). Using a commercially available standard bone mineral phantom, we were able to estimate the concentration of HAP to an accuracy from 94 to 97% when partial volume effects were absent. However, when partial volume effects were present, two methods of estimating HAP produced significant errors (1 to 384%, and 17 to 52%). We conclude that significant partial voluming errors degrade the accuracy of HAP quantitation and that further evaluation and corrections are needed before such quantitation is clinically applied.

Calcium Chloride↗
PubMed1994

Incremental evaluation of exercise capacity as an independent predictor of coronary artery disease presence and extent.

To determine the independent incremental value of exercise capacity (METS) concerning the presence and extent of coronary artery disease, we analyzed data from 800 patients with suspected coronary disease who underwent both exercise testing and coronary angiography. We performed logistic regression analysis of clinical and exercise test data with an incremental design to mimic the usual flow of data acquisition. Separate analyses were performed concerning coronary disease presence (> or = 1 vessel with a > or = 50% lesion) and extent (three-vessel/left main disease). Diagnostic accuracy was determined by calculating receiver operating characteristic (ROC) curve areas. When considered alone, METS was a significant predictor of both presence and extent of disease. Multivariate analysis revealed that METS was an independent predictor of disease extent but not presence. However, comparison of ROC curve areas failed to show any loss of accuracy when METS was removed from the coronary disease extent analysis. Despite the strong univariate relationship between exercise capacity and coronary disease presence and extent and the independence of exercise capacity as a predictor of coronary disease extent, the lack of an additional incremental accuracy attributed to its consideration virtually cancels its value as a diagnostic variable for assessing both coronary disease presence and extent.

Adult↗
PubMed1994

Diagnostic accuracy of predicting coronary artery disease related to patients' characteristics.

Patients' demographic and clinical characteristics may affect diagnostic accuracy of cardiologists. We asked a group of experienced cardiologists from three institutions to estimate the pretest probability of coronary artery disease in 257 patients referred for diagnostic coronary angiography and with no history of previous myocardial infarction nor valvular heart disease. Physicians pretest estimates were compared with the diagnostic findings of coronary angiography. We tested the influence of five variables on the accuracy of the pretest estimates: age, sex, chest pain characteristics, rest electrocardiogram and electrocardiographic exercise test result. Cardiologists tended to overestimate the presence of coronary artery disease and this tendency was particularly remarkable in the group of patients showing a negative exercise test. Pretest diagnostic accuracy was 0.72 when the test result was negative and 0.85 when the test result was positive (95% confidence interval of the difference 0.03 to 0.23; p < 0.001). The diagnosis of coronary artery disease was also more accurate for male than for female patients (0.81 vs 0.70; 95% confidence interval of the difference 0.02 to 0.21; p < 0.02). Characteristics of chest pain, age and rest electrocardiogram did not affect the level of pretest diagnostic accuracy. Cardiologists should be cognizant of correctly interpreting a negative exercise test and the clinical data of female patients; in both cases, they should move circumspect of the diagnosis of coronary artery disease.

Age Factors↗
PubMed1994

Reproducibility of digital subtraction fluoroscopic readings for coronary artery calcification.

RATIONALE AND OBJECTIVES: Digital subtraction fluoroscopy, an inexpensive screening test for coronary atherosclerosis, is highly sensitive in detecting coronary calcifications. However, no previous study has reported interobserver agreement for this test. METHODS: Six hundred and thirty-one subjects underwent digital subtraction fluoroscopy in the 60 degrees left anterior oblique projection. Images were acquired with pulsed fluoroscopy at 15 frames per second. An averaged mask was subtracted from successive images. These fluoroscopic images were stored on a digital disk and replayed in cine loop format. An observer, blinded to clinical information, read the fluoroscopic studies for the presence of calcium in the left main-left anterior descending artery, circumflex artery, and right coronary artery. The images were then stored on digital tape and reread by a second blinded observer. RESULTS: The percentages of interobserver agreement regarding the presence and absence of calcium in left main-left anterior descending, circumflex, and right coronary arteries, were 91.9%, 92.9%, and 92.2%, respectively. The overall kappa values, which are 0.85, 0.77, and 0.82 in left main-left anterior descending, circumflex, and right coronary arteries, respectively, show a highly significant level of agreement (P < .0001). CONCLUSION: Digital subtraction fluoroscopy is a reliable screening test for coronary calcifications.

Calcinosis↗
PubMed1994

Accuracy of quantifying coronary hydroxyapatite with electron beam tomography.

RATIONALE AND OBJECTIVES: The electron beam tomography coronary calcium score continues to be used without experimental validation. To determine its accuracy, a series of experiments was performed. METHODS: A chest phantom model was constructed with coronary arteries represented by cylindrical holes containing hydroxyapatite granules embedded in a gelatin matrix to simulate coronary arteries. Experiments were performed to determine the relationship between the mass of hydroxyapatite in each of these arteries, the coronary calcium score currently used in coronary screening, and an alternative method of estimating mass from the images. The model was scanned with equal amounts of hydroxyapatite in each artery: 1) when the cylindrical heart was rotated 36 degrees 10 times between scans, and 2) when the particle diameters varied from 0.1 mm to 4 mm. The scores were calculated, and a subtraction algorithm was applied to estimate the exact mass of hydroxyapatite in each artery. RESULTS: The hydroxyapatite scores varied by 42% with position and by 1.54 x 10(6)% with particle diameter. The estimated masses from the subtraction algorithm were more stable with position and particle size, with maximum percent errors of 10% and 14% for position and particle size, respectively. CONCLUSIONS: These results suggest that the coronary calcium score is invalid, and that more precise and clinically relevant methods, such as the arterial summation method, should be rigorously tested in clinical studies.

Algorithms↗
PubMed1992

Development and validation of a logistic regression-derived algorithm for estimating the incremental probability of coronary artery disease before and after exercise testing.

OBJECTIVES: Our goals were to develop and validate a multivariate algorithm for estimating the incremental probability of the presence of coronary artery disease. BACKGROUND: Multivariate methods, including logistic regression analysis, have been extensively applied to diagnostic exercise testing. However, few previous studies have included both an incremental design and external validation. METHODS: A retrospective collection of clinical, exercise test and catheterization data was performed involving four U.S. referral medical centers. All patients had no prior history of coronary disease and had undergone coronary angiography < or = 3 months after exercise stress testing. An algorithm was developed in one center (590 patients with a 41% prevalence of coronary artery disease) with the use of logistic regression analysis and was validated in the other three centers (1,234 patients, 70% prevalence). The algorithm incorporated pretest variables (age, gender, symptoms, diabetes, cholesterol), exercise electrocardiographic (ECG) variables (mm of ST segment depression, ST slope, peak heart rate, metabolic equivalents [METs], exercise angina) and one thallium variable. Discrimination was measured with receiver operating characteristic curve analysis. Calibration (that is, reliability) was assessed from a comparison of probability estimates and the actual prevalence of disease. RESULTS: The overall incremental receiver operating characteristic curve areas for the validation group were pretest, -0.738 +/- 0.016; postexercise ECG, 0.78 (SE 0.017); and postthallium, 0.82 (SE 0.016); p < 0.01 for both increments. Within the three validation institutions, the institution with a disease prevalence closest to that of the derivation institution had the best incremental receiver operating characteristic curve areas. There was a stepwise incremental improvement in calibration especially from exercise ECG to thallium testing. CONCLUSIONS: An incremental multivariate algorithm derived in one center reliably estimated disease probability in patients from three other centers. The incremental value of testing was best demonstrated when the derivation and validation groups had a similar disease prevalence. This algorithm may be useful in decision making that relates to the diagnosis of coronary disease.

Algorithms↗
PubMed1992

Radiographically detectable calcium and atherosclerosis: the connection and its exploitation.

The early detection of coronary atherosclerosis may be impossible if we continue to depend on its pathophysiologic effects (ischemia) for our screening tests. Insoluble crystalline calcium phosphate, which is ubiquitous in our inorganic and biologic worlds, precipitates relatively early in atherosclerotic lesions. Since coronary calcification is specific for atherosclerosis and since calcium is a strong radiation absorber in the X-ray frequency range, sensitive radiographic techniques such as dual-energy subtraction fluoroscopy and ultrafast computed tomography hold promise as screening tests for this disease.

Calcinosis↗