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PubMed1989

Calcification of umbilical artery: two distinct lesions.

The clinical and pathological features of five cases of calcification of umbilical cord vessels were reviewed. Two distinct lesions were identified: calcification could produce either sclerosis of the wall or obliteration of the lumen. In three cases there was calcification within the media and adventitia of the umbilical arteries, with extension into Wharton's jelly in one case. The pathogenesis of this pattern of calcification--the sclerotic variant--is unclear but the findings of inflammation in the umbilical cord and its vessels, membranes, and decidua suggest intrauterine infection. In two cases there was complete calcification of umbilical arterial lumina resulting in total obliteration. The findings of fetal vessels in the chorionic plate with medial calcification in one of these two cases raises the possibility of thrombosis within the umbilical cord vessels as a cause, but the latter was not found. One infant from each group was liveborn. Both had shown signs of fetal distress in utero and delivered prematurely. The other three pregnancies resulted in macerated stillbirth preterm.

Adult↗
PubMed1978

Correlation of fluoroscopically detected coronary artery calcification with exercise stress testing in asymptomatic men.

Cardiac fluoroscopy followed by a submaximal exercise electrocardiogram was used to evaluate 129 healthy men (average age 49 p 6) for assessment of possible latent ischemic heart disease in an asymptomatic population. Of 108 subjects who completed the exercise protocol, 37 (34%) had at least one fluoroscopically detected calcified coronary artery. Of the 16 subjects with a positive exercise stress test, 13 (81%) had calcification of at least one coronary artery, Thirteen of 37 (35%) with calcification had a positive exercise test. Those with calcification of at least one coronary artery had a ninefold increased risk of a positive exercise stress test (p less than 0.0001). The location of a calcific deposit conferred greater risk of exercise-induced ischemic changes than did multivessel involvement. Forty-seven per cent of men with calcification in the left anterior descending coronary artery had an abnormal exercise electrocardiogram vs. 33% and 16% of persons with left circumflex and right coronary artery calcifications, respectively.

Adult↗
PubMed1989

Disappearing breast calcifications.

Seventeen patients aged 47-67 years had 20 foci of disappearing breast calcifications. Firm compression was used to obtain craniocaudal and oblique mediolateral views of each patient. The authors categorized calcifications according to shape, size, number, position, and likelihood of benignity or malignancy. The right breast was the site of disappearing calcifications more often than the left. The most common configuration of disappearing calcifications was round or oval. All calcifications but one were found in dense glandular areas of the breast. Dense glandular tissue within 1 cm of the border with the stroma was the most common location. Only one of 20 foci suggested malignancy. The disappearance of breast calcifications is uncommon but probably not rare.

Aged↗
PubMed1989

Coronary artery calcifications: significance of incidental detection on CT scans.

A scoring system was devised for the assessment of coronary artery calcifications apparent on computed tomographic (CT) scans, with width and length used to assess severity. The degree of calcification was compared with the presence of stenoses of 70% or greater at cardiac catheterization in 46 patients who underwent both studies. Although many significantly stenosed vessels showed no calcification, heavy calcifications had a high positive predictive value for significant disease. In a separate branch of the study, the perioperative cardiac morbidity and mortality were compared in 30 age- and sex-matched pairs of patients undergoing thoracotomy who did and did not have coronary calcifications on CT scans obtained before surgery. Patients with calcifications had a higher frequency of cardiac complications, including arrhythmias, ischemia, hypotension, myocardial infarction, and death.

Adult↗
PubMed1996

Calcification in focal nodular hyperplasia: a new problem for differentiation from fibrolamellar hepatocellular carcinoma.

PURPOSE: To describe calcification in focal nodular hyperplasia (FNH) of the liver, which poses a new problem for the differentiation of FNH from fibrolamellar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ultrasound, computed tomography, and magnetic resonance imaging findings of 357 FNH lesions diagnosed in the past 5 years in 295 patients (274 female, 21 male; aged 14-72 years) were retrospectively reviewed with emphasis on intralesional calcification. RESULTS: Calcifications were seen in five FNH lesions (1.4%) as small, solitary spots located centrally or peripherally within the lesions. Morphologic features of these calcifications were similar to those of calcifications in two of six fibrolamellar HCCs in the same period. CONCLUSION: Calcification in FNH is a rare and atypical finding that poses further difficulty for differentiation from fibrolamellar HCC.

Adult↗
PubMed1996

Breast arterial calcifications: association with diabetes mellitus and cardiovascular mortality. Work in progress.

PURPOSE: To determine the relationship between breast arterial calcification, diabetes mellitus, and subsequent cardiovascular and noncardiovascular mortality. MATERIALS AND METHODS: A prospective cohort study was carried out in 12,239 women aged 50-68 years who participated in a breast cancer screening program. The screening mammograms were coded for the presence of breast arterial calcification. Diabetes (n = 442) was defined as use of insulin or oral hypoglycemic agents, use of a restricted diet for diabetes, or the presence of glucosuria. Data were available from questionnaires and urine glucose tests. Hazard ratios, which were adjusted for age, smoking, parity, and obesity, were calculated from mortality data after 16-19 years of follow-up. RESULTS: Breast arterial calcification was seen in 9.0% (1,107 of 12,239) of all women and in 15.4% (68 of 442) of the diabetic women. An excess cardiovascular mortality of 40% (hazard ratio = 1.4; 95% confidence interval = 1.1, 1.8) was found for all women with breast arterial calcification. In diabetic women, the presence of breast arterial calcification was associated with a 90% (hazard ratio = 1.9; 95% confidence interval = 1.1, 3.2) increase in cardiovascular mortality. CONCLUSION: Breast arterial calcification represents an independent risk factor for cardiovascular mortality in women over 50 years of age, especially in those with diabetes.

Aged↗
PubMed1997

Breast calcification and mass detection with mammographic anode-filter combinations of molybdenum, tungsten, and rhodium.

PURPOSE: To determine whether contrast loss on mammograms obtained with tungsten (W)-molybdenum (Mo), rhodium (Rh)-Rh, and W-Rh anode-filter units affects calcification and mass detection relative to that on mammograms obtained with Mo-Mo anode-filter units. MATERIALS AND METHODS: Three unfixed cadaveric breasts of 4.0-, 5.5-, or 7.0-cm thickness were imaged with three mammographic units with Mo-Mo, W-Mo, Rh-Rh, and W-Rh anode-filter combinations. Calcification clusters (<300 microm in diameter) and masses (0.5-1.2 cm) placed on the cadaveric breasts simulated abnormal mammograms. Thirty-five images without and 57 images with added calcifications and masses were acquired with a 180-speed screen-film system and interpreted by four mammographic specialists. With a 150-speed screen-film system, 10 normal images and 30 abnormal images with added calcifications were obtained with Mo-Mo and Rh-Rh equipment and read by three of the four radiologists. RESULTS: For the 180-speed system, there were statistically significant differences (P < .05) in detection of calcifications on Mo-Mo images compared with W-Mo, Rh-Rh, and W-Rh images. These differences disappeared with the 150-speed system. For mass detection with the 180-speed system, W-Rh was significantly better than Mo-Mo (P = .02). CONCLUSION: Dose savings and increased penetration with Rh-Rh and W-Rh anode-filter combinations may decrease calcification detection if fast screen-film systems are used, but mass detection may be improved.

Aged↗
PubMedDate not supplied

Stroke as the first manifestation of calcific aortic stenosis.

Heart valve calcifications are rarely recognized as a potential source for cerebral embolism. Previous studies have identified mitral, but not aortic, valve calcifications to be risk factors for stroke. Based on these studies, heart surgery is unlikely to be indicated in patients who present with a stroke and an 'incidental' aortic valve calcification. We report a case of a 46-year-old man presenting with acute onset of left-sided weakness and numbness. A previous smoking history was the only cardiovascular risk factor found. Head CT scan revealed a right middle cerebral artery territory infarct and an adjacent high-density lesion. CT angiography demonstrated the presence of calcific embolic material in the middle cerebral artery. A search for embolic sources revealed a calcific aortic stenosis (CAS). Initially placed on coumadin, the patient developed silent myocardial infarction 2 months later, presumed to be also embolic in origin from the CAS. After aortic valve replacement, the patient has been symptom-free during a 2-year follow-up. In conclusion, CT angiography may be the method of choice for detecting calcific cerebral emboli, and demonstration of a causal relationship between CAS and an embolic stroke by CT angiography may be an important adjunct in surgical decision-making.

Aortic Valve Stenosis↗
PubMed2001

Soluble osteopontin and vascular calcification in hemodialysis patients.

BACKGROUND: Vascular calcification often occurs in patients with uremia. As osteopontin (OPN) is not only involved in the physiological but also the pathological calcification of tissues, OPN may be associated with the pathogenesis of aortic calcification in hemodialysis (HD) patients. METHODS: We examined the expression of OPN in atherosclerotic aortas of HD patients. In addition, we performed a prospective longitudinal study by using CT scans to detect aortic calcifications and by measuring the plasma OPN concentration by ELISA in HD patients (20 men, 16 women; mean age 55.2 +/- 21.3 years) and in healthy volunteers (18 men, 17 women; mean age 54.0 +/- 13.2 years). RESULTS: By immunohistochemical staining, OPN was abundantly localized in atherosclerotic plaques of HD patients. The macrophages surrounding the atheromatous plaques were identified as the OPN-expressing cells. We furthermore found that the concentration of soluble plasma OPN was significantly higher in HD patients as compared with the concentrations in age-matched healthy volunteers (837.3 +/- 443.2 vs. 315.1 +/- 117.4 ng/ml, p < 0.01). The OPN concentration was positively correlated with the aortic calcification index in HD patients (r = 0.749, p < 0.01). CONCLUSION: These data suggest that OPN, secreted by macrophages, plays a role in the calcification of atheromatous plaques in HD patients.

Adult↗
PubMed2005

Cardiovascular calcification in end stage renal disease.

Extensive atherosclerosis and heavy vascular and valvular calcifications are common complications of end stage chronic kidney disease (CKD-V) and are related to a high incidence of cardiovascular events. In CKD-V vascular calcifications occur both in the subintimal space and in the runica media. Intimal calcification is associated with atherosclerosis and is therefore a universal finding. On the contrary, medial calcification is characteristically associated with advanced CKD and diabetes mellitus. Numerous metabolic and endocrine abnormalities, primarily involving calcium and phosphorus metabolism, are found in CKD. Furthermore, CKD-V is believed to be a state of heightened inflammation and oxidative stress. All of these dysfunctions occur early in the course of the renal failure and likely contribute to the development and progression of vascular calcification and atherosclerosis. This review is centred on the pathobiology of vascular calcification in CKD-V, its detection with modern imaging modalities and the therapeutic approaches currently available to slow its progression.

Calcinosis↗
PubMed1993

Renal calcification in very low birth weight infants.

Between January 1990 and December 1991, serial real-time ultrasound examinations and analyses of urine were performed on a total of 50 infants with birth weights less than 1,500 g to assess the incidence of renal calcification. Five infants (10%) developed renal calcification at a mean age of 48.8 +/- 14.1 days. These 5 infants with renal calcification had significantly shorter gestations (28.2 +/- 0.8 vs. 30.1 +/- 1.7 weeks, p < 0.0005) and lower birth weights (934 +/- 45 vs. 1,311 +/- 188 g, p < 0.0005) when compared with infants without renal calcification. None of the affected infants were treated with furosemide. Affected infants had a mean urine volume of 85.8 +/- 11.3 ml/kg/24 h, mean urine calcium level of 5.07 +/- 1.18 mg/kg/24 h, mean urine calcium to creatinine (mg/mg) ratio of 0.67 +/- 0.09, and a mean urine N-acetyl-beta-D-glucosaminidase (NAG) to creatinine (U/g) ratio of 259 +/- 133. Urinalyses showed that affected infants had significantly higher urine pH values and hematuria. Alkaline phosphatase concentrations and initial parathyroid hormone levels were not different among the two groups. In summary, renal calcification occurred in 10% of very low birth weight infants and multiple risk factors seem to be contributory. The smaller, sicker and more immature infants appear to have increased risk for developing renal calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcinosis↗
PubMed2003

Osteo/chondrocytic transcription factors and their target genes exhibit distinct patterns of expression in human arterial calcification.

OBJECTIVE: Mineralization-regulating proteins are found deposited at sites of vascular calcification. However, the relationship between the onset of calcification in vivo and the expression of genes encoding mineralization-regulating proteins is unknown. This study aimed to determine the temporal and spatial pattern of expression of key bone and cartilage proteins as atherosclerotic calcification progresses. METHODS AND RESULTS: Using reverse transcription-polymerase chain reaction on a panel of noncalcified and calcified human arterial samples, two classes of proteins could be identified: (1) Matrix Gla protein, osteonectin, osteoprotegerin, and aggrecan were constitutively expressed by vascular smooth muscle cells (VSMCs) in the normal vessel media but downregulated in calcified arteries whereas (2) alkaline phosphatase, bone sialoprotein, osteocalcin, and collagen II were expressed predominantly in the calcified vessel together with Cbfa1, Msx2, and Sox9, transcription factors that regulate expression of these genes. In the calcified plaque in situ hybridization identified subsets of VSMCs expressing osteoblast and chondrocyte-like gene expression profiles whereas osteoclast-like macrophages were present around sites of calcification. CONCLUSIONS: These observations suggest a sequence of molecular events in vascular calcification beginning with the loss of expression by VSMCs, of constitutive inhibitory proteins, and ending with expression by VSMCs and macrophages of chondrocytic, osteoblastic, and osteoclastic-associated proteins that orchestrate the calcification process.

Calcinosis↗
PubMed2006

High-resolution X-ray microtomography is a sensitive method to detect vascular calcification in living rats with chronic renal failure.

OBJECTIVE: Chronic renal failure (CRF) is associated with a 10- to 20-fold increase in cardiovascular risk. Vascular calcification is a prominent feature of cardiovascular disease in patients with end-stage renal failure and contributes to the excess mortality in this population. In this study, we explored in vivo X-ray microtomography (micro-CT) as a tool to detect and follow-up vascular calcifications in the aorta of living rats with adenine-induced CRF. METHODS AND RESULTS: With in vivo micro-CT, calcification of the aorta in uremic rats was clearly discernible on transversal virtual cross-sections. Micro-CT findings correlated well with tissue calcium content and histology. Repetitive scans in animals with light, moderate, and severe vascular calcification showed good reproducibility with minimal interference of motion artifacts. Moreover, both calcified volume and area could be quantified with this method. CONCLUSIONS: In vivo micro-CT scanning is a sensitive method to detect vascular calcifications in CRF rats, allowing follow-up and quantification of the development, and potential reversal during treatment, of vascular calcifications in living animals.

Animals↗
PubMedDate not supplied

Cardiovascular disease and arterial calcification in insulin-dependent diabetes mellitus: interrelations and risk factor profiles. Pittsburgh Epidemiology of Diabetes Complications Study-V.

Cardiovascular disease is a frequent complication of insulin-dependent diabetes mellitus (IDDM), but the prevalence, interrelations, and risk factors of its principal components (coronary, cerebrovascular, and lower-extremity arterial disease) and of medial arterial wall calcification are not well understood. To address these issues, data from the Epidemiology of Diabetes Complications Study (n = 657) baseline examination were examined. The term coronary heart disease (CHD) was applied to those with myocardial infarction or angina, whereas lower-extremity arterial disease (LEAD) was applied to those who had undergone amputation of a lower limb or who had an ankle to arm blood pressure ratio less than 0.8 at rest or after exercise. Calcification of the lower-extremity arteries was considered to be present if ankle pressure was more than 100 mm Hg higher than brachial pressure. Although the prevalence of CHD was low, LEAD was significantly more common in women than in men (p less than 0.01), whereas calcification was more frequent in men than in women (p less than 0.01). Ten percent of those with LEAD also had CHD, and 8% with LEAD had calcification. Modeling of potential risk factors (e.g., diabetes duration and glycosylated hemoglobin) revealed that duration, female gender, fibrinogen, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and high density lipoprotein cholesterol to apolipoprotein A-I ratio were independent predictors of LEAD, whereas for CHD only, diabetes duration and hypertension contributed to CHD. Calcification revealed a mixed pattern, with duration, hypertension, and triglyceride to apolipoprotein A-I ratio being the statistically significant associated factors. The results suggest that although LEAD, CHD, and calcification often coexist, their risk factor profiles differ.

Adult↗
PubMed2000

Polymorphisms of the human matrix gla protein (MGP) gene, vascular calcification, and myocardial infarction.

The matrix Gla protein (MGP) is an important inhibitor of vessel and cartilage calcification that is strongly expressed in human calcified, atherosclerotic plaques and could modulate plaque calcification and coronary heart disease risk. Using a genetic approach, we explored this possibility by identifying polymorphisms of the MGP gene and testing their possible association with myocardial infarction (MI) and plaque calcification. Eight polymorphisms were identified in the coding and 5'-flanking sequences of the MGP gene. All polymorphisms were investigated in 607 patients with MI and 667 control subjects recruited into the ECTIM Study (Etude Cas-Témoins de l'Infarctus du Myocarde) and in 717 healthy individuals with echographically assessed arterial calcification and atherosclerosis who were participating in the AXA Study. In the ECTIM Study, alleles and genotypes were distributed similarly in patients and controls in the whole study group; in only 1 subgroup of subjects defined as being at low risk for MI were the concordant A-7 and Ala 83 alleles more frequent in patients with MI than in controls (P<0.003). In the AXA Study among subjects with femoral atherosclerosis, the same alleles were more common in the presence than the absence of plaque calcification (P<0.025). The other MGP polymorphisms were not associated with any investigated clinical phenotype. Transient transfection experiments with allelic promoter-reporter gene constructs and DNA-protein interaction assays were carried out to assess possible in vitro functionality of the promoter variants detected at positions -814, -138, and -7 relative to the start of transcription. When compared with the -138 T allele, the minor -138 C: allele consistently conferred a reduced promoter activity of -20% (P<0.0001) in rat vascular smooth muscle cells and of -50% (P<0.004) in a human fibroblast cell line, whereas the other polymorphisms, including -7, displayed no evidence of in vitro functionality. We conclude that the A-7 or Ala 83 alleles of the MGP gene may confer an increased risk of plaque calcification and MI; however, the observed relationships are weak or limited to subgroups of patients and therefore need confirmation.

Adolescent↗
PubMed2004

Unexpected severe calcification after transplantation of bone marrow cells in acute myocardial infarction.

BACKGROUND: There has been a rapid increase in the number of clinical trials using unselected bone marrow (BM) cells or the mononuclear fraction of BM cells for treating ischemic heart diseases. Thus far, no significant deleterious effects or complications have been reported in any studies using BM-derived cells for treatment of various cardiac diseases. METHODS AND RESULTS: Seven-week-old female Fisher-344 rats underwent surgery to induce acute myocardial infarction and were randomized into 3 groups of 16 rats, each receiving intramyocardial injection of either 7x10(5) DiI-labeled total BM cells (TBMCs), the same number of DiI-labeled, clonally expanded BM multipotent stem cells, or the same volume of phosphate-buffered saline in the peri-infarct area. Echocardiography 2 weeks after cell transplantation indicated intramyocardial calcification in 4 of 14 surviving rats (28.5%) in the TBMC group. Histological examination with hematoxylin and eosin staining and von Kossa staining confirmed the presence of extensive intramyocardial calcification. Alkaline phosphatase staining revealed strong positivity surrounding the calcified area suggestive of ongoing osteogenic activity. Fluorescent microscopic examination revealed that acellular calcific areas were surrounded by DiI-labeled TBMCs, suggesting the direct involvement of transplanted TBMCs in myocardial calcification. In contrast, in hearts receiving equal volumes of saline or BM multipotent stem cells delivered in the same manner, there was no evidence of calcification. CONCLUSIONS: These results demonstrate that direct transplantation of unselected BM cells into the acutely infarcted myocardium may induce significant intramyocardial calcification.

Animals↗
PubMed2004

Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study.

BACKGROUND: Calcification is a common finding in human coronary arteries; however, the relationship between calcification patterns, plaque morphology, and patterns of remodeling of culprit lesions in a comparison of patients with acute coronary syndromes (ACS) and those with stable conditions has not been documented. METHODS AND RESULTS: Preinterventional intravascular ultrasound (IVUS) images of 178 patients were studied, 61 with acute myocardial infarction (AMI), 70 with unstable angina pectoris (UAP), and 47 with stable angina pectoris (SAP). The frequency of calcium deposits within an arc of less than 90 degrees for all calcium deposits was significantly different in culprit lesions of patients with AMI, UAP, and SAP (P<0.0001). Moreover, the average number of calcium deposits within an arc of <90 degrees per patient was significantly higher in AMI than in SAP (P<0.0005; mean+/-SD, AMI 1.4+/-1.3, SAP 0.5+/-0.8). Conversely, calcium deposits were significantly longer in SAP patients (P<0.0001; mean+/-SD, AMI 2.2+/-1.6, UAP 1.9+/-1.8, and SAP 4.3+/-3.2 mm). In AMI patients, the typical pattern was spotty calcification, associated with a fibrofatty plaque and positive remodeling. In ACS patients showing negative remodeling, no calcification was the most frequent observation. Conversely, SAP patients had the highest frequency of extensive calcification. CONCLUSIONS: Our observations show that IVUS allows the identification of vulnerable plaques in coronary arteries, not only by identifying a fibrofatty plaque and positive remodeling, but also by identifying a spotty pattern of calcification.

Aged↗
PubMed1994

Fast computed tomography detection of coronary calcification in the diagnosis of coronary artery disease. Comparison with angiography in patients < 50 years old.

BACKGROUND: The predominant cause of coronary artery calcification is atherosclerosis. Although fast x-ray computed tomography (CT) has been demonstrated to be a sensitive technique to detect coronary calcification, the increasing prevalence of calcification with age has been associated with a low specificity for identifying obstructive atherosclerosis. We hypothesized that the specificity of this test would be improved in a younger patient population, making it more useful in the diagnosis of coronary artery disease. METHODS AND RESULTS: We compared fast CT-detected calcification with coronary angiography in 106 patients under the age of 50 years. Nonenhanced fast CT scans consisting of 20 contiguous 3-mm tomograms of the proximal coronary arteries were obtained during a single breath hold. A positive scan was defined as 4 contiguous voxels (> or = 1 mm2) of density > 130 Hounsfield units in the region of the epicardial coronary arteries. Calcification detected by fast CT had an 85% sensitivity to predict patients with significant coronary artery disease (> or = 50% diameter stenosis), with a specificity of 45%. Although the sensitivity to detect multivessel disease was 94%, the sensitivity to detect single-vessel disease was 75%. Changing the threshold for defining a positive fast CT scan from 4 to 2 contiguous voxels produced a small improvement in sensitivity, to 88%, but reduced specificity to 36%. CONCLUSIONS: Although the specificity to detect angiographically significant coronary disease with fast CT improves in a younger patient population, it continues to be relatively low. In contrast to older patient populations, a small but significant number of patients < 50 years old with angiographically significant coronary artery disease do not have coronary calcification demonstrated by fast CT. Thus, caution should be used in excluding significant coronary artery disease on the basis of a negative fast CT study.

Adult↗