To assess vascular calcification in the patients of hypoparathyroidism using multidetector computed tomography scan

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Abstract

Background:

Our pilot data showed an increased intima media thickness in the patients with sporadic idiopathic hypoparathyroidism (SIH). Alteration in homeostasis of calcium, phosphate, and parathyroid hormone (PTH) may predispose to increase the risk of cardiovascular morbidity and mortality. The data on objective assessment of this increased risk is however lacking.

Objective:

To assess the effect of altered calcium, phosphate, and PTH homeostasis in the patients with SIH on coronary calcium score (a marker of increase vascular risk) by multidetector computed tomography scan (MDCT).

Methods:

In this case-control study, we measured coronary CT calcium score in 30 patients of SIH and compared with 40 age and sex matched healthy subjects. Correlation of coronary calcium score with biochemical parameters was evaluated.

Results:

Three of the 30 cases (10%) with SIH were found to have coronary artery calcification (CAC) of varying degree, whereas none of the control showed CAC ( P = 0.07). The patients with CAC had significantly lower serum calcium levels (albumin corrected), as compared to the patients without CAC. Inverse correlation of CAC was found with serum calcium levels. No correlation was found with other biochemical parameters.

Conclusion:

The vascular risk is increased in the patients with SIH as assessed by coronary calcium score measured by MDCT. Low serum calcium levels might be a predisposing factor for this increased risk.

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Most cited references 19

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Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons.

J A Rumberger, B Brundage, D Rader … (1999)

Coronary artery disease is the No. 1 cause of death in the developed world. Effective means of treatment such as drug therapy to lower cholesterol levels are available, but clinical application to patients at highest risk remains imprecise. Electron beam computed tomography (EBCT) has been suggested as a means to diagnose subclinical coronary disease and facilitate risk stratification, but no current interpretive consensus exists in clinical practice. We critically reviewed current, pertinent literature regarding EBCT coronary calcium scanning from a clinical perspective and, in particular, studies that evaluated it as a measure of atherosclerotic coronary disease. Additionally, we reviewed studies that quantified the EBCT "calcium score" in relationship to coronary heart disease events. The available data suggest that the EBCT calcium score can help identify persons at higher than anticipated risk of future coronary events: the greater the EBCT coronary calcium score, the greater the extent of atherosclerotic plaque disease. Based on the literature review, we offer EBCT interpretation guidelines as they relate to drug therapy and risk reduction in asymptomatic persons with borderline cholesterol levels. Considerable evidence shows that coronary calcium is specific for atherosclerotic plaque and that it can be sensitively detected and accurately quantified by using EBCT. The coronary calcium score can help guide initiation of clinical prevention programs as part of a risk stratification and management scheme aimed at improving outcomes in patients determined to be at highest risk of coronary disease for their respective age and gender.

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Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease.

A Chalian, M. Mar Bernal, Prajesh Kothawala … (2009)

Chronic kidney disease (CKD) is a powerful risk factor for all-cause mortality and its most common aetiology, cardiovascular (CV) mortality. Mineral metabolism disturbances occur very early during the course of CKD but their control has been poor. A number of studies have assessed the relationship between all-cause mortality, CV mortality and events with mineral disturbances in CKD patients, but with considerable discrepancy and heterogeneity in results. Thus, a systematic review was conducted to assess methodological and clinical heterogeneity by comparing designs, analytical approaches and results of studies. Medline, EMBASE and Cochrane databases were systematically searched for articles published between January 1980 and December 2007. Thirty-five studies were included in the review. All-cause mortality was the most commonly assessed outcome (n = 29). Data on CV mortality risk (n = 11) and CV events (congestive heart failure, stroke, myocardial infarction) (n = 4) are limited. The studies varied in populations scrutinized, exposure assessments, covariates adjusted and reference mineral levels used in risk estimation. A significant risk of mortality (all-cause, CV) and of CV events was observed with mineral disturbances. The data supported a greater mortality risk with phosphorus, followed by calcium and parathyroid hormone (PTH). The threshold associated with a significant all-cause mortality risk varied from 3.5-3.9 mg/dL (reference: 2.5-2.9) to 6.6-7.8 mg/dL (reference: 4.4-5.5) for high phosphorus, 10.5 mg/dL (reference: 9-9.5) for high calcium, 8.8) to 300 pg/mL (reference: 200-300) to >480 pg/mL (reference: 5.5 (reference: 3.5-5.5) and >6.5 mg/dL (reference: 476.1 pg/mL (reference: <476.1) for PTH. Serious limitations were observed in the quality and methodology across studies. In spite of enormous heterogeneity across studies, a significant mortality risk was observed with mineral disturbances in dialysis patients. Data on risk in pre-dialysis patients were less conclusive due to even more limited (numerically) evidence.

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Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility--MESA study.

Jennifer Nelson, Melissa Anderson Polusny, Nathan D. Wong … (2005)

To evaluate the effect of scanner type and calcium measure on the reproducibility of calcium measurements. This investigation was approved by the institutional review boards of each study site and by the Institutional Review Board of the Los Angeles Biomedical Research Institute. Informed consent for scanning and participation was obtained from all participants. The study was Health Insurance Portability and Accountability Act compliant. The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter observational study of 6814 participants undergoing demographic, risk factor, and subclinical disease evaluations. Coronary artery calcium was measured by using duplicate CT scans. Three study centers used electron-beam computed tomography (CT), and three used multi-detector row CT. Coronary artery calcium was detected in 3355 participants. Three calcium measurement methods-Agatston score, calcium volume, and interpolated volume score-were evaluated. Mean absolute differences between calcium measures on scans 1 and 2, excluding cases for which both scans had a measure of zero, was modeled by using linear regression to compare reproducibility between scanner types. A repeated measures analysis of variance test was used to compare reproducibility across calcium measures, with mean percentage absolute difference as the outcome measure. Rescan reproducibility in relation to misregistrations, noise, and motion artifacts was also examined. Variables were log transformed to create a more normal distribution. Concordance for presence of calcium between duplicate scans was high and similar for both electron-beam and multi-detector row CT (96%, kappa = 0.92). Mean absolute difference between calcium scores for the two scans was 15.8 for electron-beam and 16.9 for multi-detector row CT scanners (P = .06). Mean relative differences were 20.1 for Agatston score, 18.3 for calcium volume, and 18.3 for interpolated volume score (P < .01). Reproducibility was lower for scans with versus those without image misregistrations or motion artifacts (P < .01 for both). Electron-beam and multi-detector row CT scanners have equivalent reproducibility for measuring coronary artery calcium. Calcium volumes and interpolated volume scores are slightly more reproducible than Agatston scores. Reproducibility is lower for scans with misregistrations or motion artifacts.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Endocrinol Metab

Journal ID (iso-abbrev): Indian J Endocrinol Metab

Journal ID (publisher-id): IJEM

Title: Indian Journal of Endocrinology and Metabolism

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2230-8210

ISSN (Electronic): 2230-9500

Publication date (Print): Nov-Dec 2015

Volume: 19

Issue: 6

Pages: 785-790

Affiliations

[1] Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

[1 ] Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Author notes

Corresponding Author: Dr. Mahesh Prakash, Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: image73@ 123456gmail.com

*Both authors contributed equally to this study

Article

Publisher ID: IJEM-19-785

DOI: 10.4103/2230-8210.167545

PMC ID: 4673807

PubMed ID: 26693429

SO-VID: 0abc9519-3f1f-4be4-81a6-4fd884c09077

License:

This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.

To assess vascular calcification in the patients of hypoparathyroidism using multidetector computed tomography scan

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Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 19

Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons.

Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease.

Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility--MESA study.

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