PMID- 38043705
OWN - NLM
STAT- MEDLINE
DCOM- 20240226
LR  - 20240226
IS  - 1535-7732 (Electronic)
IS  - 1051-0443 (Linking)
VI  - 35
IP  - 3
DP  - 2024 Mar
TI  - Clinical Utility of Infrapopliteal Calcium Score for the Evaluation of Severity 
      of Peripheral Artery Disease.
PG  - 370-376.e2
LID - S1051-0443(23)00859-X [pii]
LID - 10.1016/j.jvir.2023.11.023 [doi]
AB  - PURPOSE: To identify associations between computed tomography (CT)-based 
      lower-extremity calcium score (LECS) across different anatomic segments and the 
      presence, severity, and clinical outcomes of peripheral artery disease (PAD). 
      MATERIALS AND METHODS: In a mixed retrospective and prospective cohort study, 139 
      patients without prior lower-extremity intervention who underwent CT angiography 
      of the aorta and lower extremities were identified. Subjects were classified as 
      asymptomatic, claudicants, or having chronic limb-threatening ischemia (CLTI). 
      LECS was measured using the Agatston method. Univariate and multivariate analyses 
      were performed across categories of PAD severity. Receiver operating 
      characteristic (ROC) analysis was performed, and an optimal cutoff point for LECS 
      was identified. Claudicants were followed prospectively for CLTI and mortality. 
      RESULTS: Higher infrapopliteal calcium score (CS) was independently associated 
      with CLTI versus claudication (odds ratio [OR], 3.24 per unit increase in 
      log(10)-transformed CS; P < .001) in addition to hemodialysis dependence and poor 
      functional status. One hundred eighty-eight Agatston units was identified as the 
      optimal cutoff for infrapopliteal CS in assessing the risk of CLTI versus 
      claudication (area under the ROC curve, 0.84 [SD +/- 0.049]). This cutoff was 
      validated in an independent cohort to be associated with progression to CLTI (OR, 
      12.8; P = .0039). In the claudicant group followed prospectively, infrapopliteal 
      CS >/=188 predicted increased risk of CLTI or death after adjusting for functional 
      status and hemodialysis dependence (Cox hazard ratio, 4.92; P = .0202). 
      CONCLUSIONS: Higher infrapopliteal CS was associated with CLTI among those with 
      symptomatic PAD. An infrapopliteal CS cutoff of 188 Agatston units may serve as a 
      useful tool to identify patients with increased risk of CLTI and mortality.
CI  - Copyright (c) 2023 SIR. Published by Elsevier Inc. All rights reserved.
FAU - Lee, Sujin
AU  - Lee S
AD  - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, 
      Massachusetts General Hospital, Boston, Massachusetts. Electronic address: 
      slee@mgh.harvard.edu.
FAU - Tanaka, Mari
AU  - Tanaka M
AD  - Division of Interventional Radiology Department of Radiology, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Patel, Shiv
AU  - Patel S
AD  - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, 
      Massachusetts General Hospital, Boston, Massachusetts.
FAU - Zacharias, Nikolaos
AU  - Zacharias N
AD  - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, 
      Massachusetts General Hospital, Boston, Massachusetts.
FAU - Hedgire, Sandeep
AU  - Hedgire S
AD  - Division of Cardiovascular Imaging, Department of Radiology, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Malhotra, Rajeev
AU  - Malhotra R
AD  - Cardiology Division, Department of Medicine, Massachusetts General Hospital, 
      Boston, Massachusetts.
FAU - Dua, Anahita
AU  - Dua A
AD  - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, 
      Massachusetts General Hospital, Boston, Massachusetts.
LA  - eng
GR  - R01 HL159514/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20231202
PL  - United States
TA  - J Vasc Interv Radiol
JT  - Journal of vascular and interventional radiology : JVIR
JID - 9203369
RN  - SY7Q814VUP (Calcium)
SB  - IM
MH  - Humans
MH  - *Calcium
MH  - Retrospective Studies
MH  - Prospective Studies
MH  - Risk Factors
MH  - Ischemia
MH  - *Peripheral Arterial Disease/diagnostic imaging/therapy
MH  - Intermittent Claudication
MH  - Treatment Outcome
MH  - Limb Salvage/adverse effects
MH  - Chronic Disease
EDAT- 2023/12/04 00:42
MHDA- 2024/02/26 06:44
CRDT- 2023/12/03 19:27
PHST- 2022/12/19 00:00 [received]
PHST- 2023/10/04 00:00 [revised]
PHST- 2023/11/26 00:00 [accepted]
PHST- 2024/02/26 06:44 [medline]
PHST- 2023/12/04 00:42 [pubmed]
PHST- 2023/12/03 19:27 [entrez]
AID - S1051-0443(23)00859-X [pii]
AID - 10.1016/j.jvir.2023.11.023 [doi]
PST - ppublish
SO  - J Vasc Interv Radiol. 2024 Mar;35(3):370-376.e2. doi: 10.1016/j.jvir.2023.11.023. 
      Epub 2023 Dec 2.