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Clinical Investigations: CARDIOLOGY |

Enhanced Coronary Calcification Determined by Electron Beam CT Is Strongly Related to Endothelial Dysfunction in Patients With Suspected Coronary Artery Disease*

Po-Hsun Huang, MD; Lung-Ching Chen, MD; Hsin-Bang Leu, MD; Philip Yu-An Ding, MD, PhD; Jaw-Wen Chen, MD; Tao-Cheng Wu, MD; Shing-Jong Lin, MD, PhD
Author and Funding Information

*From the Division of Cardiology (Drs. Huang, L-C Chen, Leu, and Ding), Department of Internal Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine (Dr. Wu); and Cardiovascular Research Center (Drs. J-W Chen and Lin), National Yang-Ming University, Taipei, Taiwan.

Correspondence to: Shing-Jong Lin, MD, PhD, Division of Cardiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan; e-mail: sjlin@vghtpe.gov.tw



Chest. 2005;128(2):810-815. doi:10.1378/chest.128.2.810
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Background: Coronary artery calcification determined by electron beam CT (EBCT) is strongly associated with total plaque burden but is not related to systemic vascular inflammation.

Aims: We sought to test the hypothesis that enhanced coronary artery calcification, a marker of atherosclerosis and plaque burden, was related to endothelial dysfunction in patients with suspected coronary artery disease (CAD).

Methods and results: One hundred twenty-four subjects with suspected CAD were enrolled. Coronary artery calcification was detected by EBCT. A noninvasive method of brachial ultrasound was used to measure endothelium-dependent flow-mediated vasodilation (FMD) and endothelium-independent nitroglycerin-mediated vasodilation (NMD). Serum high-sensitivity C-reactive protein (hsCRP) and monocyte chemoattractant protein-1 (MCP-1) levels were also determined. Of the 124 patients, the calcium scores ranged from 0 to 4,394. All subjects were classified into three groups according to coronary calcium scores: group 1, score 0 (n = 26); group 2, scores 1 to 199 (n = 50); group 3, scores ≥ 200 (n = 48). There was an inverse association between the degree of coronary artery calcification and the endothelium-dependent FMD in the three groups (6.9 ± 0.6% vs 5.3 ± 0.3% vs 3.7 ± 0.3%, respectively; p < 0.001) but not the endothelium-independent NMD. Besides, no significant difference in serum levels of hsCRP and MCP-1 were found among the three groups. However, both the serum levels of hsCRP and MCP-1 were correlated significantly with endothelium-dependent FMD (r = − 0.211, p = 0.019; and r = − 0.188, p = 0.037, respectively). By multivariate analysis, enhanced coronary calcification was a strong independent predictor of endothelial dysfunction (p < 0.001).

Conclusion: Enhanced coronary artery calcification strongly predicted endothelial dysfunction in patients with suspected CAD. Also, serum levels of hsCRP and MCP-1 were significantly correlated with endothelial function. These findings suggested that both calcium deposition and inflammation were involved in endothelial dysfunction.

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