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Introduction: There is conflicting evidence whether lower extremity arterial calcification coincides with coronary arterial calcification (CAC). The aims of this study were to investigate the associations between (1) femoral and crural calcification with CAC, and (2) femoral and crural calcification pattern with CAC., Research Design and Methods: This cross-sectional study included 405 individuals (74% men, 62.6±10.9 years) from the ARTEMIS cohort study at high risk of cardiovascular disease (CVD) who underwent a CT scan of the femoral, crural and coronary arteries. High CVD risk was defined as history/presence of cerebrovascular disease, coronary artery disease, abdominal aortic aneurysm, renal artery stenosis, peripheral artery disease or CVD risk factors: diabetes mellitus type 2, hypertension, hyperlipidemia. Calcification score within each arterial bed was expressed in Agatston units. Dominant calcification patterns (intimal, medial, absent/indistinguishable) were determined via a CT-guided histologically validated scoring algorithm. Multivariable-adjusted multinomial logistic regression analyses were used. Replication was performed in an independent population of individuals with diabetes mellitus type 2 (Early-HFpEF cohort study)., Results: Every 100-point increase in femoral and crural calcification score was associated with 1.23 (95% CI=1.09 to 1.37, p<0.001) and 1.28 (95% CI=1.11 to 1.47, p=0.001) times higher odds of having CAC within tertile 3 (high) versus tertile 1 (low), respectively. The association appeared stronger for crural versus femoral arteries. Moreover, the presence of femoral intimal (OR=10.81, 95% CI=4.23 to 27.62, p<0.001), femoral medial (OR=10.37, 95% CI=3.92 to 27.38, p<0.001) and crural intimal (OR=6.70, 95% CI=2.73 to 16.43, p<0.001) calcification patterns were associated with higher odds of having CAC within tertile 3 versus tertile 1, independently from concomitant calcification score. This association appeared stronger for intimal versus medial calcification patterns. The replication analysis yielded similar results., Conclusions: Higher femoral and crural calcification scores were associated with higher CAC. Moreover, the presence of femoral intimal, femoral medial and crural intimal calcification patterns was associated with increased CAC. It appears that arterial calcification is a systemic process which occurs simultaneously in various arterial beds., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: The ankle brachial index (ABI) is often used as a proxy for medial arterial calcification (MAC) in studies investigating MAC as a cardiovascular risk factor, but evidence supporting this hypothesis is sparse. This study aims to investigate the use of an elevated ABI as proxy for MAC, as visualized with computed tomography (CT)., Methods: Cross-sectional data of 718 participants with, or at risk of cardiovascular disease was used. The ABI was calculated using cutoffs >1.4 and > 1.3. The presence of MAC was assessed in the crural and femoral arteries by CT imaging. Modified Poisson regression was used to assess the association between an elevated ABI and the presence of MAC, and test characteristics were calculated., Results: MAC was found in 25.0% of participants. An ABI >1.4 was found in 8.7% of participants, of whom 45.2% had MAC. An elevated ABI was significantly associated with the presence of MAC (RR 1.74, CI: 1.26-2.40). However, poor positive specific agreement (23.3%, CI: 13.9-34.3), sensitivity (15.7%, CI: 10.4-21.1) and positive predictive value (45.2%, CI: 32.8-57.5) were found. Despite good specificity (93.6%, CI: 91.6-95.7) the area under the receiving operator curve remained poor (54.7%, CI: 51.8-57.6). Negative specific agreement (84.5%, CI: 81.4-87.0) and negative predictive value (77.0%, CI: 73.7-80.2) were acceptable., Conclusions: An elevated ABI is insufficient to serve as a true diagnostic proxy for MAC. Studies that have drawn conclusions on the association between MAC and cardiovascular disease, solely based on the ABI, are likely to underestimate the found effects., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: To assess specific risk factors and biomarkers associated with intimal arterial calcification (IAC) and medial arterial calcification (MAC)., Methods: We conducted a cross-sectional study in patients with or at risk of vascular disease from the SMART study(n = 520) and the DCS cohort(n = 198). Non-contrast computed tomography scanning of the lower extremities was performed and calcification in the femoral and crural arteries was scored as absent, predominant IAC, predominant MAC or indistinguishable. Multinomial regression models were used to assess the associations between cardiovascular risk factors and calcification patterns. Biomarkers for inflammation, calcification and vitamin K status were measured in a subset of patients with IAC(n = 151) and MAC(n = 151)., Results: Femoral calcification was found in 77% of the participants, of whom 38% had IAC, 28% had MAC and 11% were scored as indistinguishable. The absolute agreement between the femoral and crural arteries was high(69%). Higher age, male sex, statin use and history of coronary artery disease were associated with higher prevalences of femoral IAC and MAC compared to absence of calcification. Smoking and low ankle-brachial-index (ABI) were associated with higher prevalence of IAC and high ABI was associated with less IAC. Compared to patients with IAC, patients with MAC more often had diabetes, have a high ABI and were less often smokers. Inactive Matrix-Gla Protein was associated with increased MAC prevalence, while osteonectin was associated with decreased risk of MAC, compared to IAC., Conclusions: When femoral calcification is present, the majority of the patients have IAC or MAC throughout the lower extremity, which have different associated risk factor profiles., Competing Interests: The authors have declared that no competing interests exist.

We evaluated the association of hepatic fat with beta-cell function estimated from the oral glucose tolerance test. In addition, we tested the hypothesis that postprandial free fatty acid (FFA) suppression after a meal tolerance test (MTT) is linked to hepatic fat. Individuals with normal glucose metabolism (NGM; n = 10 with low and n = 10 with high insulin secretion, matched for insulin sensitivity and sex), impaired glucose metabolism (IGM; n = 14), and type 2 diabetes mellitus (DM; n = 14) underwent a 75-g oral glucose tolerance test and MTT. beta-Cell function estimates were calculated from C-peptide using a mathematical model. Liver fat was quantified by proton magnetic resonance ((1)H-MR) spectroscopy. Area under the curve (AUC) of triglycerides (TG) and FFA responses during MTT represented postprandial lipid responses. Linear regression models were adjusted for age, sex, and additionally for insulin sensitivity for IGM/DM subjects. Liver fat content was equal for the NGM groups with low and high insulin secretion: 4.5% (2.6-6.0) (median, interquartile range) and 4.9% (2.3-7.8), respectively; liver fat percentages of IGM and diabetic subjects were significantly higher: 11.2 (6.7-21.1) and 10.0 (7.8-24.5). Liver fat showed a fairly strong, significant negative association with insulin sensitivity, but was not associated with beta-cell function. Significant associations of liver fat with fasting TG and AUC(TG) were shown in the total study population and in IGM/DM subjects separately. No relationship existed between fasting FFA or AUC(FFA) and liver fat. We conclude that fat accumulation in the liver is tightly linked to insulin sensitivity but not to beta-cell function. Furthermore, liver fat is associated with circulating TG levels, but not with FFA concentrations.

Objective: To assess the value of diagnostic laparoscopy (DL) and laparoscopic ultrasonography (LUS) in the staging and selection of patients with colorectal liver metastasis., Summary Background Data: Preoperative imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging are limited in the assessment of the number and exact location of hepatic metastases and in the detection of extrahepatic metastatic disease. Consequently, the surgeon is often faced with a discrepancy between preoperative imaging results and perioperative findings, resulting in either a different resection than planned or no resection at all., Methods: Fifty consecutive patients were planned for DL and LUS in a separate surgical sitting to assess the resectability of their liver metastases. All patients were considered to be candidates for resection on the basis of preoperative imaging studies., Results: Laparoscopy could not be performed in 3 of the 50 patients because of dense adhesions. The remaining 47 patients underwent DL. On the basis of DL and LUS, 18 (38%) patients were ruled out as candidates for resection. Of the 29 patients who subsequently underwent open exploration and intraoperative ultrasonography, another 6 (13%) were deemed to have unresectable disease., Conclusions: The combination of DL and LUS significantly improves the selection of candidates for resection of colorectal liver metastases and effectively reduces the number of unnecessary laparotomies.

Background: Previous studies have demonstrated the high sensitivity and moderate specificity of standard magnetic resonance (MR) spin-echo (SE) and gradient-echo (GE) techniques in predicting the patency of coronary artery bypass grafts. These techniques, however, do not provide quantitative information. Therefore, the objectives of this study were first to investigate whether MR cine GE images, performed in addition to standard SE images, have additional value for the assessment of graft patency and second to assess the graft function by measuring the flow pattern and flow rate with MR phase velocity imaging., Methods and Results: Forty-seven patients with previous histories of coronary artery bypass grafting underwent angiography and MR SE and cine GE phase velocity imaging. SE and GE images were evaluated by three independent observers blinded to the angiographic results. The spatial mean velocity and volume flow were measured and repeated for each image at consecutive 50-millisecond intervals throughout the cardiac cycle. The 47 patients had 98 proximal aortotomies, of which 60 were single and 38 sequential grafts. Seventy-three grafts were patent; 25 were occluded. Eighty-four grafts (86%) were eligible for comparison of the results of SE and GE images. Assessment of patency was inconclusive on SE images in 7 grafts (5 occluded by angiography) and on GE images in 7 grafts (2 occluded). A comparison of the results of contrast angiography and SE and GE MR imaging techniques showed that both techniques had a high sensitivity (both 98%) and somewhat lower specificity (85% and 88%, respectively) for graft patency. Combined analysis of the SE and GE images did not improve the accuracy. The strength of the interobserver agreement on GE images was good (kappa = 0.66), whereas on SE images the agreement was moderate (kappa = 0.51). Adequate MR phase velocity profiles were obtained in 62 (85%) of the 73 angiographically patent grafts. Graft flow was characterized by a balanced biphasic forward flow pattern. The volume flow of sequential grafts to 3 regions (136 +/- 106 mL/min) was significantly higher than in single grafts (63 +/- 41 mL/min, P < .01)., Conclusions: Considering the good interobserver agreement and the 85% success rate of quantitative flow measurements, cine GE phase velocity mapping is a promising clinical tool in the noninvasive assessment of graft patency and function.

Magnetic resonance imaging (MRI) is a non-invasive modality which can be used for direct visualization of coronary artery bypass grafts. Spin-echo and gradient-echo (cine-MRI) techniques are now available on standard MR machines and provide information on graft morphology and graft patency with a 90% accuracy. By combining the standard techniques with MR phase velocity mapping, the flow rate in the graft can be measured, thereby offering a unique non-invasive assessment of the graft function. Newer techniques include MR coronary angiography, pharmacologically induced stress MRI, ultrafast MRI of the first-pass (perfusion) of a paramagnetic contrast agent through the myocardium, and 31P MR spectroscopy of high-energy phosphate metabolism of the myocardium. All of these may develop into valuable diagnostic tools for the assessment of functional results after CABG or PTCA, but still require clinical validation. At present, MRI is a useful screening procedure for assessment of graft patency and function in post-operative pain syndromes and in late graft occlusion or stenosis.