Cardiovascular Diseases Clinical Trial
To rescan 6,700 subjects in the MESA study to obtain computed tomography measures of calcification.
BACKGROUND:
This study is ancillary to the MultiEthnic Study of Atherosclerosis (MESA) Trial, a
prospective investigation of the etiology and natural history of atherosclerosis and the
ability of non-invasive tools to measure atherosclerotic burden and identify high risk
individuals in a large, population-based cohort. The development of computed tomography (CT)
to evaluate coronary calcification (CC) now provides a tool to directly measure coronary
atherosclerosis non-invasively. The information obtained by CT however provides more
information than CC alone. CT has the ability to measure and quantitate aortic valve
calcification (AVC), mitral annular calcification (MAC), aortic wall calcification and left
ventricular size (LVS). The longitudinal nature of this study will allow epidemiologic
associations to be established for a multitude of risk factors and these measures,
establishing both the time sequence for each measure and consistency of the association in a
variety of populations (ethnicity, gender, geographical location and age). Magnetic
resonance imaging of the heart will also be obtained as part of the MESA trial, and
comparisons of LV size by CT to magnetic resonance measures will also be performed.
DESIGN NARRATIVE:
This study is ancillary to the MultiEthnic Study of Atherosclerosis (MESA) Trial, a
prospective investigation of the etiology and natural history of atherosclerosis and the
ability of non-invasive tools to measure atherosclerotic burden and identify high risk
individuals in a large, population-based cohort. The development of computed tomography (CT)
to evaluate coronary calcification (CC) now provides a tool to directly measure coronary
atherosclerosis non-invasively. The information obtained by CT however provides more
information than CC alone. CT has the ability to measure and quantitate aortic valve
calcification (AVC), mitral annular calcification (MAC), aortic wall calcification and left
ventricular size (LVS). The longitudinal nature of this study will allow epidemiologic
associations to be established for a multitude of risk factors and these measures,
establishing both the time sequence for each measure and consistency of the association in a
variety of populations (ethnicity, gender, geographical location and age). Magnetic
resonance imaging of the heart will also be obtained as part of the MESA trial, and
comparisons of LV size by CT to magnetic resonance measures will also be performed. The
investigators will utilize scans already obtained as part of the calcium scanning (at
baseline and 3.5 year follow-up), and make these four measures on baseline and follow-up
scans obtained. The additive value of these simple measures to CC score could possibly
provide clinicians with even more power to identify and stratify the high-risk cardiac
patient with both findings. This study will also establish the prevalence, in a population
based study, of all both AVC and MAC, using a technique highly sensitive to see these
abnormalities. It has been postulated that a 'total atherosclerotic burden' could be
obtained by adding CAC to thoracic aortic calcification, and this total atherosclerosis
score (with or without MAC and AVC) might better predict cardiovascular events than CAC
alone. Similarly, this cohort of 6,700 patients with repeat scans can be assessed for
factors that enhance or inhibit progression of LVS, mitral annular, aortic valve or wall
calcification, lending insight into therapies that have efficacy against progression of
aortic sclerosis or left ventricular enlargement.
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Observational Model: Cohort, Time Perspective: Prospective
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