One-step integrated coronary-carotid-cerebral computed tomography angiography to evaluate cardiovascular and cerebrovascular atherosclerosis

PURPOSE

This study aims to develop a low-radiation dose, one-step integrated coronary-carotid-cerebral computed tomography angiography (ICCC-CTA) technique to analyze the relationship between cardiovascular and cerebrovascular atherosclerosis and evaluate the risk factors of plaque to provide an early-stage treatment to patients and reduce vascular events.

METHODS

A total of 300 consecutive asymptomatic patients with cardiovascular risk factors who underwent ICCC-CTA were enrolled in this prospective study. The association between coronary and carotid-cerebrovascular atherosclerosis was assessed. The primary cardiovascular risk factors for various plaque types in cardiovascular or cerebrovascular disease were evaluated using multivariate analysis.

RESULTS

Among 300 patients, 189 (63%) had plaques in their coronary and cerebral arteries. The presence of calcified and mixed plaques in the carotid-cerebral and coronary arteries was strongly correlated (χ2 = 20.71, P = 0.001; χ2 = 8.96, P = 0.003, respectively). Multivariate logistic regression analysis revealed that abnormal blood glucose [OR = 1.44, 95% CI 0.12-0.62, P = 0.01] and abnormal total cholesterol [OR = 1.28, 95% CI 0.07-0.46, P = 0.01] are risk factors in all the models in the coronary artery, non-calcified plaque group. Abnormal blood glucose [OR = 1.43, 95% CI 0.11-0.61, P = 0.01] and abnormal systolic blood pressure [OR = 1.02, 95% CI 0.01-0.04, P = 0.02] are risk factors in all the models in the coronary artery calcified plaque group. Abnormal blood glucose level [OR = 1.44, 95% CI = 0.12-0.62, P = 0.01] was only a risk factor in the non-calcified plaque carotid-cerebral artery group.

CONCLUSIONS

We confirm that elevated blood glucose and total cholesterol levels are associated with coronary and carotid-cerebrovascular plaques using the novel one-step low dose cerebral-carotid-cardiac CTA technique. These findings will provide insights for further studies focusing on developing low-radiation dose one-step ICCC-CTA to screen cardiovascular/cerebrovascular plaques in general population with cardiovascular risk factors.

ADVANCES IN KNOWLEDGE

We developed a low-radiation dose, one-step ICCC-CTA technique to detect cardiovascular and cerebrovascular atherosclerosis. We evaluated the risk factors for plaque burden for the early treatment and reduction of vascular events. These findings supported the development of low-radiation dose one-step ICCC-CTA to screen for cardiovascular/cerebrovascular disease in general population with cardiovascular risk factors.

The value of mobile magnetic resonance imaging in early warning for stroke: A prospective case-control study

Aims

To evaluate the predictive value of mobile magnetic resonance imaging (MRI) in screening stroke.

Methods

This was a prospective case-control study performed on healthy residents over 40 years old in remote rural areas of northern China between May 2019 and May 2020. Multivariate logistic regression and receiver operator characteristic curve (ROC) analysis were used to evaluate the screening model.

Results

A total of 1,224 patients (500 [40.8%] men) enrolled, including 56 patients who suffered from stroke (aged 64.05 ± 7.27). The individuals who developed stroke were significantly older (P < 0.001), had a significantly higher occurrence of heart disease (P = 0.015), diabetes (P = 0.005), dyslipidemia (P = 0.009), and significantly increased waist circumference (P = 0.02), systolic blood pressure (SBP) (P = 0.003), glycosylated hemoglobin (HbA1c) level (P = 0.007), triglyceride (TG) level (P = 0.025), low density lipoprotein cholesterol (LDL-c) level (P = 0.04), and homocysteine (HCY) level (P < 0.001). Multivariate logistic regression analysis showed that age (OR = 1.055, 95% CI: 1.017–1.094, P = 0.004), HCY (OR = 1.029, 95% CI: 1.012–1.047, P = 0.001) and mobile MRI (OR = 4.539, 95% CI: 1.726–11.939, P = 0.002) were independently associated with stroke. The area under the curve (AUC) of the combined model including national screening criteria, mobile MRI results, and stroke risk factors was 0.786 (95% CI: 0.721–0.851), with a sensitivity of 69.6% and specificity of 80.4%.

Conclusion

Mobile MRI can be used as a simple and easy means to screen stroke.

Impact of CircRNAs on Ischemic Stroke

Circular RNA (circRNA) is a recently discovered class of endogenous non-coding RNA that is generated by cyclization, driven by intron pairing, and regulated by related regulators. An important biological function of CircRNA is acting as a molecular sponge to significantly alter miRNA levels over a short period. Several studies have shown that circRNA is closely related to stroke. Therefore, a better understanding of CircRNA function and regulatory mechanism in ischemic brain will help us for the early detection, early diagnosis, and early treatment of stroke. Here, we summary the biological characteristics, expression of circRNA, and its effect on outcome after ischemic stroke.

Artificial Intelligence in Cardiovascular Atherosclerosis Imaging

At present, artificial intelligence (AI) has already been applied in cardiovascular imaging (e.g., image segmentation, automated measurements, and eventually, automated diagnosis) and it has been propelled to the forefront of cardiovascular medical imaging research. In this review, we presented the current status of artificial intelligence applied to image analysis of coronary atherosclerotic plaques, covering multiple areas from plaque component analysis (e.g., identification of plaque properties, identification of vulnerable plaque, detection of myocardial function, and risk prediction) to risk prediction. Additionally, we discuss the current evidence, strengths, limitations, and future directions for AI in cardiac imaging of atherosclerotic plaques, as well as lessons that can be learned from other areas. The continuous development of computer science and technology may further promote the development of this field.

The Role of the lncRNA MALAT1 in Neuroprotection against Hypoxic/Ischemic Injury

Hypoxic and ischemic brain injury can cause neurological disability and mortality, and has become a serious public health problem worldwide. Long-chain non-coding RNAs are involved in the regulation of many diseases. Metastasis-related lung adenocarcinoma transcript 1 (MALAT1) is a type of long non-coding RNA (lncRNA), known as long intergenic non-coding RNA (lincRNA), and is highly abundant in the nervous system. The enrichment of MALAT1 in the brain indicates that it may be associated with important functions in pathophysiological processes. Accordingly, the role of MALAT1 in neuronal cell hypoxic/ischemic injury has been gradually discovered over recent years. In this article, we summarize recent research regarding the neuroprotective molecular mechanism of MALAT1 and its regulation of pathophysiological processes of brain hypoxic/ischemic injury. MALAT1 may function as a regulator through interaction with proteins or RNAs to perform its role, and may therefore serve as a therapeutic target in cerebral hypoxia/ischemia.

Overview of Traditional Mongolian Medical Warm Acupuncture

Mongolian medical warm acupuncture is a traditional therapy of Mongolian medicine and was developed by people living on the Mongolian Plateau. This kind of traditional oriental medicine has a long history. The main characteristics of Mongolian medical warm acupuncture are the acupoints and the needles used. Its theory is based on the human anatomical structure and the distinct local culture. Mongolian medical warm acupuncture has been practiced for centuries and proved to be very effective in the treatment of age-related diseases, including the musculoskeletal and nervous diseases. This paper aims to briefly introduce the history and scope of Mongolian medical warm acupuncture, with a particular focus on age-related diseases, where Mongolian medical warm acupuncture has shown significant beneficial effects.

Predictive value of coronary artery calcium score in cardiovascular disease

We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and the role of CACS in the detection of subclinical noncalcified atherosclerotic plaque. A total of 15,884 participants in five studies were included in this meta-analysis. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated. The results showed that CHD incidence significantly increased with increased CACS (HR=0.05, 95% CI 0.03-0.06, Z=5.82, P=0.002). The CHD rate was low and further increased with CACS of 101-300. With CACS >300, the CHD rate was highest. Similarly, CVD rate was low with CACS of 0, increased with CACS of 1-100 (HR=0.03, 95% CI 0.01-0.06, Z=1.66, P=0.096), and further increased with CACS of 101-300. With CACS >300, the CVD rate was highest. Clinical evidence indicated that the higher the CACS, the higher the CHD and CVD rates, while the CVD rate does not always decreased compared with CHD rate with the same CACS, especially with CACS of 0.

Prospectively electrocardiogram-gated high-pitch spiral acquisition mode dual-source CT coronary angiography in patients with high heart rates: comparison with retrospective electrocardiogram-gated spiral acquisition mode

OBJECTIVE

To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode.

MATERIALS AND METHODS

Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 ± 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed.

RESULTS

There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 ± 0.306 [group A] vs. 1.084 ± 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 ± 0.16 mSv in group A and 7.1 ± 1.05 mSv in group B (p = 0.001).

CONCLUSION

In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.