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Kataoka Y, Puri R, Andrews J, Honda S, Nishihira K, Asaumi Y, Noguchi T, Yasuda S, Nicholls SJ. In vivovisualization of lipid coronary atheroma with intravascular near-infrared spectroscopy. Expert Rev Cardiovasc Ther 2017; 15:775-785. [DOI: 10.1080/14779072.2017.1367287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Rishi Puri
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
- Cleveland Clinic Coordinating Center for Clinical Trials (C5), Cleveland Clinic, Cleveland, OH, USA
- Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Jordan Andrews
- Heart Health, South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Satoshi Honda
- Heart Health, South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Kensaku Nishihira
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Japan
| | - Stephen J Nicholls
- Heart Health, South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia
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Coronary CT angiography characteristics of OCT-defined thin-cap fibroatheroma: a section-to-section comparison study. Eur Radiol 2017; 28:833-843. [DOI: 10.1007/s00330-017-4992-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/11/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022]
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Shan P, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL, Weisz G, Stuckey TD, Brodie BR, Généreux P, Crowley A, Kirtane AJ, Stone GW, Maehara A. Does calcium burden impact culprit lesion morphology and clinical results? An ADAPT-DES IVUS substudy. Int J Cardiol 2017; 248:97-102. [PMID: 28818353 DOI: 10.1016/j.ijcard.2017.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/13/2017] [Accepted: 08/09/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increasing coronary lesion calcification is thought to be associated with adverse percutaneous coronary intervention (PCI) and clinical outcomes. We investigated the effects of calcium burden on culprit lesion morphology and clinical events after intravascular ultrasound (IVUS)-guided PCI in the ADAPT-DES study. METHODS ADAPT-DES was a prospective, multicenter registry of 8582 consecutive patients undergoing successful PCI using DES. A pre-specified virtual histology (VH)-IVUS substudy of 638 culprit lesions (638 patients) had both pre- and post-PCI VH-IVUS. We divided lesions into tertiles according to pre-PCI percent dense calcium volume (DCV%=dense calcium/plaque volume×100). RESULTS Compared with low and intermediate DCV% tertiles, patients in the high DCV% tertile had the largest arc of superficial calcium, highest percentage of necrotic core volume, and smallest remodeling index; they were also more likely to have advanced lesion morphology such as attenuated plaque and VH thin-cap fibroatheromas. In the high DCV% tertile IVUS guidance was associated with a minimum stent area that was smaller than tertiles with less calcium (p=0.01), but acceptable range, and similar stent expansion (73.8±16.8% vs. 74.0±19.2% vs. 72.4±17.3%, p=0.62) after more frequent use of rotational atherectomy and higher maximum inflation pressure. There was no significant association between pre-PCI DCV% and 2-year target lesion revascularization or major adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis). CONCLUSIONS Increasing coronary artery calcification burden was associated with more advanced, complex VH-IVUS lesion morphology, but not with adverse clinical outcomes, perhaps due to more aggressive PCI techniques that optimized stent expansion.
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Affiliation(s)
- Peiren Shan
- Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China; Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Michael J Rinaldi
- Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC, USA
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, NY, USA; Montefiore Medical Center, Bronx, NY, USA
| | - Thomas D Stuckey
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
| | - Bruce R Brodie
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
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Mamdani N, Tung B, Wang Y, Jaffer FA, Tawakol A. Imaging the Coronary Artery Plaque: Approaches, Advances, and Challenges. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9419-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Bom MJ, van der Heijden DJ, Kedhi E, van der Heyden J, Meuwissen M, Knaapen P, Timmer SA, van Royen N. Early Detection and Treatment of the Vulnerable Coronary Plaque. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005973. [DOI: 10.1161/circimaging.116.005973] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Early identification and treatment of the vulnerable plaque, that is, a coronary artery lesion with a high likelihood of rupture leading to an acute coronary syndrome, have gained great interest in the cardiovascular research field. Postmortem studies have identified clear morphological characteristics associated with plaque rupture. Recent advances in invasive and noninvasive coronary imaging techniques have empowered the clinician to identify suspected vulnerable plaques in vivo and paved the way for the evaluation of therapeutic agents targeted at reducing plaque vulnerability. Local treatment of vulnerable plaques by percutaneous coronary intervention and systemic treatment with anti-inflammatory and low-density lipoprotein–lowering drugs are currently being investigated in large randomized clinical trials to assess their therapeutic potential for reducing adverse coronary events. Results from these studies may enable a more patient-tailored strategy for the treatment of coronary artery disease.
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Affiliation(s)
- Michiel J. Bom
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Dirk J. van der Heijden
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Elvin Kedhi
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan van der Heyden
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Martijn Meuwissen
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Paul Knaapen
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Stefan A.J. Timmer
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Niels van Royen
- From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.J.B., D.J.v.d.H., P.K., S.A.J.T., N.v.R.); Department of Cardiology, Isala Hartcentrum, Zwolle, The Netherlands (E.K.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.v.d.H.); and Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.)
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Abstract
PURPOSE OF REVIEW Cardiac allograft vasculopathy (CAV) is a major limitation to long-term survival after heart transplantation. Innovative new techniques to diagnose CAV have been applied to detect disease. This review will examine the current diagnostic and treatment options available to clinicians for CAV. RECENT FINDINGS Diagnostic modalities addressing the pathophysiology underlying CAV (arterial wall thickening and decreased coronary blood flow) improve diagnostic sensitivity when compared to traditional (angiography and dobutamine stress echocardiography) techniques. SUMMARY Limited options are available to prevent and treat CAV; however, progress has been made in making an earlier and more accurate diagnosis. Future research is needed to identify the optimal time to modify immunosuppression and investigate novel treatments for CAV.
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Fibrinogen in relation to degree and composition of coronary plaque on intravascular ultrasound in patients undergoing coronary angiography. Coron Artery Dis 2017; 28:23-32. [PMID: 27755007 DOI: 10.1097/mca.0000000000000442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to provide additional insight into the role of fibrinogen in coronary artery disease by investigating the associations between plasma fibrinogen with both degree and composition of coronary atherosclerosis as determined by virtual histology-intravascular ultrasound. PATIENTS AND METHODS In 581 patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina pectoris, preprocedural blood samples were drawn for fibrinogen, C-reactive protein (CRP), interleukin-6, and plasminogen activator inhibitor-1 measurements, and virtual histology-intravascular ultrasound of a nonculprit coronary artery was performed. The degree [plaque volume, plaque burden (PB), and lesions with PB≥70%] and the composition of coronary atherosclerotic plaque (fibrous, fibrofatty, dense calcium, necrotic core tissue, and thin-cap fibroatheroma lesions) were assessed. RESULTS Fibrinogen showed a tendency toward a positive association with PB [β (95% CI): 2.55 (-0.52-5.61) increase in PB per ln(g/l) fibrinogen, P=0.09], which was driven significantly by an association in the ACS subgroup [β (95% CI): 4.11 (0.01-8.21) increase in PB per ln(g/l) fibrinogen, P=0.049]. Fibrinogen was also related to the presence of lesions with PB 70% or more in both the full cohort [OR (95% CI): 2.27 (1.17-4.43), P=0.016] and ACS patients [OR (95% CI): 2.92 (1.17-7.29), P=0.022]. All associations were independent of established cardiovascular risk factors, but not CRP. Interleukin-6 and plasminogen activator inhibitor-1 did not provide incremental value to fibrinogen when examining the associations with degree of atherosclerosis. Substantial associations with plaque composition were absent. CONCLUSION Fibrinogen is associated with degree of coronary atherosclerosis, especially in ACS patients. However, whether this association is independent of CRP might be questioned and needs further investigation.
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A Review of the Clinical Utility of Intravascular Ultrasound and Optical Coherence Tomography in the Assessment and Treatment of Coronary Artery Disease. Cardiol Rev 2017; 25:68-76. [DOI: 10.1097/crd.0000000000000128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hougaard M, Hansen HS, Thayssen P, Antonsen L, Junker A, Veien K, Jensen LO. Influence of ezetimibe in addition to high-dose atorvastatin therapy on plaque composition in patients with ST-segment elevation myocardial infarction assessed by serial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:110-117. [DOI: 10.1016/j.carrev.2016.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/11/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
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The Role of Virtual Histology Intravascular Ultrasound in the Identification of Coronary Artery Plaque Vulnerability in Acute Coronary Syndromes. Cardiol Rev 2017; 24:303-309. [PMID: 26886467 DOI: 10.1097/crd.0000000000000100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Markers of coronary plaque vulnerability, such as a high lipid burden, increased inflammatory activity, and a thin fibrous cap, have been identified in histological studies. In vivo, grayscale intravascular ultrasound (IVUS) provides more in-depth information on coronary artery plaque burden than conventional angiography but is unable to accurately distinguish between noncalcific tissue types within the plaque. An analysis of IVUS radiofrequency backscatter based on spectral pattern recognition, such as virtual histology IVUS, allows detailed scrutiny of plaque composition and classification of coronary lesions. This review discusses the virtual histology IVUS technology and its accuracy in identifying vulnerable plaque features, focusing on its use in predicting patient outcomes after acute coronary syndrome, and its limitations in clinical practice.
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The Future of Intravascular Imaging: Are We Primed to Detect Vulnerable Plaques? CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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63
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Souza CF, Maehara A, Mintz GS, Matsumura M, Alves CMR, Carlos Carvalho A, Caixeta A. Tissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study. Catheter Cardiovasc Interv 2017; 90:1107-1114. [PMID: 28191713 DOI: 10.1002/ccd.26954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 01/01/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We sought to assess a new modality of radiofrequency intravascular ultrasound (IVUS) called iMAP-IVUS (Boston Scientific, Santa Clara, California) during the evaluation of patients presenting with high-risk acute coronary syndromes. BACKGROUND There are limited data on plaque tissue characterization and phenotype classification using iMAP-IVUS. METHODS In the iWonder study patients presenting with ST-elevation myocardial infarction (STEMI) or non-STEMI underwent three-vessel grayscale IVUS and iMAP-IVUS tissue characterization prior to percutaneous intervention. In total 385 lesions from 100 patients were divided into culprit (n = 100) and nonculprit (n = 285) lesions. Lesion phenotype was classified as (i) thin-cap fibroatheroma (iMAP-derived TCFA); (ii) thick-cap fibroatheroma; (iii) pathological intimal thickening; (iv) fibrotic plaque; and (v) fibrocalcific plaque. RESULTS Culprit lesions had smaller minimum lumen cross-sectional area (MLA) with greater plaque burden compared to non-culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non-culprit lesions. iMAP-IVUS revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the MLA site (all P < 0.001). Any fibroatheroma was more frequently identified in culprit lesions compared with non-culprit lesions (93% vs. 78.9%, P = 0.001), anywhere within the lesion 19.0%, P < 0.001) as well as at the MLA site (18.0% vs. 9.5%, P = 0.07). CONCLUSIONS Three-vessel radiofrequency iMAP-IVUS demonstrated a greater plaque burden and higher prevalence of any fibroatheroma as well as iMAP-derived TCFAs in culprit versus non-culprit lesions in patients presenting with STEMI or non-STEMI undergoing percutaneous coronary intervention. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Cristiano F Souza
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | - Akiko Maehara
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York.,Department of Interventional Cardiology, Columbia University Medical Center, New York, New York
| | - Gary S Mintz
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York
| | - Mitsuaki Matsumura
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York
| | - Claudia M R Alves
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Adriano Caixeta
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil.,Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Abudayyeh I, Tran BG, Tobis JM. Optimizing Coronary Angioplasty with FFR and Intravascular Imaging. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eshtehardi P, Brown AJ, Bhargava A, Costopoulos C, Hung OY, Corban MT, Hosseini H, Gogas BD, Giddens DP, Samady H. High wall shear stress and high-risk plaque: an emerging concept. Int J Cardiovasc Imaging 2017; 33:1089-1099. [PMID: 28074425 DOI: 10.1007/s10554-016-1055-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
Abstract
In recent years, there has been a significant effort to identify high-risk plaques in vivo prior to acute events. While number of imaging modalities have been developed to identify morphologic characteristics of high-risk plaques, prospective natural-history observational studies suggest that vulnerability is not solely dependent on plaque morphology and likely involves additional contributing mechanisms. High wall shear stress (WSS) has recently been proposed as one possible causative factor, promoting the development of high-risk plaques. High WSS has been shown to induce specific changes in endothelial cell behavior, exacerbating inflammation and stimulating progression of the atherosclerotic lipid core. In line with experimental and autopsy studies, several human studies have shown associations between high WSS and known morphological features of high-risk plaques. However, despite increasing evidence, there is still no longitudinal data linking high WSS to clinical events. As the interplay between atherosclerotic plaque, artery, and WSS is highly dynamic, large natural history studies of atherosclerosis that include WSS measurements are now warranted. This review will summarize the available clinical evidence on high WSS as a possible etiological mechanism underlying high-risk plaque development.
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Affiliation(s)
- Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Ankit Bhargava
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Charis Costopoulos
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Olivia Y Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Michel T Corban
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Hossein Hosseini
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Bill D Gogas
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Don P Giddens
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
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Giavarini A, Kilic ID, Redondo Diéguez A, Longo G, Vandormael I, Pareek N, Kanyal R, De Silva R, Di Mario C. Intracoronary Imaging. Heart 2017; 103:708-725. [DOI: 10.1136/heartjnl-2015-307888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Maezawa H, Maeda A, Iso Y, Sakai T, Suzuki H. The histological characteristics and virtual histology findings of the tissues obtained by a distal protection device during endovascular therapy for peripheral artery disease. J Cardiol 2017; 69:125-130. [DOI: 10.1016/j.jjcc.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 11/26/2022]
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69
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Lee W, Choi GJ, Cho SW. Numerical study to indicate the vulnerability of plaques using an idealized 2D plaque model based on plaque classification in the human coronary artery. Med Biol Eng Comput 2016; 55:1379-1387. [PMID: 27943103 DOI: 10.1007/s11517-016-1602-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/28/2016] [Indexed: 11/25/2022]
Abstract
Atherosclerosis is one of the leading causes of death in the world. In this study, an idealized 2D plaque model based on plaque classification in the coronary artery is developed. When creating the idealized 2D model for each plaque type (fibrocalcic, FC; fibrofatty, FT; calcified fibroatheroma, CaFA; fibroatheroma, FA; calcified thin-cap fibroatheroma, CaTCFA; thin-cap fibroatheroma, TCFA), the cap thickness and stenosis by diameter were set as variables. In order to establish the correlation between each plaque type and plaque rupture, a numerical simulation was performed and the stress and stress gradient were reviewed to analyze the mechanical behavior. Results show that both the TCFA and CaTCFA plaque types, which have the smallest cap thicknesses of the different types of plaque, showed relatively high stress values in the thin membrane when compared with the FT type. The FT type is considered to be relatively stable since it does not have necrotic core or a thin membrane. With a stenosis rate of 50% and a cap thickness of 60 μm, the TCFA and CaTCFA types showed approximately 11 and 110% higher stress values, respectively, and 679 and 1568% higher negative stress gradient values, respectively. In other words, the plaque types with thin caps, which have weak load-bearing capacities, showed high stress values and high negative stress gradients in the radial direction. It is understood that this result could indicate the possibility of plaque rupture.
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Affiliation(s)
- Wookjin Lee
- School of Mechanical Engineering, Chung-Ang University, Seoul, South Korea
| | - Gyu Jin Choi
- School of Mechanical Engineering, Chung-Ang University, Seoul, South Korea
| | - Seong Wook Cho
- School of Mechanical Engineering, Chung-Ang University, Seoul, South Korea.
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Hildebrandt H, Patsalis P, Al-Rashid F, Neuhäuser M, Rassaf T, Heusch G, Kahlert P, Kleinbongard P. Quantification and characterisation of released plaque material during bioresorbable vascular scaffold implantation into right coronary artery lesions by multimodality intracoronary imaging. EUROINTERVENTION 2016; 12:1481-1489. [DOI: 10.4244/eij-d-15-00207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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71
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound and Virtual Histology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Akiko Maehara
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
| | - Gary S. Mintz
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
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Abstract
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.
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Affiliation(s)
- Jonathan A Batty
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Shristy Subba
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Peter Luke
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Li Wing Chi Gigi
- Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
| | - Hannah Sinclair
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
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73
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Ma T, Zhou B, Hsiai TK, Shung KK. A Review of Intravascular Ultrasound-based Multimodal Intravascular Imaging: The Synergistic Approach to Characterizing Vulnerable Plaques. ULTRASONIC IMAGING 2016; 38:314-31. [PMID: 26400676 PMCID: PMC4803636 DOI: 10.1177/0161734615604829] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Catheter-based intravascular imaging modalities are being developed to visualize pathologies in coronary arteries, such as high-risk vulnerable atherosclerotic plaques known as thin-cap fibroatheroma, to guide therapeutic strategy at preventing heart attacks. Mounting evidences have shown three distinctive histopathological features-the presence of a thin fibrous cap, a lipid-rich necrotic core, and numerous infiltrating macrophages-are key markers of increased vulnerability in atherosclerotic plaques. To visualize these changes, the majority of catheter-based imaging modalities used intravascular ultrasound (IVUS) as the technical foundation and integrated emerging intravascular imaging techniques to enhance the characterization of vulnerable plaques. However, no current imaging technology is the unequivocal "gold standard" for the diagnosis of vulnerable atherosclerotic plaques. Each intravascular imaging technology possesses its own unique features that yield valuable information although encumbered by inherent limitations not seen in other modalities. In this context, the aim of this review is to discuss current scientific innovations, technical challenges, and prospective strategies in the development of IVUS-based multi-modality intravascular imaging systems aimed at assessing atherosclerotic plaque vulnerability.
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Affiliation(s)
- Teng Ma
- NIH Resource Center on Medical Ultrasonic Transducer Technology, Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Bill Zhou
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tzung K Hsiai
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - K Kirk Shung
- NIH Resource Center on Medical Ultrasonic Transducer Technology, Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
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74
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Chen H, Kassab GS. Microstructure-based biomechanics of coronary arteries in health and disease. J Biomech 2016; 49:2548-59. [PMID: 27086118 PMCID: PMC5028318 DOI: 10.1016/j.jbiomech.2016.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 12/27/2022]
Abstract
Coronary atherosclerosis is the major cause of mortality and disability in developed nations. A deeper understanding of mechanical properties of coronary arteries and hence their mechanical response to stress is significant for clinical prevention and treatment. Microstructure-based models of blood vessels can provide predictions of arterial mechanical response at the macro- and micro-mechanical level for each constituent structure. Such models must be based on quantitative data of structural parameters (constituent content, orientation angle and dimension) and mechanical properties of individual adventitia and media layers of normal arteries as well as change of structural and mechanical properties of atherosclerotic arteries. The microstructural constitutive models of healthy coronary arteries consist of three major mechanical components: collagen, elastin, and smooth muscle cells, while the models of atherosclerotic arteries should account for additional constituents including intima, fibrous plaque, lipid, calcification, etc. This review surveys the literature on morphology, mechanical properties, and microstructural constitutive models of normal and atherosclerotic coronary arteries. It also provides an overview of current gaps in knowledge that must be filed in order to advance this important area of research for understanding initiation, progression and clinical treatment of vascular disease. Patient-specific structural models are highlighted to provide diagnosis, virtual planning of therapy and prognosis when realistic patient-specific geometries and material properties of diseased vessels can be acquired by advanced imaging techniques.
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Affiliation(s)
- Huan Chen
- California Medical Innovations Institute, Inc., San Diego, CA 92121, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, Inc., San Diego, CA 92121, United States.
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75
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Coronary bifurcation stent morphology in dual-source CT: validation with micro-CT. Int J Cardiovasc Imaging 2016; 32:1659-1665. [DOI: 10.1007/s10554-016-0953-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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Honda S, Kataoka Y, Kanaya T, Noguchi T, Ogawa H, Yasuda S. Characterization of coronary atherosclerosis by intravascular imaging modalities. Cardiovasc Diagn Ther 2016; 6:368-81. [PMID: 27500094 DOI: 10.21037/cdt.2015.12.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery disease (CAD) is highly prevalent in Western countries and is associated with morbidity, mortality, and a significant economic burden. Despite the development of anti-atherosclerotic medical therapies, many patients still continue to suffer from coronary events. This residual risk indicates the need for better risk stratification and additional therapies to achieve more reductions in cardiovascular risk. Recent advances in imaging modalities have contributed to visualizing atherosclerotic plaques and defining lesion characteristics in vivo. This innovation has been applied to refining revascularization procedure, assessment of anti-atherosclerotic drug efficacy and the detection of high-risk plaques. As such, intravascular imaging plays an important role in further improvement of cardiovascular outcomes in patients with CAD. The current article reviews available intravascular imaging modalities with regard to its method, advantage and disadvantage.
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Affiliation(s)
- Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; ; Department of Advanced Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; ; Department of Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; ; Department of Advanced Cardiovascular Medicine, Graduated School of Medical Science, Kumamoto University, Kumamoto, Japan
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77
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Enhanced IVUS: Advances Allowing Higher Resolution and Integrated Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9384-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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78
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Deng CX, Hong X, Stegemann JP. Ultrasound Imaging Techniques for Spatiotemporal Characterization of Composition, Microstructure, and Mechanical Properties in Tissue Engineering. TISSUE ENGINEERING PART B-REVIEWS 2016; 22:311-21. [PMID: 26771992 DOI: 10.1089/ten.teb.2015.0453] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ultrasound techniques are increasingly being used to quantitatively characterize both native and engineered tissues. This review provides an overview and selected examples of the main techniques used in these applications. Grayscale imaging has been used to characterize extracellular matrix deposition, and quantitative ultrasound imaging based on the integrated backscatter coefficient has been applied to estimating cell concentrations and matrix morphology in tissue engineering. Spectral analysis has been employed to characterize the concentration and spatial distribution of mineral particles in a construct, as well as to monitor mineral deposition by cells over time. Ultrasound techniques have also been used to measure the mechanical properties of native and engineered tissues. Conventional ultrasound elasticity imaging and acoustic radiation force imaging have been applied to detect regions of altered stiffness within tissues. Sonorheometry and monitoring of steady-state excitation and recovery have been used to characterize viscoelastic properties of tissue using a single transducer to both deform and image the sample. Dual-mode ultrasound elastography uses separate ultrasound transducers to produce a more potent deformation force to microscale characterization of viscoelasticity of hydrogel constructs. These ultrasound-based techniques have high potential to impact the field of tissue engineering as they are further developed and their range of applications expands.
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Affiliation(s)
- Cheri X Deng
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Xiaowei Hong
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan
| | - Jan P Stegemann
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan
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79
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Determining carotid plaque vulnerability using ultrasound center frequency shifts. Atherosclerosis 2016; 246:293-300. [DOI: 10.1016/j.atherosclerosis.2016.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/29/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
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80
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Corban MT, Hung OY, Mekonnen G, Eshtehardi P, Eapen DJ, Rasoul-Arzrumly E, Al Kassem H, Manocha P, Ko YA, Sperling LS, Quyyumi AA, Samady H. Elevated Levels of Serum Fibrin and Fibrinogen Degradation Products Are Independent Predictors of Larger Coronary Plaques and Greater Plaque Necrotic Core. Circ J 2016; 80:931-7. [PMID: 26911453 DOI: 10.1253/circj.cj-15-0768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Co-existence of vulnerable plaque and pro-thrombotic state may provoke acute coronary events. It was hypothesized that elevated serum levels of fibrin and fibrinogen degradation products (FDP) are associated with larger total plaque and necrotic core (NC) areas. METHODS AND RESULTS Seventy-five patients presenting with stable anginal symptoms (69%) or stabilized acute coronary syndrome (ACS; 31%), and found to have non-obstructive coronary artery disease (CAD) with a fractional flow reserve >0.8, were studied. Invasive virtual histology intravascular ultrasound (VH-IVUS) was performed in 68 LAD arteries, 6 circumflex arteries, and 1 right coronary artery. Serum FDP levels were measured using ELISA technique. Plaque volumetrics and composition were assessed in each VH-IVUS frame and averaged. The median age of patients was 56 (47-63) years; 52% were men and 23% had diabetes. The average length of coronary artery studied was 62 mm. After adjustment for systemic risk factors, medications, CRP levels and ACS, male gender (P<0.001) and serum FDP levels (P=0.02) were independent predictors of a larger NC area. Older age (P<0.001), male gender (P<0.0001) and increased serum FDP level (P=0.03) were associated with a larger plaque area. CONCLUSIONS In patients with CAD, a higher serum level of FDP is independently associated with larger plaques and greater plaque NC.
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Affiliation(s)
- Michel T Corban
- Division of Cardiology, Department of Medicine, Emory University School of Medicine
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81
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Koskinas KC, Zaugg S, Yamaji K, García-García HM, Taniwaki M, Klingenberg R, Moschovitis A, Lüscher TF, van Tits LJ, Matter CM, Windecker S, Räber L. Changes of coronary plaque composition correlate with C-reactive protein levels in patients with ST-elevation myocardial infarction following high-intensity statin therapy. Atherosclerosis 2016; 247:154-60. [PMID: 26921743 DOI: 10.1016/j.atherosclerosis.2016.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Levels of inflammatory biomarkers associate with changes of coronary atheroma burden in statin-treated patients with stable coronary artery disease. This study sought to determine changes of plaque composition in vivo in relation to high-sensitivity C-reactive protein (hs-CRP) levels in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin therapy. METHODS The IBIS-4 study performed serial (baseline and 13-month), 2-vessel intravascular ultrasound (IVUS) and radiofrequency-IVUS of the non-infarct-related arteries in patients with STEMI treated with high-intensity statin therapy. The present analysis included 44 patients (80 arteries) with serial measurements of hs-CRP. RESULTS At follow-up, median low-density lipoprotein cholesterol (LDL-C) levels decreased from 126 to 77 mg/dl, HDL-C increased from 44 to 47 mg/dl, and hs-CRP decreased from 1.6 to 0.7 mg/L. Regression of percent atheroma volume (-0.99%, 95% CI -1.84 to -0.14, p = 0.024) was accompanied by reduction of percent fibro-fatty (p = 0.04) and fibrous tissue (p < 0.001), and increase in percent necrotic core (p = 0.006) and dense calcium (p < 0.001). Follow-up levels of hs-CRP, but not LDL-C, correlated with changes in percent necrotic core (p = 0.001) and inversely with percent fibrous tissue volume (p = 0.008). Similarly, baseline-to-follow-up change of hs-CRP correlated with the change in percent necrotic core volume (p = 0.02). CONCLUSIONS In STEMI patients receiving high-intensity statin therapy, stabilization of VH-IVUS-defined necrotic core was confined to patients with lowest on-treatment levels and greatest reduction of hs-CRP. Elevated CRP levels at follow-up may identify progression of high-risk coronary plaque composition despite intensive statin therapy and overall regression of atheroma volume.
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Affiliation(s)
| | - Serge Zaugg
- Clinical Trials Unit, Bern University, Bern, Switzerland
| | - Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Masanori Taniwaki
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Aris Moschovitis
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas F Lüscher
- Cardiology Department, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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82
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Gender differences in plaque characteristics of culprit lesions in patients with ST elevation myocardial infarction. Heart Vessels 2016; 31:1767-1775. [DOI: 10.1007/s00380-016-0806-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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83
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Circulating Microparticles and Coronary Plaque Components Assessed by Virtual Histology Intravascular Ultrasound of the Target Lesion in Patients with Stable Angina. PLoS One 2016; 11:e0148128. [PMID: 26812147 PMCID: PMC4727898 DOI: 10.1371/journal.pone.0148128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/13/2016] [Indexed: 11/23/2022] Open
Abstract
High levels of microparticles (MPs) circulate in the blood of patients with atherosclerotic diseases where they can serve as potential biomarkers of vascular injury and cardiovascular outcome. We used virtual histology intravascular ultrasound (VH-IVUS) to evaluate the relationship between the levels of circulating MPs and the coronary plaque composition in patients with stable angina. We included 35 patients with stable angina (22 men, age 64 ± 9 years) and a de novo target lesion. Preintervention gray-scale and VH-IVUS analysis was performed across the target lesion. Volumetric analysis was performed over a 10-mm-long segment centered at the minimum luminal site. Blood samples were obtained from the femoral artery before coronary angioplasty. MPs were measured using a solid-phase capture assay from a commercial kit. We divided participants into either a low MPs group or high MPs group based on the median value of MPs. There was no significant difference in baseline characteristics between the groups. The plaque burden and remodeling index were similar between the groups. The presence of VH-IVUS-derived thin-cap fibroatheroma was not different between the groups. The percentage of the necrotic core (NC) was significantly higher in the high MPs group than in the low MPs group, both in planar (17.0 ± 8.8% vs. 24.1 ± 6.9%, p = 0.012) and volumetric analyses (17.0 ± 4.8% vs. 22.1 ± 4.3%, p = 0.002). Circulating MPs were positively correlated with the percentage of the NC area at the minimal luminal site (r = 0.491, p = 0.003) and the percentage of the NC volume (r = 0.496, p = 0.002). Elevated levels of circulating MPs were associated with the amount of NC in the target lesion in those with stable angina, suggesting a potential role of circulating MPs as a biomarker for detecting unstable plaque in patients with stable angina.
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84
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Hung OY, Molony D, Corban MT, Rasoul-Arzrumly E, Maynard C, Eshtehardi P, Dhawan S, Timmins LH, Piccinelli M, Ahn SG, Gogas BD, McDaniel MC, Quyyumi AA, Giddens DP, Samady H. Comprehensive Assessment of Coronary Plaque Progression With Advanced Intravascular Imaging, Physiological Measures, and Wall Shear Stress: A Pilot Double-Blinded Randomized Controlled Clinical Trial of Nebivolol Versus Atenolol in Nonobstructive Coronary Artery Disease. J Am Heart Assoc 2016; 5:JAHA.115.002764. [PMID: 26811165 PMCID: PMC4859395 DOI: 10.1161/jaha.115.002764] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background We hypothesized that nebivolol, a β‐blocker with nitric oxide–mediated activity, compared with atenolol, a β‐blocker without such activity, would decrease oxidative stress and improve the effects of endothelial dysfunction and wall shear stress (WSS), thereby reducing atherosclerosis progression and vulnerability in patients with nonobstructive coronary artery disease. Methods and Results In this pilot double‐blinded randomized controlled trial, 24 patients treated for 1 year with nebivolol 10 mg versus atenolol 100 mg plus standard medical therapy underwent baseline and follow‐up coronary angiography with assessments of inflammatory and oxidative stress biomarkers, microvascular function, endothelial function, and virtual histology intravascular ultrasound. WSS was calculated from computational fluid dynamics. Virtual histology intravascular ultrasound segments were assessed for vessel volumetrics and remodeling. There was a trend toward more low‐WSS segments in the nebivolol cohort (P=0.06). Low‐WSS regions were associated with greater plaque progression (P<0.0001) and constrictive remodeling (P=0.04); conversely, high‐WSS segments demonstrated plaque regression and excessive expansive remodeling. Nebivolol patients had decreased lumen and vessel areas along with increased plaque area, resulting in more constrictive remodeling (P=0.002). There were no significant differences in biomarker levels, microvascular function, endothelial function, or number of thin‐capped fibroatheromas per vessel. Importantly, after adjusting for β‐blocker, low‐WSS segments remained significantly associated with lumen loss and plaque progression. Conclusion Nebivolol, compared with atenolol, was associated with greater plaque progression and constrictive remodeling, likely driven by more low‐WSS segments in the nebivolol arm. Both β‐blockers had similar effects on oxidative stress, microvascular function, and endothelial function. Clinical Trial Registration URL: https://clinicaltrials.gov/. Unique identifier: NCT01230892.
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Affiliation(s)
- Olivia Y Hung
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - David Molony
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (D.M., L.H.T., D.P.G.)
| | - Michel T Corban
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Emad Rasoul-Arzrumly
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Charles Maynard
- Department of Health Services, University of Washington, Seattle, WA (C.M.)
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Saurabh Dhawan
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Lucas H Timmins
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.) Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (D.M., L.H.T., D.P.G.)
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA (M.P.)
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.) Division of Cardiology, Department of Internal Medicine, Yonsei UniversityWonju College of Medicine, Wonju, Republic of Korea (S.G.A.)
| | - Bill D Gogas
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Michael C McDaniel
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Don P Giddens
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (D.M., L.H.T., D.P.G.)
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
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85
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Tomai F, De Luca L, Petrolini A, Di Vito L, Ghini AS, Corvo P, De Persio G, Parisi F, Pongiglione G, Giulia Gagliardi M, Prati F. Optical coherence tomography for characterization of cardiac allograft vasculopathy in late survivors of pediatric heart transplantation. J Heart Lung Transplant 2016; 35:74-79. [DOI: 10.1016/j.healun.2015.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/14/2015] [Accepted: 08/27/2015] [Indexed: 01/25/2023] Open
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Enhanced characterization of calcified areas in intravascular ultrasound virtual histology images by quantification of the acoustic shadow: validation against computed tomography coronary angiography. Int J Cardiovasc Imaging 2015; 32:543-52. [PMID: 26667446 PMCID: PMC4819503 DOI: 10.1007/s10554-015-0820-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/27/2015] [Indexed: 01/07/2023]
Abstract
We enhance intravascular ultrasound virtual histology (VH) tissue characterization by fully automatic quantification of the acoustic shadow behind calcified plaque. VH is unable to characterize atherosclerosis located behind calcifications. In this study, the quantified acoustic shadows are considered calcified to approximate the real dense calcium (DC) plaque volume. In total, 57 patients with 108 coronary lesions were included. A novel post-processing step is applied on the VH images to quantify the acoustic shadow and enhance the VH results. The VH and enhanced VH results are compared to quantitative computed tomography angiography (QTA) plaque characterization as reference standard. The correlation of the plaque types between enhanced VH and QTA differs significantly from the correlation with unenhanced VH. For DC, the correlation improved from 0.733 to 0.818. Instead of an underestimation of DC in VH with a bias of 8.5 mm(3), there was a smaller overestimation of 1.1 mm(3) in the enhanced VH. Although tissue characterization within the acoustic shadow in VH is difficult, the novel algorithm improved the DC tissue characterization. This algorithm contributes to accurate assessment of calcium on VH and could be applied in clinical studies.
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87
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Koskinas KC, Ughi GJ, Windecker S, Tearney GJ, Räber L. Intracoronary imaging of coronary atherosclerosis: validation for diagnosis, prognosis and treatment. Eur Heart J 2015; 37:524-35a-c. [DOI: 10.1093/eurheartj/ehv642] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/09/2015] [Indexed: 12/11/2022] Open
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88
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Hong SJ, Kim BK, Shin DH, Kim JS, Ko YG, Choi D, Jang Y, Hong MK. Impact of Coronary Plaque Characteristics on Late Stent Malapposition after Drug-Eluting Stent Implantation. Yonsei Med J 2015; 56:1538-44. [PMID: 26446634 PMCID: PMC4630040 DOI: 10.3349/ymj.2015.56.6.1538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/18/2014] [Accepted: 12/23/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the impact of pre-procedural coronary plaque composition assessed by virtual histology intravascular ultrasound (VH-IVUS) on late stent malapposition assessed by optical coherence tomography (OCT) following drug-eluting stent (DES) implantation. MATERIALS AND METHODS The study population consisted of 121 patients (121 lesions) who underwent both pre-procedural VH-IVUS and follow-up OCT after DES implantation. The association between pre-procedural plaque composition [necrotic core (NC), dense calcium (DC), fibrotic (FT), and fibro-fatty (FF) volumes] assessed by VH-IVUS and late stent malapposition (percent malapposed struts) or strut coverage (percent uncovered struts) assessed by follow-up OCT was evaluated. RESULTS Pre-procedural absolute total NC, DC, FT, and FF plaque volumes were 22.9±19.0, 7.9±9.6, 63.8±33.8, and 16.5±12.4 mm³, respectively. At 6.3±3.1 months post-intervention, percent malapposed and uncovered struts were 0.8±2.5% and 15.3±16.7%, respectively. Pre-procedural absolute total NC and DC plaque volumes were positively correlated with percent malapposed struts (r=0.44, p<0.001 and r=0.45, p<0.001, respectively), while pre-procedural absolute total FT plaque volume was weakly associated with percent malapposed struts (r=0.220, p=0.015). Pre-procedural absolute total DC plaque volume was the only independent predictor of late stent malapposition on multivariate analysis (β=1.12, p=0.002). There were no significant correlations between pre-intervention plaque composition and percent uncovered struts. CONCLUSION Pre-procedural plaque composition was associated with late stent malapposition but not strut coverage after DES implantation. Larger pre-procedural absolute total DC plaque volumes were associated with greater late stent malapposition.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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89
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Virtual Histology-Intravascular Ultrasound. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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90
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Kim K, Wagner WR. Non-invasive and Non-destructive Characterization of Tissue Engineered Constructs Using Ultrasound Imaging Technologies: A Review. Ann Biomed Eng 2015; 44:621-35. [PMID: 26518412 DOI: 10.1007/s10439-015-1495-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/23/2015] [Indexed: 12/14/2022]
Abstract
With the rapid expansion of biomaterial development and coupled efforts to translate such advances toward the clinic, non-invasive and non-destructive imaging tools to evaluate implants in situ in a timely manner are critically needed. The required multi-level information is comprehensive, including structural, mechanical, and biological changes such as scaffold degradation, mechanical strength, cell infiltration, extracellular matrix formation and vascularization to name a few. With its inherent advantages of non-invasiveness and non-destructiveness, ultrasound imaging can be an ideal tool for both preclinical and clinical uses. In this review, currently available ultrasound imaging technologies that have been applied in vitro and in vivo for tissue engineering and regenerative medicine are discussed and some new emerging ultrasound technologies and multi-modality approaches utilizing ultrasound are introduced.
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Affiliation(s)
- Kang Kim
- Center for Ultrasound Molecular Imaging and Therapeutics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA. .,Heart and Vascular Institute, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, 15213, USA. .,Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, PA, 15213, USA. .,McGowan Institute for Regenerative Medicine, University of Pittsburgh and UPMC, Pittsburgh, PA, 15219, USA.
| | - William R Wagner
- Department of Bioengineering, University of Pittsburgh School of Engineering, Pittsburgh, PA, 15213, USA.,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh and UPMC, Pittsburgh, PA, 15219, USA
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91
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Percutaneous Transcatheter Assessment of the Left Main Coronary Artery. JACC Cardiovasc Interv 2015; 8:1529-39. [DOI: 10.1016/j.jcin.2015.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022]
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92
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Qian Z, Dhungel A, Vazquez G, Weeks M, Voros S, Rinehart S. Coronary artery calcium: 0.5 mm slice-thickness reconstruction with adjusted attenuation threshold outperforms 3.0 mm by validating against spatially registered intravascular ultrasound with radiofrequency backscatter. Acad Radiol 2015; 22:1128-37. [PMID: 26036721 DOI: 10.1016/j.acra.2015.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES Coronary artery calcium (CAC) images can be reconstructed with thinner slice thickness on some modern multidetector-row computed tomography scanners without additional radiation. We hypothesized that the isotropic 0.5-mm CAC reconstruction outperforms the conventional 3.0-mm reconstruction in detecting and quantifying coronary calcium, and we proposed to compare them by validating against spatially registered intravascular ultrasound with radiofrequency backscatter-virtual histology (IVUS-VH). MATERIALS AND METHODS Twenty-seven patients were enrolled, and 5976 mm of coronary arteries were analyzed. A semiautomatic software was developed to coregister CAC and IVUS-VH on a detailed slice-by-slice basis. Calcium detection and calcium volume quantification were evaluated and compared using varying calcium attenuation thresholds. Algorithms for deriving individualized optimal threshold and comparable Agatston score on the 0.5-mm reconstruction were developed. RESULTS The isotropic 0.5-mm reconstruction achieved significantly higher area under receiver-operating curve than the conventional 3.0-mm reconstruction (0.9 vs. 0.74, P < .001). Using the optimal threshold, the 0.5-mm reconstruction had higher sensitivity (0.79 vs. 0.65), specificity (0.85 vs. 0.77), positive predictive value (0.42 vs. 0.29), and negative predictive value (0.97 vs. 0.94) than the 3.0 mm. Individualized optimal threshold was significantly correlated with the image noise (r = 0.66, P < .001) in the 0.5-mm reconstruction. CONCLUSIONS By optimizing the calcium threshold, the 0.5-mm reconstruction is superior to the conventional 3.0-mm in detecting and quantifying calcium, which may improve the clinical value of CAC without additional radiation.
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93
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Murray SW, Stables RH, Garcia-Garcia HM, Grayson AD, Shaw MA, Perry RA, Serruys PW, Palmer ND. Construction and validation of a plaque discrimination score from the anatomical and histological differences in coronary atherosclerosis: the Liverpool IVUS-V-HEART (Intra Vascular UltraSound-Virtual-Histology Evaluation of Atherosclerosis Requiring Treatment) study. EUROINTERVENTION 2015; 10:815-23. [PMID: 24472736 DOI: 10.4244/eijv10i7a141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS New markers to help stratify coronary atherosclerosis are needed. Although attempts have been made to differentiate active lesions from those that are stable, none of these has ever been formalised into a discriminatory score. The aim of this study was to analyse the differences between culprit ACS lesions and culprit stable angina lesions with intravascular ultrasound-derived virtual histology and to construct and validate a plaque score. METHODS AND RESULTS Prior to percutaneous coronary intervention (PCI), we performed volumetric, intravascular ultrasound-derived virtual histology (IVUS-VH) analysis in acute coronary syndrome (ACS) culprit lesions (AC - n=70) and stable angina culprit lesions (SC - n=35). A direct statistical comparison of IVUS-VH data and multiple logistic regression analysis was undertaken. Four main factors were found to be associated (p<0.05) with an AC lesion phenotype: necrotic core/dense calcium (NC/DC) ratio; minimum lumen area <4 mm2 (MLA <4); remodelling index @MLA >1.05 and VH-TCFA presence. Calculation of each logistic regression coefficient and the equation produces an active plaque discrimination score with an AUC of 0.96 on receiver operating characteristics (ROC) analysis. Validation of the score in 50 independent plaques from the Thoraxcenter in Rotterdam revealed an AUC of 0.71, confirming continued diagnostic ability. CONCLUSIONS We have found four features on IVUS and VH that can predict and discriminate ACS culprit lesion phenotypes from those that are clinically stable. Subsequently, we have constructed and validated the Liverpool Active Plaque Score based upon these features. It is hoped this score may help diagnose active coronary plaques, in the future, to help prevent major adverse cardiac events.
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Affiliation(s)
- Scott W Murray
- Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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94
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Irving J. CTO pathophysiology: how does this affect management? Curr Cardiol Rev 2015; 10:99-107. [PMID: 24694103 PMCID: PMC4021289 DOI: 10.2174/1573403x10666140331142349] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022] Open
Abstract
Chronic total occlusion (CTO)
pathophysiology has been described in a few, small studies using post mortem
histology, and more recently, in vivo intravascular ultrasound (IVUS) to
analyse the constituents of occluded segments. Recent improvements in equipment
and techniques have revealed new insights into physical characteristics of
occluded coronaries, which in turn enable predictable procedural success. The
purpose of this review is to consider the published evidence describing CTO
pathophysiology from the perspective of the hybrid algorithm approach to CTO
PCI. Methods: Literature
searches using “Chronic Occlusion”, “angioplasty”, and” pathology” as keywords.
Further searches on “coronary” “collateral”, “Viability”. Bibliographies were
scrutinised for further key publications in an iterative process. Papers
describing animal models were excluded.
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95
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Yoon S, Williams J, Kang BJ, Yoon C, Cabrera-Munoz N, Jeong JS, Lee SG, Shung KK, Kim HH. Angled-focused 45 MHz PMN-PT single element transducer for intravascular ultrasound imaging. SENSORS AND ACTUATORS. A, PHYSICAL 2015; 228:16-22. [PMID: 25914443 PMCID: PMC4405812 DOI: 10.1016/j.sna.2015.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A transducer with an angled and focused aperture for intravascular ultrasound imaging has been developed. The acoustic stack for the angled-focused transducer was made of PMN-PT single crystal with one matching layer, one protective coating layer, and a highly damped backing layer. It was then press-focused to a desired focal length and inserted into a thin needle housing with an angled tip. A transducer with an angled and unfocused aperture was also made, following the same fabrication procedure, to compare the performance of the two transducers. The focused and unfocused transducers were tested to measure their center frequencies, bandwidths, and spatial resolutions. Lateral resolution of the angled-focused transducer (AFT) improved more than two times compared to that of the angled-unfocused transducer (AUT). A tissue-mimicking phantom in water and a rabbit aorta tissue sample in rabbit blood were scanned using AFT and AUT. Imaging with AFT offered improved contrast, over imaging with AUT, of the tissue-mimicking phantom and the rabbit aorta tissue sample by 23 dB and 8 dB, respectively. The results show that AFT has strong potential to provide morphological and pathological information of coronary arteries with high resolution and high contrast.
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Affiliation(s)
- Sangpil Yoon
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Jay Williams
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Bong Jin Kang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Changhan Yoon
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Nestor Cabrera-Munoz
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Jong Seob Jeong
- Department of Medical Biotechnology, Dongguk University, Seoul 100-715, Republic of Korea
| | - Sang Goo Lee
- IBULE Photonics Co., Ltd., Incheon, Republic of Korea
| | - K. Kirk Shung
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Hyung Ham Kim
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
- Analogic Corporation, Peabody, MA 01960, USA
- Corresponding author at: 8 Centennial Drive, Peabody, MA 01960, USA. Tel.: +1 978 326 4511. (H.H. Kim)
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96
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Zhang M, Sara JD, Wang FL, Liu LP, Su LX, Zhe J, Wu X, Liu JH. Increased plasma BMP-2 levels are associated with atherosclerosis burden and coronary calcification in type 2 diabetic patients. Cardiovasc Diabetol 2015; 14:64. [PMID: 26003174 PMCID: PMC4450848 DOI: 10.1186/s12933-015-0214-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/08/2015] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Although Bone morphogenetic protein-2 (BMP-2) is a known mediator of bone regeneration and vascular calcification, to date no study has investigated the relationship between BMP-2 and type 2 diabetes mellitus (T2DM) and its possible role in coronary artery disease (CAD). The purpose of this study is to evaluate the relationship of BMP-2 with atherosclerosis and calcification in patients with T2DM. METHODS 124 subjects were enrolled in this study: 29 patients with T2DM and CAD; 26 patients with T2DM and without CAD; 36 patients with CAD and without T2DMand 34 without T2DM or CAD (control group). Severity of coronary lesions was assessed using coronary angiography and intravascular ultrasound (IVUS). Plasma BMP-2 levels were quantified using a commercially available ELISA kit. RESULTS Compared to the control group, the mean plasma BMP-2 level was significantly higher in T2DM patients with or without CAD (20.1 ± 1.7 or 19.3 ± 1.5 pg/ml, vs 17.2 ± 3.3 pg/ml, P < 0.001). In a multivariable linear regression analysis, both T2DM and CAD were significantly and positively associated with BMP-2 (Estimate, 0.249; standard error (SE), 0.063; p <0.0001; Estimate, 0.400; SE, 0.06; p < 0.0001). Plasma BMP-2 was also strongly correlated with glycosylated hemoglobin A1c (HbA1c) (Spearman ρ = -0.31; p = 0.0005). SYNTAX score was also significantly associated with BMP-2 (Spearman ρ = 0.46; p = 0.0002). Using the results from IVUS, plasma BMP-2 levels were shown to positively correlate with plaque burden (Spearman ρ = 0.38, P = 0.002) and plaque calcification (Spearman ρ =0.44, P = 0.0003) and to negatively correlate with lumen volume (Spearman ρ =0.31, P = 0.01). CONCLUSIONS Our study demonstrates that patients with T2DM had higher circulating levels of BMP-2 than normal controls. Plasma BMP-2 levels correlated positively with plaque burden and calcification in patients with T2DM.
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Affiliation(s)
- Ming Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China.
- Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.
| | - Jaskanwal Deep Sara
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
| | - Fei-long Wang
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
| | - Li-Ping Liu
- Department of Nephrology, First Hospital of Tsinghua University, Beijing, China.
| | - Li-Xiao Su
- Department of Biostatistics, Rutgers School of Public Health, The State University of New Jersey, Piscataway, NJ, USA.
| | - Jing Zhe
- Department of Biostatistics, University at Buffalo, the State University of New York, Buffalo, NY, 14214, USA.
| | - Xi Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China.
- Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.
| | - Jing-hua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China.
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Koskinas KC, Windecker S, Räber L. Regression of coronary atherosclerosis: Current evidence and future perspectives. Trends Cardiovasc Med 2015; 26:150-61. [PMID: 26089122 DOI: 10.1016/j.tcm.2015.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/09/2015] [Accepted: 05/09/2015] [Indexed: 12/20/2022]
Abstract
Coronary atherosclerosis has been considered a chronic disease characterized by ongoing progression in response to systemic risk factors and local pro-atherogenic stimuli. As our understanding of the pathobiological mechanisms implicated in atherogenesis and plaque progression is evolving, effective treatment strategies have been developed that led to substantial reduction of the clinical manifestations and acute complications of coronary atherosclerotic disease. More recently, intracoronary imaging modalities have enabled detailed in vivo quantification and characterization of coronary atherosclerotic plaque, serial evaluation of atherosclerotic changes over time, and assessment of vascular responses to effective anti-atherosclerotic medications. The use of intracoronary imaging modalities has demonstrated that intensive lipid lowering can halt plaque progression and may even result in regression of coronary atheroma when the highest doses of the most potent statins are used. While current evidence indicates the feasibility of atheroma regression and of reversal of presumed high-risk plaque characteristics in response to intensive anti-atherosclerotic therapies, these changes of plaque size and composition are modest and their clinical implications remain largely elusive. Growing interest has focused on achieving more pronounced regression of coronary plaque using novel anti-atherosclerotic medications, and more importantly on elucidating ways toward clinical translation of favorable changes of plaque anatomy into more favorable clinical outcomes for our patients.
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Affiliation(s)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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98
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Campos CM, Fedewa RJ, Garcia-Garcia HM, Vince DG, Margolis MP, Lemos PA, Stone GW, Serruys PW, Nair A. Ex vivovalidation of 45 MHz intravascular ultrasound backscatter tissue characterization. Eur Heart J Cardiovasc Imaging 2015; 16:1112-9. [DOI: 10.1093/ehjci/jev039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/14/2022] Open
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Sato T, Kameyama T, Noto T, Ueno H, Inoue H. Enhanced expression of hemoglobin scavenger receptor CD163 in accumulated macrophages within filtered debris between acute coronary syndromes and stable angina pectoris. Int Heart J 2015; 56:150-6. [PMID: 25740391 DOI: 10.1536/ihj.14-224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary intraplaque hemorrhage up-regulates hemoglobin scavenger receptor CD163 expression on macrophages, and has an association with vulnerable plaque development. During percutaneous coronary intervention, mechanical plaque disruption exposes potentially embolic atheromatous contents from culprit plaque.In 37 patients with stable angina pectoris (SAP, n = 20) or acute coronary syndrome (ACS, n = 17), atherothrombotic debris was collected using a filter-based distal embolic protection device. We immunohistochemically determined CD14-positive macrophages and CD163-positive macrophages in filtered debris. We also examined the relation of CD14- and CD163-positive macrophages with culprit plaque volume and components evaluated with ultrasonic tissue characterization (VH-IVUS).The only significant difference in clinical characteristics between the two groups was in hs-CRP. In ACS, the percentage of CD14- and CD163-positive macrophages to the whole cells (%CD14 and %CD163, respectively) was significantly higher than that in SAP (20.1 ± 8.2 versus 8.8 ± 6.8%, P < 0.001 and 32.6 ± 18.9 versus 9.0 ± 3.8%, P < 0.001, respectively). In IVUS indices of culprit plaque, the remodeling index was significantly higher in ACS than in SAP. However, necrotic core component (%NC) in ACS was significantly higher than that in SAP. Furthermore, fibrotic component (%Fibrous) in ACS was significantly lower than that in SAP (56.1 ± 4.7 versus 60.1 ± 3.3%, P = 0.03). %CD14 and %CD163 had a significant positive correlation with %NC (%CD14: r = 0.40, P = 0.01 and %CD163: r = 0.45, P = 0.01), but only %CD163 was negatively correlated with %Fibrous (%CD163: r = -0.48, P = 0.01).These findings suggest that the presence of CD14- and CD163-positive macrophages may reflect plaque inflammation, NC expansion, and plaque vulnerability in patients with coronary heart disease.
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Affiliation(s)
- Takao Sato
- Second Department of Internal Medicine, University of Toyama
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100
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Reproducibility of intravascular ultrasound radiofrequency data analysis (virtual histology) with a 45-MHz rotational imaging catheter in ex vivo human coronary arteries. J Cardiol 2015; 65:134-42. [DOI: 10.1016/j.jjcc.2014.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/01/2014] [Accepted: 05/07/2014] [Indexed: 11/22/2022]
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