101
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Toczek J. Evolution of arterial [ 18F]-sodium fluoride uptake and calcification. J Nucl Cardiol 2021; 28:1946-1948. [PMID: 31792919 DOI: 10.1007/s12350-019-01969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jakub Toczek
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, USA.
- Veterans Affairs Connecticut Healthcare System, West Haven, USA.
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102
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Anderson JL, Knight S, McCubrey RO, May HT, Mason S, Bunch TJ, Min DB, Cutler MJ, Le VT, Muhlestein JB, Knowlton KU. Absent or Mild Coronary Calcium Predicts Low-Risk Stress Test Results and Outcomes in Patients Considered for Flecainide Therapy. J Cardiovasc Pharmacol Ther 2021; 26:648-655. [PMID: 34546822 DOI: 10.1177/10742484211046671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Flecainide is a useful antiarrhythmic for atrial fibrillation (AF). However, because of ventricular proarrhythmia risk, a history of myocardial infarction (MI) or coronary artery disease (CAD) is a flecainide exclusion, and stress testing is used to exclude ischemia. We assessed whether absent/mild coronary artery calcium (CAC) can supplement or avoid the need for stress testing. METHODS We assessed ischemic burden using regadenoson Rb-82 PET/CT in 1372 AF patients ≥50 years old without symptoms or signs of clinical CAD. CAC was determined qualitatively by low dose attenuation computed tomography (CT) (n = 816) or by quantitative CT (n = 556). Ischemic burden and clinical outcomes were compared by CAC burden. RESULTS Patients with CAC absent or mild (n = 766, 57.2%) were younger, more frequently female, and had higher BMI but lower rates of diabetes, hypertension, and dyslipidemia. Average ischemic burden was lower in CAC-absent/mild patients, and CAC-absent/mild patients showed greater coronary flow reserve, had fewer referrals for coronary angiography, and less often had obstructive CAD. Revascularization at 90 days was lower, and the rate of longer-term major adverse cardiovascular events was favorable. CONCLUSIONS An easily administered, inexpensive, low radiation CAC scan can identify a subset of flecainide candidates with a low ischemic burden on PET stress testing that rarely needs coronary angiography/intervention and has favorable outcomes. Absent or mild CAC-burden combined with other clinical information may avoid or complement routine stress testing. However, additional, ideally randomized and multicenter trials are indicated to confirm these findings before replacing stress testing with CAC screening in selecting patients for flecainide therapy in clinical practice.
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Affiliation(s)
- Jeffrey L Anderson
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Stacey Knight
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Raymond O McCubrey
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Heidi T May
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Steve Mason
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Thomas J Bunch
- 14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - David B Min
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Michael J Cutler
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Viet T Le
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,Rocky Mountain University of Health Professionals, Provo, UT, USA
| | - Joseph B Muhlestein
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Kirk U Knowlton
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,14434University of Utah, School of Medicine, Salt Lake City, UT, USA
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103
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Computed tomography of coronary artery atherosclerosis: A review. J Med Imaging Radiat Sci 2021; 52:S19-S39. [PMID: 34479831 DOI: 10.1016/j.jmir.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022]
Abstract
Coronary artery atherosclerosis resulting in ischemic cardiac disease is the leading cause of mortality in the United States. In symptomatic patients, invasive diagnostic methods like catheter angiography, intravascular ultrasound, or vascular endoscopy may be used. However, for primary prevention of atherosclerotic coronary artery disease in asymptomatic patients, non-invasive methods are more commonly utilized like stress imaging, single-photon emission computed tomography (SPECT) and coronary artery calcification scoring. Coronary computed tomographic angiography (CCTA) is an excellent diagnostic tool for detection of coronary artery plaque and ability to identify resultant stenoses with an excellent negative predictive value which can potentially result in optimal exclusion of the presence of coronary artery disease. Long term follow up after a negative CCTA has repeatedly demonstrated very low incidence of future adverse coronary events, attesting its predictive value. CCTA based management is associated with improved CAD outcome in stable angina. Coronary CTA is valuable in acute chest pain evaluation in the emergency department helping in better triage. CT perfusion and CT-FFR are both very promising tools for assessment of hemodynamic significance of coronary artery stenosis.
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104
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van den Hoogen IJ, van Rosendael AR, Lin FY, Gianni U, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Hyun Choi J, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic J, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Virmani R, Samady H, Stone PH, Narula J, Chang HJ, Min JK, Shaw LJ, Bax JJ. Measurement of compensatory arterial remodelling over time with serial coronary computed tomography angiography and 3D metrics. Eur Heart J Cardiovasc Imaging 2021; 23:1336-1344. [PMID: 34468717 DOI: 10.1093/ehjci/jeab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The magnitude of alterations in which coronary arteries remodel and narrow over time is not well understood. We aimed to examine changes in coronary arterial remodelling and luminal narrowing by three-dimensional (3D) metrics from serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicentre registry of patients with suspected coronary artery disease who underwent clinically indicated serial CCTA (median interscan interval = 3.3 years), we quantitatively measured coronary plaque, vessel, and lumen volumes on both scans. Primary outcome was the per-segment change in coronary vessel and lumen volume from a change in plaque volume, focusing on arterial remodelling. Multivariate generalized estimating equations including statins were calculated comparing associations between groups of baseline percent atheroma volume (PAV) and location within the coronary artery tree. From 1245 patients (mean age 61 ± 9 years, 39% women), a total of 5721 segments were analysed. For each 1.00 mm3 increase in plaque volume, the vessel volume increased by 0.71 mm3 [95% confidence interval (CI) 0.63 to 0.79 mm3, P < 0.001] with a corresponding reduction in lumen volume by 0.29 mm3 (95% CI -0.37 to -0.21 mm3, P < 0.001). Serial 3D arterial remodelling and luminal narrowing was similar in segments with low and high baseline PAV (P ≥ 0.496). No differences were observed between left main and non-left main segments, proximal and distal segments and side branch and non-side branch segments (P ≥ 0.281). CONCLUSIONS Over time, atherosclerotic coronary plaque reveals prominent outward arterial remodelling that co-occurs with modest luminal narrowing. These findings provide additional insight into the compensatory mechanisms involved in the progression of coronary atherosclerosis.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Ontact Health, Inc, Seoul, South Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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105
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Masuda T, Nakaura T, Funama Y, Oda S, Okimoto T, Sato T, Noda N, Yoshiura T, Baba Y, Arao S, Hiratsuka J, Awai K. Deep learning with convolutional neural network for estimation of the characterisation of coronary plaques: Validation using IB-IVUS. Radiography (Lond) 2021; 28:61-67. [PMID: 34404578 DOI: 10.1016/j.radi.2021.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Deep learning approaches have shown high diagnostic performance in image classifications, such as differentiation of malignant tumors and calcified coronary plaque. However, it is unknown whether deep learning is useful for characterizing coronary plaques without the presence of calcification using coronary computed tomography angiography (CCTA). The purpose of this study was to compare the diagnostic performance of deep learning with a convolutional neural network (CNN) with that of radiologists in the estimation of coronary plaques. METHODS We retrospectively enrolled 178 patients (191 coronary plaques) who had undergone CCTA and integrated backscatter intravascular ultrasonography (IB-IVUS) studies. IB-IVUS diagnosed 81 fibrous and 110 fatty or fibro-fatty plaques. We manually captured vascular short-axis images of the coronary plaques as Portable Network Graphics (PNG) images (150 × 150 pixels). The display window level and width were 100 and 700 Hounsfield units (HU), respectively. The deep-learning system (CNN; GoogleNet Inception v3) was trained on 153 plaques; its performance was tested on 38 plaques. The area under the curve (AUC) obtained by receiver operating characteristic analysis of the deep learning system and by two board-certified radiologists was compared. RESULTS With the CNN, the AUC and the 95% confidence interval were 0.83 and 0.69-0.96, respectively; for radiologist 1 they were 0.61 and 0.42-0.80; for radiologist 2 they were 0.68 and 0.51-0.86, respectively. The AUC for CNN was significantly higher than for radiologists 1 (p = 0.04); for radiologist 2 it was not significantly different (p = 0.22). CONCLUSION DL-CNN performed comparably to radiologists for discrimination between fatty and fibro-fatty plaque on CCTA images. IMPLICATIONS FOR PRACTICE The diagnostic performance of the CNN and of two radiologists in the assessment of 191 ROIs on CT images of coronary plaques whose type corresponded with their IB-IVUS characterization was comparable.
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Affiliation(s)
- T Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki-city, Okayama 701-0193, Japan.
| | - T Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Y Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - S Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - T Okimoto
- Department of Cardiovascular Internal Medicine, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - T Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - N Noda
- Department of Radiological Technologist, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan
| | - T Yoshiura
- Department of Radiological Technology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, Hiroshima 730-8655, Japan
| | - Y Baba
- Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama-Pref, 350-1298, Japan
| | - S Arao
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki-city, Okayama 701-0193, Japan
| | - J Hiratsuka
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki-city, Okayama 701-0193, Japan
| | - K Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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106
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Bax AM, van Rosendael AR, Ma X, van den Hoogen IJ, Gianni U, Tantawy SW, Hollenberg EJ, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Virmani R, Samady H, Stone PH, Berman DS, Min JK, Narula J, Lin FY, Chang HJ, Shaw LJ. Comparative differences in the atherosclerotic disease burden between the epicardial coronary arteries: quantitative plaque analysis on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:322-330. [PMID: 33215192 DOI: 10.1093/ehjci/jeaa275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS Anatomic series commonly report the extent and severity of coronary artery disease (CAD), regardless of location. The aim of this study was to evaluate differences in atherosclerotic plaque burden and composition across the major epicardial coronary arteries. METHODS AND RESULTS A total of 1271 patients (age 60 ± 9 years; 57% men) with suspected CAD prospectively underwent coronary computed tomography angiography (CCTA). Atherosclerotic plaque volume was quantified with categorization by composition (necrotic core, fibrofatty, fibrous, and calcified) based on Hounsfield Unit density. Per-vessel measures were compared using generalized estimating equation models. On CCTA, total plaque volume was lowest in the LCx (10.0 ± 29.4 mm3), followed by the RCA (32.8 ± 82.7 mm3; P < 0.001), and LAD (58.6 ± 83.3 mm3; P < 0.001), even when correcting for vessel length or volume. The prevalence of ≥2 high-risk plaque features, such as positive remodelling or spotty calcification, occurred less in the LCx (3.8%) when compared with the LAD (21.4%) or RCA (10.9%, P < 0.001). In the LCx, the most stenotic lesion was categorized as largely calcified more often than in the RCA and LAD (55.3% vs. 39.4% vs. 32.7%; P < 0.001). Median diameter stenosis was also lowest in the LCx (16.2%) and highest in the LAD (21.3%; P < 0.001) and located more distal along the LCx when compared with the RCA and LAD (P < 0.001). CONCLUSION Atherosclerotic plaque, irrespective of vessel volume, varied across the epicardial coronary arteries; with a significantly lower burden and different compositions in the LCx when compared with the LAD and RCA. These volumetric and compositional findings support a diverse milieu for atherosclerotic plaque development and may contribute to a varied acute coronary risk between the major epicardial coronary arteries.
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Affiliation(s)
- A Maxim Bax
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Alexander R van Rosendael
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Inge J van den Hoogen
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Umberto Gianni
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Sara W Tantawy
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Emma J Hollenberg
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Daniele Andreini
- Department of Medicine, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
| | | | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan University Hospital, Busan, South Korea
| | - Edoardo Conte
- Department of Medicine, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Hugo Marques
- Department of Radiology,UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- Department of Radiology,UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal.,Department of Cardiology, NOVA Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Gianluca Pontone
- Department of Medicine, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Fay Y Lin
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Leslee J Shaw
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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107
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Casolo G, Gabrielli D, Colivicchi F, Murrone A, Grosseto D, Gulizia MM, Di Fusco S, Domenicucci S, Scotto di Uccio F, Di Tano G, Orso F, Grippo G, Abrignani M, Valente S, Corda M. ANMCO POSITION PAPER: Prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis. Eur Heart J Suppl 2021; 23:C164-C175. [PMID: 34456643 PMCID: PMC8388609 DOI: 10.1093/eurheartj/suab072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis often affects the coronary arterial tree. Frequently the disease does not translate in significant narrowing of the vessels, thus determining only a non-obstructive disease. This condition that is described as non-obstructive coronary artery disease (NobsCAD) should be distinguished from the absence of disease (i.e. smooth coronary arteries) as it carries a specific prognostic value. The detection and reporting of NobsCAD should prompt preventive measures that can be individualized upon the degree of the underlying burden of disease. The accompanying clinical condition, the other cardiovascular risk factors present, and the description of the severity and extent of NobsCAD should provide the framework for an individualized treatment that should also consider the best available scientific evidence and guidelines. The description of NobsCAD represents important information to be collected whenever a coronary angiogram (both invasive and non-invasive) is performed. Treating the patient according to the presence and extent of NobsCAD offers prognostic benefits well beyond those offered by considering only the traditional cardiovascular risk factors. In order to reach this goal, NobsCAD should not be confused with the absence of coronary atherosclerosis or even ignored when detected as if it was a trivial information to provide.
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Affiliation(s)
- Giancarlo Casolo
- Cardiology Department, Ospedale Versilia, Lido di Camaiore (LU), Via Aurelia 335, 55041 Lido di Camaiore, Italy
| | - Domenico Gabrielli
- Cardiology-CCU Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Adriano Murrone
- Cardiology Department, Ospedali di Castello e Gubbio-Gualdo Tadino, Azienda USL Umbria 1, Perugia, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo Cuore, Heart Care Foundation, Via la Marmora 36, Florence, Italy
| | - Stefania Di Fusco
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | | | | | | | - Francesco Orso
- Cardiology and Geriatric Medicine Department, AOU Careggi, Firenze, Italy
| | | | | | - Serafina Valente
- Clinical-Surgical Cardiology and ICU Department, Ospedale Santa Maria alle Scotte, Siena, A.O.U. Senese, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
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108
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Nakamoto Y, Kitagawa T, Sasaki K, Tatsugami F, Awai K, Hirokawa Y, Kihara Y. Clinical implications of 18F-sodium fluoride uptake in subclinical aortic valve calcification: Its relation to coronary atherosclerosis and its predictive value. J Nucl Cardiol 2021; 28:1522-1531. [PMID: 31482532 DOI: 10.1007/s12350-019-01879-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uptake of 18F-sodium fluoride (18F-NaF) on positron emission tomography (PET) reflects active calcification. Application of this technique in the early phase of aortic valve calcification (AVC) is of clinical interest. We investigated clinical implications of 18F-NaF uptake in subclinical AVC evaluated simultaneously with coronary atherosclerosis, and the utility of 18F-NaF uptake in predicting AVC progression. METHODS We studied 25 patients with subclinical AVC and coronary plaques detected on computed tomography (CT) who underwent 18F-NaF PET/CT. AVC score, volume, mean density, and the presence of high-risk coronary plaque were evaluated on CT in each patient. Focal 18F-NaF uptake in AVC and in coronary plaques was quantified with the maximum tissue-to-background ratio (TBRmax). RESULTS There were positive correlations between AVC TBRmax (A-TBRmax) and AVC parameters on CT. The 14 patients with high-risk coronary plaque had significantly higher A-TBRmax than those without such plaque (1.60 ± 0.18 vs 1.42 ± 0.13, respectively; P = 0.012). A-TBRmax positively correlated with maximum TBRmax of coronary plaque per patient (r = 0.55, P = 0.0043). In the 11 patients who underwent follow-up CT scan, A-TBRmax positively correlated with subsequent increase in AVC score (r = 0.74, P = 0.0091). CONCLUSION Our 18F-NaF PET- and CT-based data indicate relationships between calcification activity in subclinical AVC and characteristics of coronary atherosclerosis. 18F-NaF PET may provide new information regarding molecular conditions and future progression of subclinical AVC.
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Affiliation(s)
- Yumiko Nakamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Ko Sasaki
- Hiroshima Heiwa Clinic, Hiroshima, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Impact of atherosclerotic extent on clinical outcome for diabetic patients with non-obstructive coronary artery disease. ATHEROSCLEROSIS PLUS 2021; 44:10-17. [PMID: 36644667 PMCID: PMC9833230 DOI: 10.1016/j.athplu.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/18/2023]
Abstract
Background and aims The prognostic impact of non-obstructive coronary artery disease (CAD) has long been underestimated due to its mild stenosis (<50% stenosis). We aim to investigate the prognostic value of atherosclerotic extent in DM patients with non-obstructive CAD. Methods The analysis was based on a single center cohort of DM patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD in 2015-2017. Based on coronary stenosis combined with segment involvement score (SIS), the study population were divided into four groups: normal (0% stenosis), non-obstructive SIS<3, non-obstructive SIS≥3 and obstructive (≥50% stenosis). The intra-class correlation (ICC) was used to test the inter-and intra-reviewer agreement. Multivariate Cox model and Kaplan-Meier method were used to evaluate the effect size of atherosclerotic extent on the prognosis. Results In total, 1241 patients (age 60.2 ± 10.4 years, 54.1% male) were included, of which 50.2% were non-obstructive. During a median follow-up of 2.6 years, 131 MACEs (10.6%) were adjudicated, including 17 cardiovascular deaths, 28 non-fatal myocardial infarctions, 64 unstable anginas requiring hospitalization and 22 strokes. Incremental event rates could be observed across the four groups. After adjustment for age, gender, hyperlipidemia and presence of high-risk plaque, Hazard Ratio (HR) for non-obstructive SIS<3, non-obstructive SIS≥3 and the obstructive group was 1.84 (95%CI: 0.70-4.79), 3.71 (95%CI: 1.37-10.00) and 5.46 (95%CI: 2.18-13.69), respectively. Compared with non-obstructive SIS<3, non-obstructive SIS≥3 showed a significantly higher risk (HR:2.02 95%CI:1.11-3.68, p = 0.021). Similar results were demonstrated when Leiden risk score was used for sensitivity analysis. Conclusion In DM patients with non-obstructive CAD, atherosclerotic extent was associated with higher risk of major adverse cardiac events at long-term follow-up. Efforts should be made to determine risk stratification for the management of DM patients with non-obstructive CAD.
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Luo G, Qian Y, Sheng X, Sun J, Wu Z, Liao F, Feng Q, Yin Y, Ding S, Pu J. Elevated Serum Levels of Soluble ST2 Are Associated With Plaque Vulnerability in Patients With Non-ST-Elevation Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:688522. [PMID: 34368249 PMCID: PMC8341076 DOI: 10.3389/fcvm.2021.688522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Recent studies have suggested that soluble suppression of tumorigenicity-2 (sST2), an inflammation-related protein receptor, is associated with atherosclerotic diseases. This study aimed to investigate the potential predictive value of sST2 on plaque vulnerability by assessing whether elevated serum levels of sST2 are associated with vulnerable plaque features in patients with non-ST-elevation acute coronary syndrome (ACS). Methods: A total of 120 patients with non-ST-elevation ACS (167 lesions) were prospectively enrolled and evaluated by standard coronary computed tomography angiography (CCTA) and coronary angiography in this study. Serum sST2 levels were measured by ELISA (Presage® ST2 Assay Kit, Critical Diagnostics), and semiautomated software (QAngioCT, Medis) was used to quantify coronary plaques. Results: The included patients were divided into 4 groups by serum sST2 level quartiles. Volumetric analysis of the whole lesion revealed that patients with higher sST2 levels had a larger absolute necrotic core (NC) volume (Quartile 4 vs. Quartile 1, 86.16 ± 59.71 vs. 45.10 ± 45.80 mm3, P = 0.001; Quartile 4 vs. Quartile 2, 86.16 ± 59.71 vs. 50.22 ± 42.56 mm3, P = 0.002) and a higher NC percentage (Quartile 4 vs. Quartile 1, 35.16 ± 9.82 vs. 23.21 ± 16.18%, P < 0.001; Quartile 4 vs. Quartile 2, 35.16 ± 9.82% vs. 22.50 ± 14.03%, P < 0.001; Quartile 4 vs. Quartile 3, 35.16 ± 9.82% vs. 25.04 ± 14.48%, P < 0.001). Correlation analysis revealed that serum sST2 levels were positively correlated with the NC (r = 0.323, P < 0.001) but negatively correlated with dense calcium (r = −0.208, P = 0.007). Furthermore, among those with plaque calcification, patients with spotty calcification exhibited higher serum sST2 levels than those with large calcification (26.06 ± 16.54 vs. 17.55 ± 7.65 ng/mL, P = 0.002). No significant differences in plaque components at the level of the minimal lumen area (MLA) were found among the groups. Conclusions: Serum sST2 levels were correlated with different coronary plaque components in patients with non-ST-elevation ACS. A higher serum level of sST2 was correlated with plaque vulnerability. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04797819.
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Affiliation(s)
- Guqing Luo
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuxuan Qian
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xincheng Sheng
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiateng Sun
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhinan Wu
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Fei Liao
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qi Feng
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yan Yin
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
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Ichikawa K, Miyoshi T, Osawa K, Miki T, Toda H, Ejiri K, Yoshida M, Nakamura K, Morita H, Ito H. Incremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease. Eur J Prev Cardiol 2021; 28:2059-2066. [PMID: 34279027 DOI: 10.1093/eurjpc/zwab120] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022]
Abstract
AIMS This study aimed to investigate additional risk stratification benefits of hepatic steatosis (HS) concurrently assessed during coronary computed tomography angiography (CTA) in a large patient cohort with suspected stable coronary artery disease (CAD). METHODS AND RESULTS In this prospective study, 1148 Japanese outpatients without a history of CAD who underwent coronary CTA for suspected stable CAD (mean age 64 ± 14 years) were included. HS, defined on CT as a hepatic-to-spleen attenuation ratio of <1.0, was examined just before the evaluation of adverse CTA findings, defined as obstructive and/or high-risk plaque. The major adverse cardiac events (MACE) were the composite of cardiac death, acute coronary syndrome, and late revascularization. The incremental predictive value of HS was evaluated using the global χ2 test and C-statistic. HS was identified in 247 (22%) patients. During a median follow-up of 3.9 years, MACE was observed in 40 (3.5%) patients. HS was significantly associated with MACE in a model that included adverse CTA findings (hazard ratio 4.01, 95% confidence interval 2.12-7.59, P < 0.001). By adding HS to the Framingham risk score and adverse CTA findings, the global χ2 score and C-statistic significantly increased from 29.0 to 49.5 (P < 0.001) and 0.74 to 0.81 (P = 0.026), respectively. In subgroup analyses in patients with diabetes mellitus and metabolic syndrome, HS had significant additive predictive value for MACE over the Framingham risk score and adverse CTA findings. CONCLUSION In patients with suspected stable CAD, concurrent evaluation of HS during coronary CTA enables more accurate detection of patients at higher risk of MACE.
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Affiliation(s)
- Keishi Ichikawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kazuhiro Osawa
- Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan, Okayama 700-8505, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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Hybrid Imaging to Assess the Impact of Vulnerable Plaque on Post Myocardial Infarction Myocardial Scar. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Multimodality imaging improves the accuracy of cardiac assessment in patients with prior myocardial infarction. The aim of this study was to investigate the association between coronary plaque vulnerability (PV) and myocardial viability in the territory irrigated by the infarct-related artery (IRA). Secondary objectives include evaluation of the systemic inflammation but also different cardiac risk scores (SYNTAX score, Duke jeopardy score, or calcium score) using hybrid imaging models of coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) in patients who have suffered a previous myocardial infarction (MI). Material and methods: The study included 45 subjects with documented MI in the 30 days prior to study enrolment, who underwent CCTA and CMR examinations. Computational postprocessing of CCTA and CMR images was used to generate fused imaging models. Based on the vulnerability degree of the associated non-culprit lesion located proximally in the IRA, the study population was divided into 3 groups: Group 1 – subjects with no sign of vulnerability (n = 7); Group 2 – subjects with 1 or 2 CT vulnerability features (n = 28); and Group 3 – subjects with >2 features of vulnerability (n = 12). Results: CCTA features indicative for the severity of coronary artery disease were not different between groups in terms of calcium scoring (460 ± 501 vs. 579 ± 430 vs. 432 ± 494, p = 0.7) or SYNTAX score (25 ± 9.2 vs. 24.9 ± 8.3 vs. 20.2 ± 11.9, p = 0.4). However, after 1 month, infarct size and the Duke jeopardy score were associated with increased PV (infarct size 8.77 ± 3.4 g in Group 1, compared to 20.87 ± 8.3 g in Group 2 and 27.99 ± 11.8 g in Group 3 (p = 0.007), while the Duke jeopardy score was 4.4 ± 1.6 in Group 1, vs. 7.07 ± 2.1 in Group 2 vs. 7.5 ± 1.73 in Group 3 (p = 0.01). Inflammatory biomarkers were directly associated with coronary plaque vulnerability (p = 0.007 for hs-CRP and p = 0.038 for MMP-9). Conclusion: In patients with prior myocardial infarction, the size of myocardial scar was directly correlated with the vulnerability degree of coronary plaques and with systemic inflammation quantified during the acute phase of the coronary event. Hybrid imaging may help to identify the hemodynamically significant plaques with superior accuracy.
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113
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Patel AA, Budoff MJ. Coronary Artery Disease in Patients with HIV Infection: An Update. Am J Cardiovasc Drugs 2021; 21:411-417. [PMID: 33184766 DOI: 10.1007/s40256-020-00451-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Premature cardiovascular disease among the HIV-infected population is of great concern among clinicians. The increased life expectancy of HIV-infected individuals is mainly due to the early detection of infection and the advent of antiretroviral therapy. Once known as a deadly disease, HIV infection has transitioned into a chronic condition. Cardiovascular disease in this population is thought to progress early due to traditional and non-traditional risk factors. Early detection of subclinical atherosclerosis has become a center of focus in research as our complete understanding of this process it not yet well known. Advancements in cardiac computed tomography angiography has enabled the exploration of coronary artery disease by further evaluation of coronary stenosis and plaque analysis. An increase in cardiovascular event rates in this population is currently thought to be linked to antiretroviral therapy, Framingham risk factors, and HIV. We sought to present an updated comprehensive review of the available literature on HIV related to atherosclerosis and cardiovascular risk.
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Affiliation(s)
- Amish A Patel
- Division of Cardiology, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
- Division of Cardiology, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
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Yang S, Lee SP, Park JB, Lee H, Kang SH, Lee SE, Kim JB, Choi SY, Kim YJ, Chang HJ. PM2.5 concentration in the ambient air is a risk factor for the development of high-risk coronary plaques. Eur Heart J Cardiovasc Imaging 2021; 20:1355-1364. [PMID: 31410457 DOI: 10.1093/ehjci/jez209] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS We aimed to investigate whether long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) in the ambient air is related to the development or growth of coronary plaques. METHODS AND RESULTS This study involved 364 residents of Seoul, Korea, who underwent serial coronary computed tomographic angiography (CCTA) at an interval of ≥2 years. Each participant's average concentration of residential PM2.5 between the two CCTAs was calculated. Primary endpoint was the development of high-risk plaque (HRP), defined as a plaque with low attenuation, spotty calcium, and positive remodelling. Secondary endpoints were the volume increase of total plaque and its component volume. Among those without HRP at baseline (n = 341), 20 patients developed HRP at follow-up CCTA, the residential PM2.5 concentration of which was significantly higher than those without HRP at follow-up (25.8 ± 2.0 vs. 25.0 ± 1.7 μg/m3 for patients with newly developed HRP vs. patients without HRP at follow-up; P = 0.047). An increase in PM2.5 concentration was associated with increased incidence of HRP at follow-up [adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.22-2.15, P < 0.001]. In a secondary analysis, the PM2.5 concentration was associated with an increased risk of the formation of either fibrofatty or necrotic core component in newly developed plaques (aHR 1.41, 95% CI 1.23-1.61, P < 0.001), and with a higher risk of total plaque volume progression in the pre-existing plaques (aHR 1.14, 95% CI 1.05-1.23, P = 0.002). CONCLUSION Exposure to higher concentration of PM2.5 in the ambient air is significantly associated with the development of high-risk coronary plaques.
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Affiliation(s)
- Seokhun Yang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 737, Yeoksam-dong, Gangnam-gu, Seoul 06236, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Juyong Brian Kim
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 737, Yeoksam-dong, Gangnam-gu, Seoul 06236, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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Otaki Y, Han D, Klein E, Gransar H, Park RH, Tamarappoo B, Hayes SW, Friedman JD, Thomson LEJ, Slomka PJ, Dey D, Cheng V, Miller RJ, Berman DS. Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRct. J Cardiovasc Comput Tomogr 2021; 16:27-33. [PMID: 34246594 DOI: 10.1016/j.jcct.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone. METHODS Per-vessel FFRct was computed in 1,395 vessels of 836 patients undergoing CCTA with 25-99% maximal stenosis. By consensus analysis, stenosis severity was graded as 25-49%, 50-69%, 70-89%, and 90-99%. HRPs including low attenuation plaque (LAP), positive remodeling (PR), and spotty calcification (SC) were assessed in lesions with maximal stenosis. Lesion FFRct was measured distal to the lesion with maximal stenosis, and FFRct<0.80 was defined as abnormal. Association of HRP and abnormal lesion FFRct was evaluated by univariable and multivariable logistic regression models. RESULTS The frequency of abnormal lesion FFRct increased with increase of stenosis severity across each stenosis category (25-49%:6%; 50-69%:30%; 70-89%:54%; 90-99%:91%, p < 0.001). Univariable analysis demonstrated that stenosis severity, LAP, and PR were predictive of abnormal lesion FFRct, while SC was not. In multivariable analyses considering stenosis severity, presence of PR, LAP, and PR and/or LAP were independently associated with abnormal FFRct: Odds ratio 1.58, 1.68, and 1.53, respectively (p < 0.02 for all). The presence of PR and/or LAP increased the frequency of abnormal FFRct with mild stenosis (p < 0.05) with a similar trend with 70-89% stenosis. The combination of 2 HRP (LAP and PR) identified more lesions with FFR < 0.80 than only 1 HRP. CONCLUSIONS Semiquantitative visual assessment of high-risk plaque features may improve the selection of studies for FFRct.
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Affiliation(s)
- Yuka Otaki
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Eyal Klein
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Rebekah H Park
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Sean W Hayes
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - John D Friedman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Victor Cheng
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Robert Jh Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
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Minamimoto R. Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT. Jpn J Radiol 2021; 39:540-557. [PMID: 33517516 PMCID: PMC8175248 DOI: 10.1007/s11604-021-01097-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
Distinct from cardiac PET performed with preparation to control physiological FDG uptake in the myocardium, standard FDG-PET/CT performed with 4-6 h of fasting will show variation in myocardial FDG uptake. For this reason, important signs of myocardial and pericardial abnormality revealed by myocardial FDG uptake tend to be overlooked. However, recognition of possible underlying disease will support further patient management to avoid complications due to the disease. This review demonstrates the mechanism of FDG uptake in the myocardium, discusses the factors affecting uptake, and provides notable image findings that may suggest underlying disease.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
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Kocyigit D, Scanameo A, Xu B. Multimodality imaging for the prevention of cardiovascular events: Coronary artery calcium and beyond. Cardiovasc Diagn Ther 2021; 11:840-858. [PMID: 34295709 PMCID: PMC8261752 DOI: 10.21037/cdt-19-654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has been the leading cause of death worldwide for more than a decade. Prevention is of utmost importance to reduce related mortality. The innovations in cardiovascular imaging technology, in addition to our improved understanding of coronary atherosclerosis pathogenesis, have resulted in cardiovascular imaging becoming one of the most influential tools for diagnosis and risk stratification in ASCVD. Although numerous publications have emerged on this topic, data that guide routine cardiology clinical practice currently focus on the utility of a limited number of such modalities, namely arterial ultrasonography and computed tomography. Herein, current evidence with respect to the role of multimodality cardiovascular imaging on ASCVD prevention will be reviewed.
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Affiliation(s)
- Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Seime T, Akbulut AC, Liljeqvist ML, Siika A, Jin H, Winski G, van Gorp RH, Karlöf E, Lengquist M, Buckler AJ, Kronqvist M, Waring OJ, Lindeman JHN, Biessen EAL, Maegdefessel L, Razuvaev A, Schurgers LJ, Hedin U, Matic L. Proteoglycan 4 Modulates Osteogenic Smooth Muscle Cell Differentiation during Vascular Remodeling and Intimal Calcification. Cells 2021; 10:1276. [PMID: 34063989 PMCID: PMC8224064 DOI: 10.3390/cells10061276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 01/02/2023] Open
Abstract
Calcification is a prominent feature of late-stage atherosclerosis, but the mechanisms driving this process are unclear. Using a biobank of carotid endarterectomies, we recently showed that Proteoglycan 4 (PRG4) is a key molecular signature of calcified plaques, expressed in smooth muscle cell (SMC) rich regions. Here, we aimed to unravel the PRG4 role in vascular remodeling and intimal calcification. PRG4 expression in human carotid endarterectomies correlated with calcification assessed by preoperative computed tomographies. PRG4 localized to SMCs in early intimal thickening, while in advanced lesions it was found in the extracellular matrix, surrounding macro-calcifications. In experimental models, Prg4 was upregulated in SMCs from partially ligated ApoE-/- mice and rat carotid intimal hyperplasia, correlating with osteogenic markers and TGFb1. Furthermore, PRG4 was enriched in cells positive for chondrogenic marker SOX9 and around plaque calcifications in ApoE-/- mice on warfarin. In vitro, PRG4 was induced in SMCs by IFNg, TGFb1 and calcifying medium, while SMC markers were repressed under calcifying conditions. Silencing experiments showed that PRG4 expression was driven by transcription factors SMAD3 and SOX9. Functionally, the addition of recombinant human PRG4 increased ectopic SMC calcification, while arresting cell migration and proliferation. Mechanistically, it suppressed endogenous PRG4, SMAD3 and SOX9, and restored SMC markers' expression. PRG4 modulates SMC function and osteogenic phenotype during intimal remodeling and macro-calcification in response to TGFb1 signaling, SMAD3 and SOX9 activation. The effects of PRG4 on SMC phenotype and calcification suggest its role in atherosclerotic plaque stability, warranting further investigations.
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Affiliation(s)
- Till Seime
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Asim Cengiz Akbulut
- Department of Biochemistry, CARIM, Maastricht University, 6229 ER Maastricht, The Netherlands; (A.C.A.); (R.H.v.G.); (L.J.S.)
| | - Moritz Lindquist Liljeqvist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Antti Siika
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Hong Jin
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
- Department of Medicine, Karolinska Institutet, 17164 Stockholm, Sweden; (G.W.); (L.M.)
| | - Greg Winski
- Department of Medicine, Karolinska Institutet, 17164 Stockholm, Sweden; (G.W.); (L.M.)
| | - Rick H. van Gorp
- Department of Biochemistry, CARIM, Maastricht University, 6229 ER Maastricht, The Netherlands; (A.C.A.); (R.H.v.G.); (L.J.S.)
| | - Eva Karlöf
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Mariette Lengquist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Andrew J. Buckler
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Malin Kronqvist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Olivia J. Waring
- Department of Pathology, CARIM, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands; (O.J.W.); (E.A.L.B.)
| | - Jan H. N. Lindeman
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Erik A. L. Biessen
- Department of Pathology, CARIM, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands; (O.J.W.); (E.A.L.B.)
| | - Lars Maegdefessel
- Department of Medicine, Karolinska Institutet, 17164 Stockholm, Sweden; (G.W.); (L.M.)
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, 81679 Munich, Germany
| | - Anton Razuvaev
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Leon J. Schurgers
- Department of Biochemistry, CARIM, Maastricht University, 6229 ER Maastricht, The Netherlands; (A.C.A.); (R.H.v.G.); (L.J.S.)
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, 52062 Aachen, Germany
| | - Ulf Hedin
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
| | - Ljubica Matic
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17164 Stockholm, Sweden; (T.S.); (M.L.L.); (A.S.); (H.J.); (E.K.); (M.L.); (A.J.B.); (M.K.); (A.R.); (U.H.)
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Borén J, Chapman MJ, Krauss RM, Packard CJ, Bentzon JF, Binder CJ, Daemen MJ, Demer LL, Hegele RA, Nicholls SJ, Nordestgaard BG, Watts GF, Bruckert E, Fazio S, Ference BA, Graham I, Horton JD, Landmesser U, Laufs U, Masana L, Pasterkamp G, Raal FJ, Ray KK, Schunkert H, Taskinen MR, van de Sluis B, Wiklund O, Tokgozoglu L, Catapano AL, Ginsberg HN. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2021; 41:2313-2330. [PMID: 32052833 PMCID: PMC7308544 DOI: 10.1093/eurheartj/ehz962] [Citation(s) in RCA: 726] [Impact Index Per Article: 242.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/10/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
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Affiliation(s)
- Jan Borén
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M John Chapman
- Endocrinology-Metabolism Division, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France.,National Institute for Health and Medical Research (INSERM), Paris, France
| | - Ronald M Krauss
- Department of Atherosclerosis Research, Children's Hospital Oakland Research Institute and UCSF, Oakland, CA 94609, USA
| | - Chris J Packard
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jacob F Bentzon
- Department of Clinical Medicine, Heart Diseases, Aarhus University, Aarhus, Denmark.,Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Mat J Daemen
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Linda L Demer
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Physiology, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert A Hegele
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia.,Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia
| | - Eric Bruckert
- INSERM UMRS1166, Department of Endocrinology-Metabolism, ICAN - Institute of CardioMetabolism and Nutrition, AP-HP, Hopital de la Pitie, Paris, France
| | - Sergio Fazio
- Departments of Medicine, Physiology and Pharmacology, Knight Cardiovascular Institute, Center of Preventive Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - Brian A Ference
- Centre for Naturally Randomized Trials, University of Cambridge, Cambridge, UK.,Institute for Advanced Studies, University of Bristol, Bristol, UK.,MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Jay D Horton
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, Leipzig, Germany
| | - Luis Masana
- Research Unit of Lipids and Atherosclerosis, IISPV, CIBERDEM, University Rovira i Virgili, C. Sant Llorenç 21, Reus 43201, Spain
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Faculty of Medicine, Technische Universität München, Lazarettstr, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marja-Riitta Taskinen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Bart van de Sluis
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Olov Wiklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, and IRCCS MultiMedica, Milan, Italy
| | - Henry N Ginsberg
- Department of Medicine, Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
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120
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Yuvaraj J, Cheng K, Lin A, Psaltis PJ, Nicholls SJ, Wong DTL. The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation. Cells 2021; 10:1196. [PMID: 34068406 PMCID: PMC8153638 DOI: 10.3390/cells10051196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
A large body of evidence arising from recent randomized clinical trials demonstrate the association of vascular inflammatory mediators with coronary artery disease (CAD). Vascular inflammation localized in the coronary arteries leads to an increased risk of CAD-related events, and produces unique biological alterations to local cardiac adipose tissue depots. Coronary computed tomography angiography (CTA) provides a means of mapping inflammatory changes to both epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) as independent markers of coronary risk. Radiodensity or attenuation of PCAT on coronary CTA, notably, provides indirect quantification of coronary inflammation and is emerging as a promising non-invasive imaging implement. An increasing number of observational studies have shown robust associations between PCAT attenuation and major coronary events, including acute coronary syndrome, and 'vulnerable' atherosclerotic plaque phenotypes that are associated with an increased risk of the said events. This review outlines the biological characteristics of both EAT and PCAT and provides an overview of the current literature on PCAT attenuation as a surrogate marker of coronary inflammation.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Andrew Lin
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA;
| | - Peter J. Psaltis
- Department of Medicine, University of Adelaide, Adelaide, SA 5005, Australia;
- South Australian Health Medical Research Institute, Adelaide, SA 5000, Australia
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
| | - Dennis T. L. Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Heart, Monash Health, Clayton, VIC 3168, Australia; (J.Y.); (K.C.); (S.J.N.)
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121
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Yuvaraj J, Lin A, Nerlekar N, Munnur RK, Cameron JD, Dey D, Nicholls SJ, Wong DTL. Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease. Cells 2021; 10:1143. [PMID: 34068518 PMCID: PMC8150579 DOI: 10.3390/cells10051143] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND High-risk plaques (HRP) detected on coronary computed tomography angiography (CTA) confer an increased risk of acute coronary syndrome (ACS). Pericoronary adipose tissue attenuation (PCAT) is a novel biomarker of coronary inflammation. This study aimed to evaluate the association of PCAT with HRP and subsequent ACS development in patients with stable coronary artery disease (CAD). METHODS Patients with stable CAD who underwent coronary CTA from 2011 to 2016 and had available outcome data were included. We studied 41 patients with HRP propensity matched to 41 controls without HRP (60 ± 10 years, 67% males). PCAT was assessed using semi-automated software on a per-patient basis in the proximal right coronary artery (PCATRCA) and a per-lesion basis (PCATLesion) around HRP in cases and the highest-grade stenosis lesions in controls. RESULTS PCATRCA and PCATLesion were higher in HRP patients than controls (PCATRCA: -80.7 ± 6.50 HU vs. -84.2 ± 8.09 HU, p = 0.03; PCATLesion: -79.6 ± 7.86 HU vs. -84.2 ± 10.3 HU, p = 0.04), and were also higher in men (PCATRCA: -80.5 ± 7.03 HU vs. -86.1 ± 7.08 HU, p < 0.001; PCATLesion: -79.6 ± 9.06 HU vs. -85.2 ± 7.96 HU, p = 0.02). Median time to ACS was 1.9 years, within a median follow-up of 5.3 years. PCATRCA alone was higher in HRP patients who subsequently presented with ACS (-76.8 ± 5.69 HU vs. -82.0 ± 6.32 HU, p = 0.03). In time-dependent analysis, ACS was associated with HRP and PCATRCA. CONCLUSIONS PCAT attenuation is increased in stable CAD patients with HRP and is associated with subsequent ACS development. Further investigation is required to determine the clinical implications of these findings.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.L.); (D.D.)
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Ravi K. Munnur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - James D. Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.L.); (D.D.)
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Dennis T. L. Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
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122
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Golub I, Lakshmanan S, Dahal S, Budoff MJ. Utilizing coronary artery calcium to guide statin use. Atherosclerosis 2021; 326:17-24. [PMID: 34000565 DOI: 10.1016/j.atherosclerosis.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide, and accounts for over 30% of annual global fatality. Coronary artery calcium (CAC) screening, a highly distinct marker of coronary atherosclerosis, serves as an important arbitrator of atherosclerotic cardiovascular disease (ASCVD). Particularly in asymptomatic individuals, CAC testing offers a model for initiating or prolonging preventative statin therapies and subsequently up- or down-risking of patients. Though recent 2018 ACC/AHA Guidelines on Blood Cholesterol recommend CAC as an arbitrator of statin use, it remains uncertain whether these recommendations have been universally followed. Thus, we present a thorough discussion about CAC as an important determinator of ASCVD risk. In this regard we highlight the key points behind coronary artery calcium scoring, as a critical platform for stratifying risk and guiding future preventative treatments. This review paper supplies a background for the 2018 Cholesterol Guidelines: the rationalization behind CAC as a crucial arbitrator of cardiovascular risk. This paper will first (1) outline the role of CAC in reclassifying ASCVD risk. Next, it will (2) discuss studies that illustrate CAC's markedly novel reduction in the number needed to treat (NNT) to ameliorate one major cardiac event. Being years removed from 2018 Guidelines provides this paper the lens to (3) elucidate upcoming value-based advantages, cost effectiveness, and patient adherence brought by CAC. Last, this paper will also (4) extend the utility of CAC beyond that of the general population, and (5) discuss pertinent limitations brought by CAC score. By summarizing the framework behind recent cholesterol guidelines for ASCVD risk assessment, this review will address the debate of use of CAC for both the clinical setting and preventative therapy applications.
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Affiliation(s)
- Ilana Golub
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA
| | | | - Suraj Dahal
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA.
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123
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Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Stanescu AG, Benedek I, Opincariu D, Hodas R, Ratiu M, Benedek T. Assessment of lesion-associated myocardial ischemia based on fusion coronary CT imaging - the FUSE-HEART study: A protocol for non-randomized clinical trial. Medicine (Baltimore) 2021; 100:e25378. [PMID: 33832124 PMCID: PMC8036075 DOI: 10.1097/md.0000000000025378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Multimodality assessment of coronary artery lesions has demonstrated superior effectiveness compared to the conventional approach, for assessing both anatomical and functional significance of a coronary stenosis. Multiple imaging modalities can be integrated into a fusion imaging tool to better assess myocardial ischemia. MATERIAL AND METHODS The FUSE-HEART trial is a single center, prospective, cohort study that will assess the impact of a coronary artery stenosis on myocardial function and viability, based on advanced fusion imaging technics derived from Cardiac Computed Tomography Angiography (CCTA). Moreover, the study will investigate the correlation between morphology and composition of the coronary plaques and myocardial ischemia in the territory irrigated by the same coronary artery. At the same time, imaging parameters will be correlated with inflammatory status of the subjects. The trial will include 100 subjects with coronary lesions found on CCTA examination. The study population will be divided into 2 groups: first group will consist of subjects with anatomically significant coronary lesions on native coronary arteries and the second one will include subjects surviving an acute myocardial infarction. The vulnerability score of the subjects will be calculated based on presence of CCTA vulnerability markers of the coronary plaques: napkin ring sign, positive remodeling, spotty calcifications, necrotic core, and low-density plaques. 3D fusion images of the coronary tree will be generated, integrating the images reflecting wall motion with the ones of coronary circulation. The fusion models will establish the correspondence between plaque composition and wall motion in the subtended myocardium of the coronary artery. The study primary outcome will be represented by the rate of major adverse cardiac events related to myocardial ischemia at 1-year post assessment, in correlation with the degree of coronary artery stenosis and myocardial ischemia or viability.The secondary outcomes are represented by the rate of re-hospitalization, rate of survival and rate of major adverse cardiovascular events (including cardiovascular death or stroke), in correlation with the morphology and composition of atheromatous plaques located in a coronary artery, and myocardial ischemia in the territory irrigated by the same coronary artery. CONCLUSION In conclusion, FUSE-HEART will be a study based on modern imaging tools that will investigate the impact of a coronary artery stenosis on myocardial function and viability, using advanced fusion imaging technics derived from CCTA, sighting to validate plaque composition and morphology, together with inflammatory biomarkers, as predictors to myocardial viability.
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Affiliation(s)
- Alexandra Gorea Stanescu
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Imre Benedek
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Diana Opincariu
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Roxana Hodas
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Mihaela Ratiu
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
- Department of Radiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Romania
| | - Theodora Benedek
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
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125
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Cardiovascular Imaging Techniques for Detection of Vulnerable Plaques. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Various cardiovascular imaging techniques were developed for the detection of vulnerable atherosclerotic plaques, hoping to be able to predict a cardiovascular event. Plaque vulnerability results from compound pathophysiological mechanisms that lead to structural and morphological changes in lesions. The aim of this review is to present the most recent techniques for the assessment of vulnerable coronary plaques such as cardiac computed tomography angiography (CCTA), optical coherence tomography, or virtual histology intravascular ultra-sound, based on literature data from the last 3 years. CCTA permits direct visualization of the intravascular lumen, together with characterization of the arterial wall. Recent studies maintain that low-attenuation plaques, spotty calcifications, positive vessel remodeling, and the napkin-ring sign are considered main markers of plaque vulnerability and instability. Emerging analytical techniques, such as machine learning or radiomics, will probably demonstrate useful as an auxiliary diagnostic tool for vulnerable plaque detection. The data from the two imaging techniques together provide useful information, especially in patients undergoing a PCI procedure for an acute coronary syndrome. Invasive and noninvasive imaging techniques are able to deliver a large amount of scientific data to assess vulnerable coronary atheromatous plaques. Recent studies demonstrated that information defined by the two techniques is complementary, and using both methods is essential for adequate diagnosis, therapeutic strategy, and prognostic assessment.
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Shaw LJ, Blankstein R, Bax JJ, Ferencik M, Bittencourt MS, Min JK, Berman DS, Leipsic J, Villines TC, Dey D, Al'Aref S, Williams MC, Lin F, Baskaran L, Litt H, Litmanovich D, Cury R, Gianni U, van den Hoogen I, R van Rosendael A, Budoff M, Chang HJ, E Hecht H, Feuchtner G, Ahmadi A, Ghoshajra BB, Newby D, Chandrashekhar YS, Narula J. Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque. J Cardiovasc Comput Tomogr 2021; 15:93-109. [PMID: 33303383 DOI: 10.1016/j.jcct.2020.11.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.
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Affiliation(s)
- Leslee J Shaw
- Weill Cornell School of Medicine, New York, NY, USA.
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - James K Min
- Weill Cornell School of Medicine; Cleerly, Inc. (started in 2020), New York, NY, USA
| | - Daniel S Berman
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Fay Lin
- Weill Cornell School of Medicine, New York, NY, USA
| | | | - Harold Litt
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Litmanovich
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, FL, USA
| | | | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | - Amir Ahmadi
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - David Newby
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | | | - Jagat Narula
- Mount Sinai School of Medicine, New York, NY, USA
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127
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Ha S, Jung S, Park HB, Shin S, Arsanjani R, Hong Y, Lee BK, Jang Y, Jeon B, Park SI, Shim H, Chang HJ. Assessment of Image Quality for Selective Intracoronary Contrast-Injected CT Angiography in a Hybrid Angio-CT System: A Feasibility Study in Swine. Yonsei Med J 2021; 62:200-208. [PMID: 33635009 PMCID: PMC7934100 DOI: 10.3349/ymj.2021.62.3.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare image quality in selective intracoronary contrast-injected computed tomography angiography (Selective-CTA) with that in conventional intravenous contrast-injected CTA (IV-CTA). MATERIALS AND METHODS Six pigs (35 to 40 kg) underwent both IV-CTA using an intravenous injection (60 mL) and Selective-CTA using an intracoronary injection (20 mL) through a guide-wire during/after percutaneous coronary intervention. Images of the common coronary artery were acquired. Scans were performed using a combined machine comprising an invasive coronary angiography suite and a 320-channel multi-slice CT scanner. Quantitative image quality parameters of CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), mean lumen diameter (MLD), and mean lumen area (MLA) were measured and compared. Qualitative analysis was performed using intraclass correlation coefficient (ICC), which was calculated for analysis of interobserver agreement. RESULTS Quantitative image quality, determined by assessing the uniformity of CT attenuation (399.06 vs. 330.21, p<0.001), image noise (24.93 vs. 18.43, p<0.001), SNR (16.43 vs. 18.52, p=0.005), and CNR (11.56 vs. 13.46, p=0.002), differed significantly between IV-CTA and Selective-CTA. MLD and MLA showed no significant difference overall (2.38 vs. 2.44, p=0.068, 4.72 vs. 4.95, p=0.078). The density of contrast agent was significantly lower for selective-CTA (13.13 mg/mL) than for IV-CTA (400 mg/mL). Agreement between observers was acceptable (ICC=0.79±0.08). CONCLUSION Our feasibility study in swine showed that compared to IV-CTA, Selective-CTA provides better image quality and requires less iodine contrast medium.
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Affiliation(s)
- Seongmin Ha
- Graduate School of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
- CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghee Jung
- CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
| | - Hyung Bok Park
- Division of Cardiology, Cardiovascular Center, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Sanghoon Shin
- Division of Cardiology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Reza Arsanjani
- Cardiovascular Center, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Youngtaek Hong
- CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeonggul Jang
- CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byunghwan Jeon
- CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
| | - Se Il Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hackjoon Shim
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Jae Chang
- CONNECT-AI R&D Center, Yonsei University College of Medicine, Seoul, Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
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128
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Son MJ, Yoo SM, Lee D, Lee HY, Song IS, Chun EJ, White CS. Current Role of Computed Tomography in the Evaluation of Acute Coronary Syndrome. Diagnostics (Basel) 2021; 11:266. [PMID: 33572267 PMCID: PMC7914414 DOI: 10.3390/diagnostics11020266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 02/07/2023] Open
Abstract
This review article provides an overview regarding the role of computed tomography (CT) in the evaluation of acute chest pain (ACP) in the emergency department (ED), focusing on characteristic CT findings.
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Affiliation(s)
- Min Ji Son
- Department of Radiology, CHA University Bundang Medical Center, Bundang 13497, Korea;
| | - Seung Min Yoo
- Department of Radiology, CHA University Bundang Medical Center, Bundang 13497, Korea;
| | - Dongjun Lee
- Military Service in Korean Army, Hongcheon 25117, Korea;
| | | | - In Sup Song
- Department of Radiology, Chun Ju Jesus General Hospital, Chun Ju 54987, Korea;
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Medical Center, Seongnam 13620, Korea;
| | - Charles S White
- Department of Radiology, University of Maryland, Baltimore, MD 21201, USA;
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130
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Chaudhry F, Kawai H, Johnson KW, Narula N, Shekhar A, Chaudhry F, Nakahara T, Tanimoto T, Kim D, Adapoe MKMY, Blankenberg FG, Mattis JA, Pak KY, Levy PD, Ozaki Y, Arbustini E, Strauss HW, Petrov A, Fuster V, Narula J. Molecular Imaging of Apoptosis in Atherosclerosis by Targeting Cell Membrane Phospholipid Asymmetry. J Am Coll Cardiol 2021; 76:1862-1874. [PMID: 33059832 DOI: 10.1016/j.jacc.2020.08.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Apoptosis in atherosclerotic lesions contributes to plaque vulnerability by lipid core enlargement and fibrous cap attenuation. Apoptosis is associated with exteriorization of phosphatidylserine (PS) and phosphatidylethanolamine (PE) on the cell membrane. Although PS-avid radiolabeled annexin-V has been employed for molecular imaging of high-risk plaques, PE-targeted imaging in atherosclerosis has not been studied. OBJECTIVES This study sought to evaluate the feasibility of molecular imaging with PE-avid radiolabeled duramycin in experimental atherosclerotic lesions in a rabbit model and compare duramycin targeting with radiolabeled annexin-V. METHODS Of the 27 rabbits, 21 were fed high-cholesterol, high-fat diet for 16 weeks. Nine of the 21 rabbits received 99mTc-duramycin (test group), 6 received 99mTc-linear duramycin (duramycin without PE-binding capability, negative radiotracer control group), and 6 received 99mTc-annexin-V for radionuclide imaging. The remaining normal chow-fed 6 animals (disease control group) received 99mTc-duramycin. In vivo microSPECT/microCT imaging was performed, and the aortas were explanted for ex vivo imaging and for histological characterization of atherosclerosis. RESULTS A significantly higher duramycin uptake was observed in the test group compared with that of disease control and negative radiotracer control animals; duramycin uptake was also significantly higher than the annexin-V uptake. Quantitative duramycin uptake, represented as the square root of percent injected dose per cm (√ID/cm) of abdominal aorta was >2-fold higher in atherosclerotic lesions in test group (0.08 ± 0.01%) than in comparable regions of disease control animals (0.039 ± 0.0061%, p = 3.70·10-8). Mean annexin uptake (0.060 ± 0.010%) was significantly lower than duramycin (p = 0.001). Duramycin uptake corresponded to the lesion severity and macrophage burden. The radiation burden to the kidneys was substantially lower with duramycin (0.49% ID/g) than annexin (5.48% ID/g; p = 4.00·10-4). CONCLUSIONS Radiolabeled duramycin localizes in lipid-rich areas with high concentration of apoptotic macrophages in the experimental atherosclerosis model. Duramycin uptake in atherosclerotic lesions was significantly greater than annexin-V uptake and produced significantly lower radiation burden to nontarget organs.
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Affiliation(s)
- Farhan Chaudhry
- Icahn School of Medicine at Mount Sinai, New York, New York; Wayne State University School of Medicine, Detroit, Michigan
| | - Hideki Kawai
- Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Kipp W Johnson
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Navneet Narula
- New York University Langone Medical Center, New York, New York
| | - Aditya Shekhar
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Dongbin Kim
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Jeffrey A Mattis
- Molecular Targeting Technologies, Inc., West Chester, Pennsylvania
| | - Koon Y Pak
- Molecular Targeting Technologies, Inc., West Chester, Pennsylvania
| | - Phillip D Levy
- Wayne State University School of Medicine, Detroit, Michigan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | | | - H William Strauss
- Icahn School of Medicine at Mount Sinai, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Artiom Petrov
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York
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131
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Kawai H, Motoyama S, Sarai M, Nagahara Y, Hattori K, Sato Y, Miyajima K, Hoshino M, Matsuyama T, Ohta M, Takahashi H, Shiino K, Sugiura A, Muramatsu T, Naruse H, Ishii J, Toyama H, Ozaki Y, Izawa H. Association of computed tomography-derived myocardial mass with fractional flow reserve-verified ischemia or subsequent therapeutic strategy. Heart Vessels 2021; 36:1099-1108. [PMID: 33533973 DOI: 10.1007/s00380-021-01789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
The aim of the present study was to examine the association of myocardial mass verified by computed tomography (CT) and invasive fractional flow reserve (FFR)-verified myocardial ischemia, or subsequent therapeutic strategy for the targeted vessels after FFR examination. We examined 333 vessels with intermediate stenoses in 297 patients (mean age 69.0 ± 9.5, 228 men) undergoing both coronary CT angiography and invasive FFR, and reviewed the therapeutic strategy after FFR. Of 333 vessels, FFR ≤ 0.80 was documented in 130 (39.0%). Myocardial volume supplied by the target vessel (MVT) was larger in those with FFR-verified ischemia than those without (53.4 ± 19.5 vs. 42.9 ± 22.2 cm3, P < 0.001). Addition of MVT to a model including patient characteristics (age, gender), visual assessment (≥ 70% stenosis, high-risk appearance), and quantitative CT vessel parameters [minimal lumen area (MLA), plaque burden at MLA, percent aggregate plaque volume] improved C-index (from 0.745 to 0.778, P = 0.020). Furthermore, of 130 vessels with FFR ≤ 0.80, myocardial volume exposed to ischemia (MVI) was larger in the vessels with early revascularization after FFR examination than those without (37.2 ± 20.0 vs. 26.8 ± 15.0 cm3, P = 0.003), and was independently associated with early revascularization [OR = 1.03, 95% confidence interval (1.02-1.11), P < 0.001]. Using an on-site CT workstation, MVT identified coronary arteries with FFR-verified ischemia easily and non-invasively, and MVI was associated with subsequent therapeutic strategy after FFR examinations.
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Affiliation(s)
- Hideki Kawai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yasuomi Nagahara
- Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Kousuke Hattori
- Department of Cardiology, Hekinan Municipal Hospital, Hekinan, Japan
| | - Yoshihiro Sato
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Keiichi Miyajima
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Meiko Hoshino
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | | | - Masaya Ohta
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Shiino
- Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Atsushi Sugiura
- Department of Cardiology, Hekinan Municipal Hospital, Hekinan, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Junnichi Ishii
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, Toyoake, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi, 470-1192, Japan
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Characteristics of culprit lesion in patients with non-ST-elevation myocardial infarction and improvement of diagnostic utility using dual energy cardiac CT. Int J Cardiovasc Imaging 2021; 37:1781-1788. [PMID: 33502653 DOI: 10.1007/s10554-020-02141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
AIMS The aim of the study was to identify the characteristics of the culprit lesions compared to non-culprit lesions in patients with non-ST-elevation-myocardial infarction using dual energy computed tomography (DECT). METHODS AND RESULTS In 29 patients, we identified 29 culprit lesions and 227 non-culprit lesions. Quantitative values such as the effective atomic number (effective-Z) and Hounsfield Units (HU) values were measured. Furthermore, all the lesions were characterised using characteristics such as composition (non-calcified, predominantly-non-calcified, predominantly-calcified, or calcified), presence of spotty calcification, remodelling index, and napkin ring sign. The mean effective-Z and HU values were significantly lower in culprit lesions than in non-culprit lesions (8.99 ± 1.21 vs 9.79 ± 1.52; p = 0.0066 and 87.41 ± 84.97 vs. 154.45 ± 176.13; p = 0.0447). The culprit lesions had a higher frequency of non-calcified plaques and predominantly non-calcified plaques, and were with a greater presence of napkin ring signs in comparison with non-culprit lesions. There were no differences in the presence of spotty calcification or remodelling index. By adding effective-Z to plaque characteristics such as non-calcified, positive remodelling, spotty calcification, and napkin rings we observed a significant increased sensitivity of detecting culprit lesions (65.5% vs.44.8%), but no significant changes in area under curve (AUC). CONCLUSION The use of DECT adds new information of the plaque composition expressed by the effective-Z, which differs significantly in culprit lesions in comparison with non-culprit lesions. The use of the effective-Z improves the diagnostic sensitivity in detection of culprit lesions.
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Merkulova IN, Shariya MA, Mironov VM, Shabanova MS, Veselova TN, Gaman SA, Barysheva NA, Shakhnovich RM, Zhukova NI, Sukhinina TS, Staroverov II, Ternovoy SK. [Computed Tomography Coronary Angiography Possibilities in "High Risk" Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound]. ACTA ACUST UNITED AC 2021; 60:64-75. [PMID: 33522469 DOI: 10.18087/cardio.2020.12.n1304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.
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Affiliation(s)
- I N Merkulova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M A Shariya
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - V M Mironov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M S Shabanova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T N Veselova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S A Gaman
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N A Barysheva
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - R M Shakhnovich
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N I Zhukova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T S Sukhinina
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - I I Staroverov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S K Ternovoy
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
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Sadamatsu K, Okutsu M, Sumitsuji S, Kawasaki T, Nakamura S, Fukumoto Y, Tsujita K, Sonoda S, Kobayashi Y, Ikari Y. Practical utilization of cardiac computed tomography for the success in complex coronary intervention. Cardiovasc Interv Ther 2021; 36:178-189. [PMID: 33428155 DOI: 10.1007/s12928-020-00751-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiovascular Medicine, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan.
| | - Masaaki Okutsu
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Sumitsuji
- Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Kawasaki
- Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Kurume, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Shinjo Sonoda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environ- Mental Health, Kitakyushu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
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Kovari H, Calmy A, Doco-Lecompte T, Nkoulou R, Marzel A, Weber R, Kaufmann PA, Buechel RR, Ledergerber B, Tarr PE. Antiretroviral Drugs Associated With Subclinical Coronary Artery Disease in the Swiss Human Immunodeficiency Virus Cohort Study. Clin Infect Dis 2021; 70:884-889. [PMID: 30958888 DOI: 10.1093/cid/ciz283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) events have been associated with certain antiretroviral therapy (ART) agents. In contrast, the influence of ART on subclinical atherosclerosis is not clear. The study objective was to assess the association between individual ART agents and the prevalence and extent of subclinical CAD. METHODS Coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) were performed in ≥45-year-old Swiss Human Immunodeficiency Virus Cohort Study participants. The following subclinical CAD endpoints were analyzed separately: CAC score >0, any plaque, calcified plaque, noncalcified/mixed plaque, segment involvement score (SIS), and segment severity score (SSS). Logistic regression models calculated by inverse probability of treatment weights (IPTW) were used to explore associations between subclinical CAD and cumulative exposure to the 10 most frequently used drugs. RESULTS There were 403 patients who underwent CCTA. A CAC score >0 was recorded in 188 (47%), any plaque in 214 (53%), calcified plaque in 151 (38%), and noncalcified/mixed plaque in 150 (37%) participants. A CAC score >0 was negatively associated with efavirenz (IPTW adjusted odds ratio per 5 years 0.73, 95% confidence interval [CI] 0.56-0.96), tenofovir disoproxil fumarate (0.68, 95% CI 0.49-0.95), and lopinavir (0.64, 95% CI 0.43-0.96). Any plaque was negatively associated with tenofovir disoproxil fumarate (0.71, 95% CI 0.51-0.99). Calcified plaque was negatively associated with efavirenz (0.7, 95% CI 0.57-0.97). Noncalcified/mixed plaque was positively associated with abacavir (1.46, 95% CI 1.08-1.98) and negatively associated with emtricitabine (0.67, 95% CI 0.46-0.99). For SSS and SIS, we found no association with any drug. CONCLUSIONS An increased risk of noncalcified/mixed plaque was only found in patients exposed to abacavir. Emtricitabine was negatively associated with noncalcified/mixed plaque, while tenofovir disoproxil fumarate and efavirenz were negatively associated with any plaque and calcified plaque, respectively.
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Affiliation(s)
- Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University of Geneva, Switzerland
| | | | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Philip E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Nakao Y, Yoshida K, Inaba S, Tanabe Y, Kurata A, Uetani T, Kido T, Inoue K, Mochizuki T, Yamaguchi O. Plaque Characterization with Computed Tomography Angiography Based on a Diluted-contrast Injection Protocol. Intern Med 2021; 60:3671-3678. [PMID: 34853256 PMCID: PMC8710393 DOI: 10.2169/internalmedicine.6683-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Coronary plaques with low attenuation on computed tomography (CT) angiography may indicate vulnerable plaques. However, plaque CT attenuation is reported to be significantly affected by intracoronary attenuation. Recently, the diluted-contrast injection protocol was established to facilitate more uniform intracoronary attenuation than can be achieved with the generally used body-weight-adjusted protocol. We validated the relationship between low-attenuation plaque on CT and lipid-rich plaque using integrated backscatter-intravascular ultrasound (IB-IVUS) as the standard reference. Methods Plaques were divided into tertiles (T1, T2, and T3) according to the plaque CT attenuation, calculated as the average of five intra-plaque regions of interest, and compared with the plaque characteristics noted on IB-IVUS. Patients Patients who underwent both CT angiography using a diluted-contrast injection protocol and IB-IVUS were retrospectively analyzed. Results Thirty-nine plaques in 32 patients were analyzed by CT angiography and IB-IVUS. The median plaque CT attenuation (Hounsfield units) of each tertile was 30 (T1), 48 (T2), and 68 (T3). Although no significant difference was noted in conventional quantitative IVUS parameters (e.g. plaque burden), the T1 with lowest plaque CT attenuation had the highest percentage lipid area by IB-IVUS [75.1% (T1), 57.8% (T2), and 50.8% (T3), respectively, p<0.01]. Furthermore, the plaque CT attenuation had a significant negative correlation with the percentage lipid area (r=-0.59, p<0.01). Conclusion CT angiography-based plaque characterization using a diluted-contrast injection protocol may aid in the quantitative detection of lipid-rich plaque.
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Affiliation(s)
- Yasuhisa Nakao
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
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Zeng P, Yang J, Liu L, Yang X, Yao Z, Ma C, Zhu H, Su J, Zhao Q, Feng K, Yang S, Zhu Y, Li X, Wang W, Duan Y, Han J, Chen Y. ERK1/2 inhibition reduces vascular calcification by activating miR-126-3p-DKK1/LRP6 pathway. Am J Cancer Res 2021; 11:1129-1146. [PMID: 33391525 PMCID: PMC7738895 DOI: 10.7150/thno.49771] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Rationale: Vascular microcalcification increases the risk of rupture of vulnerable atherosclerotic lesions. Inhibition of ERK1/2 reduces atherosclerosis in animal models while its role in vascular calcification and the underlying mechanisms remains incompletely understood. Methods: Levels of activated ERK1/2, DKK1, LRP6 and BMP2 in human calcific aortic valves were determined. ApoE deficient mice received ERK1/2 inhibitor (U0126) treatment, followed by determination of atherosclerosis, calcification and miR-126-3p production. C57BL/6J mice were used to determine the effect of U0126 on Vitamin D3 (VD3)-induced medial arterial calcification. HUVECs, HAECs and HASMCs were used to determine the effects of ERK1/2 inhibitor or siRNA on SMC calcification and the involved mechanisms. Results: We observed the calcification in human aortic valves was positively correlated to ERK1/2 activity. At cellular and animal levels, U0126 reduced intimal calcification in atherosclerotic lesions of high-fat diet-fed apoE deficient mice, medial arterial calcification in VD3-treated C57BL/6J mice, and calcification in cultured SMCs and arterial rings. The reduction of calcification was attributed to ERK1/2 inhibition-reduced expression of ALP, BMP2 and RUNX2 by activating DKK1 and LRP6 expression, and consequently inactivating both canonical and non-canonical Wnt signaling pathways in SMCs. Furthermore, we determined ERK1/2 inhibition activated miR-126-3p production by facilitating its maturation through activation of AMPKα-mediated p53 phosphorylation, and the activated miR-126-3p from ECs and SMCs played a key role in anti-vascular calcification actions of ERK1/2 inhibition. Conclusions: Our study demonstrates that activation of miR-126-3p production in ECs/SMCs and interactions between ECs and SMCs play an important role in reduction of vascular calcification by ERK1/2 inhibition.
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Henzel J, Kępka C, Kruk M, Makarewicz-Wujec M, Wardziak Ł, Trochimiuk P, Dzielińska Z, Demkow M. High-Risk Coronary Plaque Regression After Intensive Lifestyle Intervention in Nonobstructive Coronary Disease: A Randomized Study. JACC Cardiovasc Imaging 2020; 14:1192-1202. [PMID: 33341413 DOI: 10.1016/j.jcmg.2020.10.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The authors sought to study the impact of diet and lifestyle intervention on changes in atherosclerotic plaque volume and composition. BACKGROUND Lifestyle and diet modification are the leading strategies to manage coronary artery disease; however, their direct impact on atherosclerosis remains unknown. Coronary plaque composition is related to the risk of future cardiovascular events independent of stenosis severity and can be conveniently evaluated with computed tomography angiography (CTA). METHODS We enrolled 92 patients (41% women; mean age 60 ± 7.7 years) with nonobstructive (<70% stenosis) coronary atherosclerosis identified by CTA. Participants were randomized (1:1) to either the DISCO (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography) intervention group (systematic follow-up by a dietitian to adhere to the Dietary Approaches to Stop Hypertension nutrition model together with optimal medical therapy [OMT]) or the control group (OMT alone). In all patients, CTA was repeated after 66.9 ± 13.7 weeks. The outcome was change (Δ) in atheroma volume and plaque composition. Based on atherosclerotic tissue attenuation ranges in Hounsfield units (HU), the following components of coronary plaque were distinguished: dense calcium (>351 HU), fibrous plaque (151 to 350 HU), and fibrofatty plaque combined with necrotic core (-30 to 150 HU), referred to as noncalcified plaque. RESULTS Percent atheroma volume increased in the control arm (Δ = +1.1 ± 3.4%; p = 0.033) versus no significant change in the experimental arm (Δ = +1.0% ± 4.2%; p = 0.127; intergroup p = 0.851). There was a reduction in noncalcified plaque in both the experimental arm (Δ = -51.3 ± 79.5 mm3 [-1.7 ± 2.7%]; p < 0.001) and the control arm (Δ = -21.3 ± 57.7 [-0.7 ± 1.9%]; p = 0.018), which was greater in the DISCO intervention group (intergroup p = 0.045). No differences in fibrous component or dense calcium changes were observed between the groups. CONCLUSIONS Controlled diet and lifestyle intervention together with OMT may slow the progression of atherosclerosis and reduce noncalcified plaque volume compared to OMT alone. (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography [DISCO-CT]; NCT02571803).
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Affiliation(s)
- Jan Henzel
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Cezary Kępka
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland.
| | - Mariusz Kruk
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | | | - Łukasz Wardziak
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Piotr Trochimiuk
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Zofia Dzielińska
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marcin Demkow
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
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Yoon SH, Kim E, Jeon Y, Yi SY, Bae HJ, Jang IK, Lee JM, Yoo SM, White CS, Chun EJ. Prognostic Value of Coronary CT Angiography for Predicting Poor Cardiac Outcome in Stroke Patients without Known Cardiac Disease or Chest Pain: The Assessment of Coronary Artery Disease in Stroke Patients Study. Korean J Radiol 2020; 21:1055-1064. [PMID: 32691541 PMCID: PMC7371620 DOI: 10.3348/kjr.2020.0103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain. Materials and Methods This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05). Conclusion Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better.
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Affiliation(s)
- Sung Hyun Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunhee Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Yongho Jeon
- Department of Applied Statistics, College of Business and Economics, Yonsei University, Seoul, Korea
| | - Sang Yoon Yi
- Department of Applied Statistics, College of Business and Economics, Yonsei University, Seoul, Korea
| | - Hee Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ik Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joo Myung Lee
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Seung Min Yoo
- Department of Radiology, CHA University Bundang Medical Center, Seongnam, Korea
| | - Charles S White
- Department of Radiology, University of Maryland, Baltimore, MD, USA
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
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The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes. J Clin Med 2020; 9:jcm9123925. [PMID: 33287329 PMCID: PMC7761760 DOI: 10.3390/jcm9123925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023] Open
Abstract
In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS.
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Taron J, Lee S, Aluru J, Hoffmann U, Lu MT. A review of serial coronary computed tomography angiography (CTA) to assess plaque progression and therapeutic effect of anti-atherosclerotic drugs. Int J Cardiovasc Imaging 2020; 36:2305-2317. [PMID: 32076919 PMCID: PMC7434668 DOI: 10.1007/s10554-020-01793-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/10/2020] [Indexed: 12/15/2022]
Abstract
Change in coronary artery plaque on serial catheter intravascular ultrasound (IVUS) is an established technique to monitor the therapeutic effect of drugs on coronary atherosclerosis. Recent advances in coronary computed tomography angiography (CTA) now allow for non-invasive assessment of change in coronary plaque. Because coronary CTA is noninvasive, it enables clinical trials with lower-risk populations, higher retention rates, and lower costs. This review presents an overview of serial coronary CTA as a noninvasive imaging technique to gauge the therapeutic effect of anti-atherosclerotic therapies. Furthermore, it reviews the increasing use of serial CTA as an imaging endpoint in completed and ongoing clinical trials.
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Affiliation(s)
- Jana Taron
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA.
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Saeyun Lee
- Division of Rheumatology/Immunology/Pulmonology, Emory University School of Medicine, Atlanta, USA
| | - John Aluru
- Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Udo Hoffmann
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Michael T Lu
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA
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Oraby AS, Alarabawy RA, Abd Alla TM, Dawoud MM. High risk plaque criteria by multislice coronary CT angiography in patients with stable vs. unstable coronary artery disease: analytic cross-sectional study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Coronary atherosclerotic plaques susceptible to rupture have distinct morphology in comparison to the stable one. Those with high lipid core overlied by fibrous cap are considered to be the most vulnerable one triggering thrombosis and acute coronary syndrome. The purpose of this study was to evaluate the role of 320-row multidetector CT as a non-invasive imaging modality for detection of high-risk plaque criteria via semi-automated quantitative coronary plaque analysis.
Results
Fifty-eight atherosclerotic plaques were evaluated by multislice coronary CT angiography; 36 lesions were detected at unstable patient group and 22 lesions were detected at stable patient group. Non-calcified plaques were more prevalent at unstable patient group, whereas calcified lesions were more prevalent at stable patient group. There was strong correlation between plaque characteristics and clinical presentation represented by OR and 95% CI (NRS; OR 11.870 and 95% CI was 2.65–53.08, LAP; OR was 6.015 and 95% CI was 2.56–14.12). So, NRS and LAP are considered to be high-risk plaque criteria.
Conclusion
Multislice coronary CT angiography could non-invasively detect high-risk plaque criteria. NRS and LAP < 60 are considered to be high-risk plaque criteria suggesting their integration into coronary risk stratification, as well as an intensification of preventive measures.
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Toia P, La Grutta L, Smeraldi T, Agnello F, Grassedonio E, Maffei E, Midiri M, Cademartiri F. Updated diagnostic & prognostic paradigm for CAD: a narrative review. Cardiovasc Diagn Ther 2020; 10:1979-1991. [PMID: 33381438 PMCID: PMC7758757 DOI: 10.21037/cdt-20-526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
Abstract
Cardiovascular diseases are the first cause of death globally; early detection of coronary artery disease (CAD) is a challenge for clinicians and radiologists. Over the past 2 decades there have been several improvements in the methods for the assessment of diagnosis and prognosis in patients with suspected CAD; most of these methods are imaging methods and they operate with high-end technologies. Cardiac computed tomography (CCT) as we know it today was introduced in 1998 and has ever progressed with constant pace. The first decade was the technical validation phase of the method while the second decade was the clinical validation phase. CCT has developed an excellent diagnostic and prognostic value; technological development together with radiation dose reduction, contributed to the widening of its clinical indications. The diagnostic value of CCT is particularly important as a first line in symptomatic patients with suspected obstructive CAD and low-to-intermediate cardiovascular risk. It is a test that should come, whenever possible, in front of functional evaluation because of its very high sensitivity and negative predictive value. The prognostic value of CCt is still investigational, even though it is becoming quite evident that the atherosclerotic phenotype plays a major role in the determination of prognosis, and as consequence, in the individualization of optimal pharmacological therapy, especially in the cohort without significant obstructive CAD. Recently, scientific and practical guidelines have been updated taking into account the role of CCT, which is able to provide a reliable and fast diagnosis with an additional resources optimization. Multiple registries and trials have been developed and will be summarized in this review. Recent guidelines highlighted the role of CCT in diagnosing suspected CAD.
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Affiliation(s)
- Patrizia Toia
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Ludovico La Grutta
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities (ProMISE), University of Palermo, Italy
| | - Tommaso Smeraldi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Francesco Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Emanuele Grassedonio
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Massimo Midiri
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Italy
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Hennessey B, Vera-Urquiza R, Mejía-Rentería H, Gonzalo N, Escaned J. Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention. Int J Cardiovasc Imaging 2020; 36:2441-2459. [DOI: 10.1007/s10554-020-02052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
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Choi H, Uceda DE, Dey AK, Abdelrahman KM, Aksentijevich M, Rodante JA, Elnabawi YA, Reddy A, Keel A, Erb-Alvarez J, Teague H, Playford MP, Zhou W, Chen MY, Gelfand JM, Bluemke DA, Buckler A, Mehta NN. Treatment of Psoriasis With Biologic Therapy Is Associated With Improvement of Coronary Artery Plaque Lipid-Rich Necrotic Core: Results From a Prospective, Observational Study. Circ Cardiovasc Imaging 2020; 13:e011199. [PMID: 32927971 DOI: 10.1161/circimaging.120.011199] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lipid-rich necrotic core (LRNC), a high-risk coronary plaque feature assessed by coronary computed tomography angiography, is associated with increased risk of future cardiovascular events in patients with subclinical, nonobstructive coronary artery disease. Psoriasis is a chronic inflammatory condition that is associated with increased prevalence of high-risk coronary plaque and risk of cardiovascular events. This study characterized LRNC in psoriasis and how LRNC modulates in response to biologic therapy. METHODS Consecutive biologic naïve psoriasis patients (n=209) underwent coronary computed tomography angiography at baseline and 1-year to assess changes in LRNC using a novel histopathologically validated software (vascuCAP Elucid Bioimaging, Boston, MA) before and after biologic therapy over 1 year. RESULTS Study participants were middle-aged, predominantly male with similar cardiometabolic and psoriasis status between treatment groups. In all participants at baseline, LRNC was associated with Framingham risk score (β [standardized β]=0.12 [95% CI, 0.00-0.15]; P=0.045), and psoriasis severity (β=0.13 [95% CI, 0.01-0.26]; P=0.029). At 1-year, participants receiving biologic therapy had a reduction in LRNC (mm2; 3.12 [1.99-4.66] versus 2.97 [1.84-4.35]; P=0.028), while those who did not receive biologic therapy over 1 year demonstrated no significant change with nominally higher LRNC (3.12 [1.82-4.60] versus 3.34 [2.04-4.74]; P=0.06). The change in LRNC was significant compared with that of the nonbiologic treated group (ΔLRNC, -0.22 mm2 versus 0.14 mm2, P=0.004) and remained significant after adjusting for cardiovascular risk factors and psoriasis severity (β=-0.09 [95% CI, -0.01 to -0.18]; P=0.033). CONCLUSIONS LRNC was associated with psoriasis severity and cardiovascular risk factors in psoriasis. Additionally, there was favorable modification of LRNC in those on biologic therapy. This study provides evidence of potential reduction in LRNC with treatment of systemic inflammation. Larger, longer follow-up prospective studies should be conducted to understand how changes in LRNC may translate into a reduction in future cardiovascular events in psoriasis.
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Affiliation(s)
- Harry Choi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Domingo E Uceda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Khaled M Abdelrahman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Milena Aksentijevich
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Aarthi Reddy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Julie Erb-Alvarez
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Heather Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Wunan Zhou
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | | | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.)
| | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
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Di Jiang M, Zhang XL, Liu H, Tang CX, Li JH, Wang YN, Xu PP, Zhou CS, Zhou F, Lu MJ, Zhang JY, Yu MM, Hou Y, Zheng MW, Zhang B, Zhang DM, Yi Y, Xu L, Hu XH, Yang J, Lu GM, Ni QQ, Zhang LJ. The effect of coronary calcification on diagnostic performance of machine learning-based CT-FFR: a Chinese multicenter study. Eur Radiol 2020; 31:1482-1493. [PMID: 32929641 DOI: 10.1007/s00330-020-07261-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the effect of coronary calcification morphology and severity on the diagnostic performance of machine learning (ML)-based coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) with FFR as a reference standard. METHODS A total of 442 patients (61.2 ± 9.1 years, 70% men) with 544 vessels who underwent CCTA, ML-based CT-FFR, and invasive FFR from China multicenter CT-FFR study were enrolled. The effect of calcification arc, calcification remodeling index (CRI), and Agatston score (AS) on the diagnostic performance of CT-FFR was investigated. CT-FFR ≤ 0.80 and lumen reduction ≥ 50% determined by CCTA were identified as vessel-specific ischemia with invasive FFR as a reference standard. RESULTS Compared with invasive FFR, ML-based CT-FFR yielded an overall sensitivity of 0.84, specificity of 0.94, and accuracy of 0.90 in a total of 344 calcification lesions. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of CT-FFR across different calcification arc, CRI, or AS levels. CT-FFR exhibited improved discrimination of ischemia compared with CCTA alone in lesions with mild-to-moderate calcification (AUC, 0.89 vs. 0.69, p < 0.001) and lesions with CRI ≥ 1 (AUC, 0.89 vs. 0.71, p < 0.001). The diagnostic accuracy and specificity of CT-FFR were higher than CCTA alone in patients and vessels with mid (100 to 299) or high (≥ 300) AS. CONCLUSION Coronary calcification morphology and severity did not influence diagnostic performance of CT-FFR in ischemia detection, and CT-FFR showed marked improved discrimination of ischemia compared with CCTA alone in the setting of calcification. KEY POINTS • CT-FFR provides superior diagnostic performance than CCTA alone regardless of coronary calcification. • No significant differences in the diagnostic performance of CT-FFR were observed in coronary arteries with different coronary calcification arcs and calcified remodeling indexes. • No significant differences in the diagnostic accuracy of CT-FFR were observed in coronary arteries with different coronary calcification score levels.
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Affiliation(s)
- Meng Di Jiang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiao Lei Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, 510080, China
| | - Chun Xiang Tang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jian Hua Li
- Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Peng Peng Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Fan Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Meng Jie Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jia Yin Zhang
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Meng Meng Yu
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110001, China
| | - Min Wen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Bo Zhang
- Department of Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Dai Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Yan Yi
- Institute of Diagnostic and Interventional Radiology and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 10029, China
| | - Xiu Hua Hu
- Department of Radiology, Shaoyifu Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, 310016, China
| | - Jian Yang
- Department of Radiology, the First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Qian Qian Ni
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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Abdelrahman KM, Chen MY, Dey AK, Virmani R, Finn AV, Khamis RY, Choi AD, Min JK, Williams MC, Buckler AJ, Taylor CA, Rogers C, Samady H, Antoniades C, Shaw LJ, Budoff MJ, Hoffmann U, Blankstein R, Narula J, Mehta NN. Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:1226-1243. [PMID: 32883417 PMCID: PMC7480405 DOI: 10.1016/j.jacc.2020.06.076] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/08/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Evaluation of coronary artery disease (CAD) using coronary computed tomography angiography (CCTA) has seen a paradigm shift in the last decade. Evidence increasingly supports the clinical utility of CCTA across various stages of CAD, from the detection of early subclinical disease to the assessment of acute chest pain. Additionally, CCTA can be used to noninvasively quantify plaque burden and identify high-risk plaque, aiding in diagnosis, prognosis, and treatment. This is especially important in the evaluation of CAD in immune-driven conditions with increased cardiovascular disease prevalence. Emerging applications of CCTA based on hemodynamic indices and plaque characterization may provide personalized risk assessment, affect disease detection, and further guide therapy. This review provides an update on the evidence, clinical applications, and emerging technologies surrounding CCTA as highlighted at the 2019 National Heart, Lung and Blood Institute CCTA Summit.
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Affiliation(s)
- Khaled M Abdelrahman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland
| | - Aloke V Finn
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland
| | - Ramzi Y Khamis
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Matthew J Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, New York
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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148
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Bing R, Loganath K, Adamson P, Newby D, Moss A. Non-invasive imaging of high-risk coronary plaque: the role of computed tomography and positron emission tomography. Br J Radiol 2020; 93:20190740. [PMID: 31821027 PMCID: PMC7465858 DOI: 10.1259/bjr.20190740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/12/2019] [Accepted: 11/30/2019] [Indexed: 11/09/2022] Open
Abstract
Despite recent advances, cardiovascular disease remains the leading cause of death globally. As such, there is a need to optimise our current diagnostic and risk stratification pathways in order to better deliver individualised preventative therapies. Non-invasive imaging of coronary artery plaque can interrogate multiple aspects of coronary atherosclerotic disease, including plaque morphology, anatomy and flow. More recently, disease activity is being assessed to provide mechanistic insights into in vivo atherosclerosis biology. Molecular imaging using positron emission tomography is unique in this field, with the potential to identify specific biological processes using either bespoke or re-purposed radiotracers. This review provides an overview of non-invasive vulnerable plaque detection and molecular imaging of coronary atherosclerosis.
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Affiliation(s)
- Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Krithika Loganath
- Wessex Heart Centre, University Hospital of Southampton, Southampton, UK
| | | | - David Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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149
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How atherosclerosis defines ischemia: Atherosclerosis quantification and characterization as a method for determining ischemia. J Cardiovasc Comput Tomogr 2020; 14:394-399. [DOI: 10.1016/j.jcct.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/04/2019] [Accepted: 10/27/2019] [Indexed: 01/23/2023]
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150
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Effect of vessel wall segmentation on volumetric and radiomic parameters of coronary plaques with adverse characteristics. J Cardiovasc Comput Tomogr 2020; 15:137-145. [PMID: 32868246 DOI: 10.1016/j.jcct.2020.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/07/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Quantitative coronary plaque parameters are increasingly being utilized as surrogate endpoints of pharmaceutical trials. However, little is known whether differences in segmentation significantly alter parameter values. METHODS Overall, 100 coronary plaques with adverse imaging characteristics were segmented automatically, by two experts (R1-R2) and three nonexperts (R3-R5). Low attenuation noncalcified (LANCP), noncalcified and calcified plaque volume were calculated and 4310 radiomic features were extracted. Intraclass correlation coefficient (ICC) values were calculated between the segmentations. RESULTS ICC values between expert readers were 0.84 [CI: 0.77-0.89] for total; 0.83 [CI: 0.76-0.88] for noncalcified; 0.96 [CI: 0.94-0.98] for calcified and 0.65 [CI: 0.51-0.75] for LANCP volumes. Comparing nonexperts' and experts' results, ICC ranged between 0.64 and 0.90 for total; 0.63-0.91 for noncalcified; 0.86-0.96 for calcified and 0.34-0.84 for LANCP volume. All readers (R1-R5) showed poor agreement with automatic segmentation (range: 0.00-0.27), except for calcified plaque volumes (range: 0.73-0.88). Regarding radiomic features, expert readers (R1-R2) achieved good reproducibility (ICC>0.80) in 88.6% (39/44) of first-order, 62.0% (424/684) of gray level co-occurrence matrix (GLCM), 75.8% (50/66) of gray level run length matrix (GLRLM) and 19.8% (696/3516) of geometrical parameters. Between experts and nonexperts, ICC ranged between: 70.5%-86.4% for first-order, 31.0%-58.3% for GLCM, 24.2%-78.8% for GLRLM and 6.2%-21.1% for geometrical features, while between all readers and automatic segmentation ICC ranged between: 25.0%-38.6%; 0.0%-0.0%; 0.0%-3.0% and 1.1%-1.4%, respectively. CONCLUSIONS Even among experts there is a considerable amount of disagreement in LANCP volumes. Nevertheless, expert readers have the best agreement which currently cannot be replaced with nonexperts' or automatic segmentation.
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