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Hell MM, Achenbach S, Schuhbaeck A, Klinghammer L, May MS, Marwan M. CT-based analysis of pericoronary adipose tissue density: Relation to cardiovascular risk factors and epicardial adipose tissue volume. J Cardiovasc Comput Tomogr 2015; 10:52-60. [PMID: 26256553 DOI: 10.1016/j.jcct.2015.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) can promote atherosclerosis. Metabolically active and inactive PCAT may display different CT densities. However, CT density could be influenced by partial volume effects and image interpolation. OBJECTIVE To investigate whether PCAT density values in CT displays differences that are larger than those attributable to interpolation and partial volume effects, which would manifest themselves through the relationship between PCAT density and distance from the contrast-enhanced coronary lumen. METHODS PCAT density analysis was performed (417 non-atherosclerotic segments, 63 patients) using dual-source CT with a threshold-based measurement method. Changes in PCAT density values depending on distance from the contrast-enhanced coronary lumen and the influence of cardiovascular risk profile were analyzed. RESULTS Mean PCAT density was -78.1 ± 5.6 HU. PCAT density decreased from proximal to distal segments in the LAD (-78.0 ± 7.3 vs. -82.4 ± 7.7 HU; p < 0.001). PCAT density was higher close to the lumen compared to more peripheral locations (-76.0 ± 6.7 vs. -78.5 ± 5.4 HU; p < 0.001). Decreasing PCAT density was significantly associated with higher epicardial adipose tissue (EAT) volume and body mass index. There was a trend of lower PCAT values with a family history of coronary artery disease. CONCLUSION CT-measured attenuation of PCAT is influenced by EAT volume and body mass index. A decrease of PCAT attenuation with increasing distance from the vessel and from proximal to distal segments may suggest variations in CT density of PCAT due to partial volume effects and image interpolation rather than solely due to differences in tissue composition or metabolic activity.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Lutz Klinghammer
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
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102
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Costopoulos C, Brown AJ, Teng Z, Hoole SP, West NEJ, Samady H, Bennett MR. Intravascular ultrasound and optical coherence tomography imaging of coronary atherosclerosis. Int J Cardiovasc Imaging 2015; 32:189-200. [DOI: 10.1007/s10554-015-0701-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
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103
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Wang T, McElroy A, Halaney D, Vela D, Fung E, Hossain S, Phipps J, Wang B, Yin B, Feldman MD, Milner TE. Detection of plaque structure and composition using OCT combined with two-photon luminescence (TPL) imaging. Lasers Surg Med 2015; 47:485-94. [PMID: 26018531 DOI: 10.1002/lsm.22366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Atherosclerosis and plaque rupture leads to myocardial infarction and stroke. A novel hybrid optical coherence tomography (OCT) and two-photon luminescence (TPL) fiber-based imaging system was developed to characterize tissue constituents in the context of plaque morphology. STUDY DESIGN/MATERIALS AND METHODS Ex vivo coronary arteries (34 regions of interest) from three human hearts with atherosclerotic plaques were examined by OCT-TPL imaging. Histological sections (4 μm in thickness) were stained with Oil Red O for lipid, Von Kossa for calcium, and Verhoeff-Masson Tri-Elastic for collagen/elastin fibers and compared with imaging results. RESULTS Biochemical components in plaques including lipid, oxidized-LDL, and calcium, as well as a non-tissue component (metal) are distinguished by multi-channel TPL images with statistical significance (P < 0.001). TPL imaging provides complementary optical contrast to OCT (two-photon absorption/emission vs scattering). Merged OCT-TPL images demonstrate the distribution of lipid deposits in registration with detailed plaque surface profile. CONCLUSIONS Results suggest that multi-channel TPL imaging can effectively identify lipid sub-types and different plaque components. Furthermore, fiber-based hybrid OCT-TPL imaging simultaneously detects plaque structure and composition, improving the efficacy of vulnerable plaque detection and characterization.
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Affiliation(s)
- Tianyi Wang
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Austin McElroy
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - David Halaney
- Division of Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | | | - Edmund Fung
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Shafat Hossain
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Jennifer Phipps
- Division of Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas
| | - Bingqing Wang
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Biwei Yin
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Marc D Feldman
- Division of Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | - Thomas E Milner
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
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Wasilewski J, Roleder M, Niedziela J, Nowakowski A, Osadnik T, Głowacki J, Mirota K, Poloński L. The role of septal perforators and "myocardial bridging effect" in atherosclerotic plaque distribution in the coronary artery disease. Pol J Radiol 2015; 80:195-201. [PMID: 25922625 PMCID: PMC4404747 DOI: 10.12659/pjr.893227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/19/2014] [Indexed: 11/09/2022] Open
Abstract
The distribution of atherosclerotic plaque burden in the human coronary arteries is not uniform. Plaques are located mostly in the left anterior descending artery (LAD), then in the right coronary artery (RCA), circumflex branch (LCx) and the left main coronary artery (LM) in a decreasing order of frequency. In the LAD and LCx, plaques tend to cluster within the proximal segment, while in the RCA their distribution is more uniform. Several factors have been involved in this phenomenon, particularly flow patterns in the left and right coronary artery. Nevertheless, it does not explain the difference in lesion frequency between the LAD and the LCx as these are both parts of the left coronary artery. Branching points are considered to be the risk points of atherosclerosis. In the LCx, the number of side branches is lower than in the LAD or RCA and there are no septal perforators with intramuscular courses like in the proximal third of the LAD and the posterior descending artery (PDA). We hypothesized that septal branches generate disturbed flow in the LAD and PDA in a similar fashion to the myocardial bridge (myocardial bridging effect). This coronary architecture determines the non-uniform plaque distribution in coronary arteries and LAD predisposition to plaque formation.
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Affiliation(s)
- Jarosław Wasilewski
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Marcin Roleder
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jacek Niedziela
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Andrzej Nowakowski
- Department of Mechanical Engineering, University of Sheffield, Sheffield, U.K
| | - Tadeusz Osadnik
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jan Głowacki
- Department of Diagnostic Imaging, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Kryspin Mirota
- Department of Mechanical Engineering Fundamentals, Faculty of Mechanical Engineering and Computer Science, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Lech Poloński
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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105
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Wang L, Parodi G, Maehara A, Valenti R, Migliorini A, Vergara R, Carrabba N, Mintz GS, Antoniucci D. Variable underlying morphology of culprit plaques associated with ST-elevation myocardial infarction: an optical coherence tomography analysis from the SMART trial. Eur Heart J Cardiovasc Imaging 2015; 16:1381-9. [DOI: 10.1093/ehjci/jev105] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/02/2015] [Indexed: 11/14/2022] Open
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106
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Michaud K, Grabherr S, Faouzi M, Grimm J, Doenz F, Mangin P. Pathomorphological and CT-angiographical characteristics of coronary atherosclerotic plaques in cases of sudden cardiac death. Int J Legal Med 2015; 129:1067-77. [DOI: 10.1007/s00414-015-1191-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
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107
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Toutouzas K, Chatzizisis YS, Riga M, Giannopoulos A, Antoniadis AP, Tu S, Fujino Y, Mitsouras D, Doulaverakis C, Tsampoulatidis I, Koutkias VG, Bouki K, Li Y, Chouvarda I, Cheimariotis G, Maglaveras N, Kompatsiaris I, Nakamura S, Reiber JHC, Rybicki F, Karvounis H, Stefanadis C, Tousoulis D, Giannoglou GD. Accurate and reproducible reconstruction of coronary arteries and endothelial shear stress calculation using 3D OCT: comparative study to 3D IVUS and 3D QCA. Atherosclerosis 2015; 240:510-9. [PMID: 25932791 DOI: 10.1016/j.atherosclerosis.2015.04.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/15/2015] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Geometrically-correct 3D OCT is a new imaging modality with the potential to investigate the association of local hemodynamic microenvironment with OCT-derived high-risk features. We aimed to describe the methodology of 3D OCT and investigate the accuracy, inter- and intra-observer agreement of 3D OCT in reconstructing coronary arteries and calculating ESS, using 3D IVUS and 3D QCA as references. METHODS-RESULTS 35 coronary artery segments derived from 30 patients were reconstructed in 3D space using 3D OCT. 3D OCT was validated against 3D IVUS and 3D QCA. The agreement in artery reconstruction among 3D OCT, 3D IVUS and 3D QCA was assessed in 3-mm-long subsegments using lumen morphometry and ESS parameters. The inter- and intra-observer agreement of 3D OCT, 3D IVUS and 3D QCA were assessed in a representative sample of 61 subsegments (n = 5 arteries). The data processing times for each reconstruction methodology were also calculated. There was a very high agreement between 3D OCT vs. 3D IVUS and 3D OCT vs. 3D QCA in terms of total reconstructed artery length and volume, as well as in terms of segmental morphometric and ESS metrics with mean differences close to zero and narrow limits of agreement (Bland-Altman analysis). 3D OCT exhibited excellent inter- and intra-observer agreement. The analysis time with 3D OCT was significantly lower compared to 3D IVUS. CONCLUSIONS Geometrically-correct 3D OCT is a feasible, accurate and reproducible 3D reconstruction technique that can perform reliable ESS calculations in coronary arteries.
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Affiliation(s)
- Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Yiannis S Chatzizisis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
| | - Maria Riga
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Andreas Giannopoulos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Shengxian Tu
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Dimitrios Mitsouras
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charalampos Doulaverakis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Ioannis Tsampoulatidis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Vassilis G Koutkias
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Konstantina Bouki
- Second Department of Cardiology, General Hospital of Nikaia, Piraeus, Greece
| | - Yingguang Li
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Grigorios Cheimariotis
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Nicos Maglaveras
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Christodoulos Stefanadis
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - George D Giannoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
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108
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Fujii K, Hao H, Shibuya M, Imanaka T, Fukunaga M, Miki K, Tamaru H, Sawada H, Naito Y, Ohyanagi M, Hirota S, Masuyama T. Accuracy of OCT, Grayscale IVUS, and Their Combination for the Diagnosis of Coronary TCFA. JACC Cardiovasc Imaging 2015; 8:451-460. [DOI: 10.1016/j.jcmg.2014.10.015] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
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109
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Niccoli G, Montone RA, Di Vito L, Gramegna M, Refaat H, Scalone G, Leone AM, Trani C, Burzotta F, Porto I, Aurigemma C, Prati F, Crea F. Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome. Eur Heart J 2015; 36:1377-84. [PMID: 25713314 DOI: 10.1093/eurheartj/ehv029] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/20/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Patients presenting with acute coronary syndrome (ACS) may have different plaque morphologies at the culprit lesion. In particular, plaque rupture (PR) has been shown as the more frequent culprit plaque morphology in ACS. However, its prognostic value is still unknown. In this study, we evaluated the prognostic value of PR, compared with intact fibrous cap (IFC), in patients with ACS. METHODS AND RESULTS We enrolled consecutive patients admitted to our Coronary Care Unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis was assessed according to such culprit lesion classification. Major adverse cardiac events (MACEs) were defined as the composite of cardiac death, non-fatal myocardial infarction, unstable angina, and target lesion revascularization (follow-up mean time 31.58 ± 4.69 months). The study comprised 139 consecutive ACS patients (mean age 64.3 ± 12.0 years, male 73.4%, 92 patients with non-ST elevation ACS and 47 with ST-elevation ACS). Plaque rupture was detected in 82/139 (59%) patients. There were no differences in clinical, angiographic, or procedural data between patients with PR when compared with those having IFC. Major adverse cardiac events occurred more frequently in patients with PR when compared with those having IFC (39.0 vs. 14.0%, P = 0.001). Plaque rupture was an independent predictor of outcome at multivariable analysis (odds ratio 3.735, confidence interval 1.358-9.735). CONCLUSION Patients with ACS presenting with PR as culprit lesion by OCT have a worse prognosis compared with that of patients with IFC. This finding should be taken into account in risk stratification and management of patients with ACS.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Rocco A Montone
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Luca Di Vito
- Department of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy C.L.I. Foundation, Rome, Italy
| | - Mario Gramegna
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Hesham Refaat
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy Institute of Cardiology, Zagazig University, Zagazig, Egypt
| | - Giancarla Scalone
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Antonio M Leone
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Italo Porto
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Francesco Prati
- Department of Cardiology, San Giovanni Addolorata Hospital, Rome, Italy C.L.I. Foundation, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
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110
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Jacobin-Valat MJ, Laroche-Traineau J, Larivière M, Mornet S, Sanchez S, Biran M, Lebaron C, Boudon J, Lacomme S, Cérutti M, Clofent-Sanchez G. Nanoparticles functionalised with an anti-platelet human antibody for in vivo detection of atherosclerotic plaque by magnetic resonance imaging. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:927-37. [PMID: 25684334 DOI: 10.1016/j.nano.2014.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 11/29/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Atherosclerosis is an inflammatory disease associated with the formation of atheroma plaques likely to rupture in which platelets are involved both in atherogenesis and atherothrombosis. The rupture is linked to the molecular composition of vulnerable plaques, causing acute cardiovascular events. In this study we propose an original targeted contrast agent for molecular imaging of atherosclerosis. Versatile USPIO (VUSPIO) nanoparticles, enhancing contrast in MR imaging, were functionalised with a recombinant human IgG4 antibody, rIgG4 TEG4, targeting human activated platelets. The maintenance of immunoreactivity of the targeted VUSPIO against platelets was confirmed in vitro by flow cytometry, transmission electronic and optical microscopy. In the atherosclerotic ApoE(-/-) mouse model, high-resolution ex vivo MRI demonstrated the selective binding of TEG4-VUSPIO on atheroma plaques. It is noteworthy that the rationale for targeting platelets within atherosclerotic lesions is highlighted by our targeted contrast agent using a human anti-αIIbβ3 antibody as a targeting moiety. FROM THE CLINICAL EDITOR Current clinical assessment of atherosclerotic plagues is suboptimal. The authors in the article designed functionalized superparamagnetic iron oxide nanoparticles with TEG4, a recombinant human antibody, to target activated platelets. By using MRI, these nanoparticles can be utilized to study the process of atheroma pathogenesis.
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Affiliation(s)
- Marie-Josée Jacobin-Valat
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Jeanny Laroche-Traineau
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Mélusine Larivière
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Stéphane Mornet
- CNRS, UPR9048, Université de Bordeaux, Institut de Chimie de la Matière Condensée de Bordeaux, Pessac, France
| | - Stéphane Sanchez
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France
| | - Marc Biran
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France
| | - Caroline Lebaron
- CNRS, UPS3044, "Baculovirus et thérapie", St Christol-Les-Alez, France
| | - Julien Boudon
- CNRS, UPR9048, Université de Bordeaux, Institut de Chimie de la Matière Condensée de Bordeaux, Pessac, France
| | - Sabrina Lacomme
- Bordeaux Imaging Center, Université Bordeaux, Bordeaux, France
| | - Martine Cérutti
- CNRS, UPS3044, "Baculovirus et thérapie", St Christol-Les-Alez, France
| | - Gisèle Clofent-Sanchez
- CNRS, UMR5536, CRMSB, Centre de Résonance Magnétique des Systèmes Biologiques, Université Bordeaux, Bordeaux, France; Plateforme Technologique et d'Innovation Biomédicale, Pessac, France.
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111
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Arbab-Zadeh A, Fuster V. The myth of the "vulnerable plaque": transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment. J Am Coll Cardiol 2015; 65:846-855. [PMID: 25601032 DOI: 10.1016/j.jacc.2014.11.041] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 11/04/2014] [Accepted: 11/25/2014] [Indexed: 01/04/2023]
Abstract
The cardiovascular science community has pursued the quest to identify vulnerable atherosclerotic plaque in patients for decades, hoping to prevent acute coronary events. However, despite major advancements in imaging technology that allow visualization of rupture-prone plaques, clinical studies have not demonstrated improved risk prediction compared with traditional approaches. Considering the complex relationship between plaque rupture and acute coronary event risk suggested by pathology studies and confirmed by clinical investigations, these results are not surprising. This review summarizes the evidence supporting a multifaceted hypothesis of the natural history of atherosclerotic plaque rupture. Managing patients at risk of acute coronary events mandates a greater focus on the atherosclerotic disease burden rather than on features of individual plaques.
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Affiliation(s)
- Armin Arbab-Zadeh
- Department of Medicine, Cardiology Division, Johns Hopkins University, Baltimore, Maryland.
| | - Valentin Fuster
- Mount Sinai Medical Center, Icahn School of Medicine, New York, New York
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112
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Alluri K, Joshi PH, Henry TS, Blumenthal RS, Nasir K, Blaha MJ. Scoring of coronary artery calcium scans: history, assumptions, current limitations, and future directions. Atherosclerosis 2015; 239:109-17. [PMID: 25585030 DOI: 10.1016/j.atherosclerosis.2014.12.040] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/07/2023]
Abstract
Coronary artery calcium (CAC) scanning is a reliable, noninvasive technique for estimating overall coronary plaque burden and for identifying risk for future cardiac events. Arthur Agatston and Warren Janowitz published the first technique for scoring CAC scans in 1990. Given the lack of available data correlating CAC with burden of coronary atherosclerosis at that time, their scoring algorithm was remarkable, but somewhat arbitrary. Since then, a few other scoring techniques have been proposed for the measurement of CAC including the Volume score and Mass score. Yet despite new data, little in this field has changed in the last 15 years. The main focus of our paper is to review the implications of the current approach to scoring CAC scans in terms of correlation with the central disease - coronary atherosclerosis. We first discuss the methodology of each available scoring system, describing how each of these scores make important indirect assumptions in the way they account (or do not account) for calcium density, location of calcium, spatial distribution of calcium, and microcalcification/emerging calcium that might limit their predictive power. These assumptions require further study in well-designed, large event-driven studies. In general, all of these scores are adequate and are highly correlated with each other. Despite its age, the Agatston score remains the most extensively studied and widely accepted technique in both the clinical and research settings. After discussing CAC scoring in the era of contrast enhanced coronary CT angiography, we discuss suggested potential modifications to current CAC scanning protocols with respect to tube voltage, tube current, and slice thickness which may further improve the value of CAC scoring. We close with a focused discussion of the most important future directions in the field of CAC scoring.
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Affiliation(s)
- Krishna Alluri
- Department of Internal Medicine, UPMC Mckeesport Hospital, Mckeesport, PA, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Parag H Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Travis S Henry
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
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113
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Noto T, Kameyama T, Satoh T, Nonomura M, Nozawa T, Inoue H. Association Between Virtual Histology Intravascular Ultrasound Findings and Subsequent Coronary Events in Patients With Acute Coronary Syndrome. Int Heart J 2015; 56:157-62. [DOI: 10.1536/ihj.14-222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takahisa Noto
- Second Department of Internal Medicine, Toyama University Hospital
| | | | - Takao Satoh
- Second Department of Internal Medicine, Toyama University Hospital
| | | | - Takashi Nozawa
- Second Department of Internal Medicine, Toyama University Hospital
| | - Hiroshi Inoue
- Second Department of Internal Medicine, Toyama University Hospital
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114
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Chen YC, Rivera J, Peter K. Tandem Stenosis to Induce Atherosclerotic Plaque Instability in the Mouse. Methods Mol Biol 2015; 1339:333-338. [PMID: 26445800 DOI: 10.1007/978-1-4939-2929-0_23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite the number of animal models of atherosclerosis, a major limitation in research on mechanisms of plaque rupture is the lack of appropriate atherosclerotic mouse models where lesions develop and progress to a vulnerable and thus rupture-prone phenotype that is typically observed in humans. Most animal models of atherosclerosis typically represent a few but not the full combination of the characteristics seen in human unstable/ruptured plaques. Such characteristics most importantly include a thin and ruptured fibrous cap, plaque inflammation, neovascularization within the plaque (vasa vasorum), plaque hemorrhage, and intravascular (often occlusive) thrombus formation. Ideally, an animal model of plaque instability/rupture would respond to current pharmacological interventions known to reduce the risk of plaque rupture, such as statins. Here we describe a mouse model of plaque instability/rupture that is based on the surgical introduction of a tandem stenosis in the carotid artery. This model results in the formation of unstable atherosclerotic plaques that reflect human plaque pathology. It will allow to further understanding of plaque instability/rupture, to identify the participating factors such as specific proteins, genes and microRNAs, and to develop imaging methods towards the detection of vulnerable, rupture-prone atherosclerotic plaques.
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Affiliation(s)
- Yung Chih Chen
- Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, St Kilda Road Central, 6492, Melbourne, VIC, 8008, Australia
- Departments of Medicine and Immunology, Monash University, Melbourne, VIC, Australia
| | - Jennifer Rivera
- Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, St Kilda Road Central, 6492, Melbourne, VIC, 8008, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, St Kilda Road Central, 6492, Melbourne, VIC, 8008, Australia.
- Departments of Medicine and Immunology, Monash University, Melbourne, VIC, Australia.
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115
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Evaluation of Vulnerable Atherosclerotic Plaques. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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116
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Abstract
It is now clearly established that Thin-Capped Fibroatheromas (TCFAs) lead to most Acute Coronary Syndromes (ACSs). The ability to selectively intervene on TCFAs predisposed to rupture and ACSs would dramatically alter the practice of cardiology. While the ability of OCT to identify thin walled plaques at micron scale resolutions has represented a major advance, it is a misconception that it can reliably identify TCFAs. One major reason is that the 'diffuse border' criteria currently used to determine 'lipid plaque' is almost undoubtedly from high scattering in the intima and not because of core composition (necrotic core). A second reason is that, rather than looking at lipid collections, studies need to be focused on identifying necrotic cores with OCT. Necrotic cores are characteristic of TCFAs and not lipid collections. Numerous other OCT approaches are available which can potentially accurately assess TCFAs, but these have not been aggressively pursed which we believe likely stems in part from the misconceptions over the efficacy of 'diffuse borders'.
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Affiliation(s)
- Mark E Brezinski
- Center for Optics and Modern Physics, Brigham and Women's Hospital, Boston, M.A, USA.,Harvard Medical School, Boston, M.A, USA.,Department of Electrical Engineering, Massachusetts Institute of Technology, Cambridge, M.A, USA
| | - Kishore J Harjai
- Richard and Marion Pearsall Heart Hospital, Geisinger Clinic, Wilkes-Barre, PA, USA
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117
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Brown AJ, Costopoulos C, West NE, Bennett MR. Contemporary invasive imaging modalities that identify and risk-stratify coronary plaques at risk of rupture. Expert Rev Cardiovasc Ther 2014; 13:9-13. [PMID: 25470576 DOI: 10.1586/14779072.2015.989836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerotic plaque rupture is responsible for the majority of myocardial infarctions, with ruptured plaques exhibiting specific morphological features, including large lipid cores, thinner overlying fibrous caps and micro-calcifications. Contemporary imaging modalities are increasingly able to characterize plaques, potentially leading to the identification of precursor lesions that are at high risk of rupture. Observational studies using invasive imaging consistently find that plaques responsible for an acute coronary event display these high-risk morphological features, and recent prospective imaging studies have now established links between baseline plaque characteristics and future cardiovascular events. Despite these promising advances, subsequent overall event rates remain too low for clinical utility. Novel technologies are now required to refine and improve our ability to identify and risk-stratify lesions at risk of rupture, if plaque-based risk evaluation is ever to become reality.
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Affiliation(s)
- Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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118
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Munnur RK, Cameron JD, Ko BS, Meredith IT, Wong DTL. Cardiac CT: atherosclerosis to acute coronary syndrome. Cardiovasc Diagn Ther 2014; 4:430-48. [PMID: 25610801 PMCID: PMC4278045 DOI: 10.3978/j.issn.2223-3652.2014.11.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA.
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119
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Brezinski ME. Practical Challenges of Current Video Rate OCT Elastography: Accounting for Dynamic and Static Tissue Properties. JOURNAL OF LASERS, OPTICS & PHOTONICS 2014; 1:112. [PMID: 29286052 PMCID: PMC5743221 DOI: 10.4172/2469-410x.1000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Optical coherence tomography (OCT) elastography (OCTE) has the potential to be an important diagnostic tool for pathologies including coronary artery disease, osteoarthritis, malignancies, and even dental caries. Many groups have performed OCTE, including our own, using a wide range of approaches. However, we will demonstrate current OCTE approaches are not scalable to real-time, in vivo imaging. As will be discussed, among the most important reasons is current designs focus on the system and not the target. Specifically, tissue dynamic responses are not accounted, with examples being the tissue strain response time, preload variability, and conditioning variability. Tissue dynamic responses, and to a lesser degree static tissue properties, prevent accurate video rate modulus assessments for current embodiments. Accounting for them is the focus of this paper. A top-down approach will be presented to overcome these challenges to real time in vivo tissue characterization. Discussed first is an example clinical scenario where OTCE would be of substantial relevance, the prevention of acute myocardial infarction or heart attacks. Then the principles behind OCTE are examined. Next, constrains on in vivo application of current OCTE are evaluated, focusing on dynamic tissue responses. An example is the tissue strain response, where it takes about 20 msec after a stress is applied to reach plateau. This response delay is not an issue at slow acquisition rates, as most current OCTE approaches are preformed, but it is for video rate OCTE. Since at video rate each frame is only 30 msec, for essentially all current approaches this means the strain for a given stress is changing constantly during the B-scan. Therefore the modulus can't be accurately assessed. This serious issue is an even greater problem for pulsed techniques as it means the strain/modulus for a given stress (at a location) is unpredictably changing over a B-scan. The paper concludes by introducing a novel video rate approach to overcome these challenges.
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Affiliation(s)
- Mark E Brezinski
- Center for Optics and Modern Physics, Brigham and Women’s Hospital, 75 Francis Street, Boston, M.A. 02115, USA
- Harvard Medical School, 25 Shattuck Street, Boston, M.A. 02115, USA
- Department of Electrical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, M.A. 02139, USA
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120
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Palacio D, Betancourt S, Gladish GW. Screening for coronary heart disease in asymptomatic patients using multidetector computed tomography: calcium scoring and coronary computed tomography angiography. Semin Roentgenol 2014; 50:111-7. [PMID: 25770341 DOI: 10.1053/j.ro.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Diana Palacio
- Department of Radiology, University of Arizona, College of Medicine, Tucson, AZ.
| | - Sonia Betancourt
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory W Gladish
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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121
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Mehrabadi M, Ku DN, Aidun CK. A Continuum Model for Platelet Transport in Flowing Blood Based on Direct Numerical Simulations of Cellular Blood Flow. Ann Biomed Eng 2014; 43:1410-21. [DOI: 10.1007/s10439-014-1168-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022]
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122
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Brezinski ME, Harjai KJ. Longitudinal necrotic shafts near TCFAs--a potential novel mechanism for plaque rupture to trigger ACS? Int J Cardiol 2014; 177:738-41. [PMID: 25449500 DOI: 10.1016/j.ijcard.2014.09.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/30/2014] [Accepted: 09/27/2014] [Indexed: 11/25/2022]
Abstract
It has been questioned for over 15 years why only less than 20% of TCFAs trigger ACS. We illustrate TCFA rupture into adjacent longitudinal necrotic shafts of massive amounts of thrombogenic material into the blood, leading to catastrophic clot formation. This is the potential mechanism for TCFAs triggering ACS. One case presented also illustrates the dangers of stent edges rupturing TCFAs.
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Affiliation(s)
- Mark E Brezinski
- Center for Optics and Modern Physics, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Electrical Engineering, Massachusetts Institute of Technology, 77 MA Avenue, Cambridge, MA 02139, USA.
| | - Kishore J Harjai
- Richard and Marion Pearsall Heart Hospital, Geisinger Clinic, Wilkes-Barre, PA 18711, USA
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123
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Pedrigi RM, de Silva R, Bovens SM, Mehta VV, Petretto E, Krams R. Thin-Cap Fibroatheroma Rupture Is Associated With a Fine Interplay of Shear and Wall Stress. Arterioscler Thromb Vasc Biol 2014; 34:2224-31. [DOI: 10.1161/atvbaha.114.303426] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review, we summarized the effect of mechanical factors (shear and wall stress) on thin-cap fibroatheroma formation and rupture. To make this review understandable for a biology-oriented audience, we start with detailed definitions of relevant mechanical metrics. We then describe how biomechanics has supported histopathologic efforts to understand the basis of plaque rupture. In addition to plaque rupture, biomechanics also contributes toward the progression of thin-cap fibroatheroma through a multitude of reported mechanobiological mechanisms. We thus propose a new mechanism whereby both shear stress and wall stress interact to create thin-cap fibroatheromas. Specifically, when regions of certain blood flow and wall mechanical stimuli coincide, they synergistically create inflammation within the cellular environment that can lead to thin-cap fibroatheroma rupture. A consequence of this postulate is that local shear stress is not sufficient to cause rupture, but it must coincide with regions of local tissue stiffening and stress concentrations that can occur during plaque progression. Because such changes to the wall mechanics occur over a micrometer scale, high spatial resolution imaging techniques will be necessary to evaluate this hypothesis and ultimately predict plaque rupture in a clinical environment.
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Affiliation(s)
- Ryan M. Pedrigi
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Ranil de Silva
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Sandra M. Bovens
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Vikram V. Mehta
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Enrico Petretto
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Rob Krams
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
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124
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Ye K, Qin J, Peng Z, Yang X, Huang L, Yuan F, Peng C, Jiang M, Lu X. Polyethylene glycol-modified dendrimer-entrapped gold nanoparticles enhance CT imaging of blood pool in atherosclerotic mice. NANOSCALE RESEARCH LETTERS 2014; 9:529. [PMID: 25288918 PMCID: PMC4184899 DOI: 10.1186/1556-276x-9-529] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/20/2014] [Indexed: 05/25/2023]
Abstract
We report a new use of dendrimer-entrapped gold nanoparticles (Au DENPs) modified by polyethylene glycol (PEG) with good biocompatibility for in vitro and in vivo imaging of atherosclerotic mice by computed tomography (CT). In this study, Au DENPs were synthesized using poly(amidoamine) (PAMAM) dendrimers of generation 5 (G5.NH2) modified by PEG monomethyl ether (G5.NH2-mPEG20) as templates. In vitro cytotoxicity and flow cytometry assays show that the formed PEGylated Au DENPs have good biocompatibility and are non-cytotoxic at the Au concentration up to 300 μM. Silver staining and transmission electron microscopy (TEM) further confirm that the Au DENPs are able to be uptaken by macrophages and are located dominantly in the lysosomes of the cells. Importantly, the formed PEGylated Au DENPs are able to be used for CT imaging of murine macrophages in vitro and macrophages in atherosclerotic mice in vivo using apolipoprotein-E-gene-deficient mice as a model. These findings suggest that the formed PEGylated Au DENPs are a promising contrast agent for CT imaging of atherosclerosis.
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Affiliation(s)
- Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
| | - Xinrui Yang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
| | - Lijia Huang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
| | - Fukang Yuan
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
| | - Chen Peng
- Department of Radiology, Shanghai Tenth People's Hospital Affiliated to Tongji University, School of Medicine, Shanghai 200072, People's Republic of China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
- Vascular Center of Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, People's Republic of China
- Vascular Center of Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China
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125
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Räber L, Taniwaki M, Zaugg S, Kelbæk H, Roffi M, Holmvang L, Noble S, Pedrazzini G, Moschovitis A, Lüscher TF, Matter CM, Serruys PW, Jüni P, Garcia-Garcia HM, Windecker S. Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4): a serial intravascular ultrasonography study. Eur Heart J 2014; 36:490-500. [DOI: 10.1093/eurheartj/ehu373] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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126
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Intracoronary Optical Coherence Tomography: Insights from Clinical Research—What Do We Need to Learn? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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127
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Sugiyama T, Kimura S, Akiyama D, Hishikari K, Kawaguchi N, Kamiishi T, Hikita H, Takahashi A, Isobe M. Quantitative assessment of tissue prolapse on optical coherence tomography and its relation to underlying plaque morphologies and clinical outcome in patients with elective stent implantation. Int J Cardiol 2014; 176:182-90. [DOI: 10.1016/j.ijcard.2014.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/28/2014] [Accepted: 07/05/2014] [Indexed: 11/28/2022]
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128
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Garcia-Garcia HM, Jang IK, Serruys PW, Kovacic JC, Narula J, Fayad ZA. Imaging plaques to predict and better manage patients with acute coronary events. Circ Res 2014; 114:1904-17. [PMID: 24902974 DOI: 10.1161/circresaha.114.302745] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Culprit lesions of patients, who have had an acute coronary syndrome commonly, are ruptured coronary plaques with superimposed thrombus. The precursor of such lesions is an inflamed thin-capped fibroatheroma. These plaques can be imaged by means of invasive techniques, such as intravascular ultrasound (and derived techniques), optical coherence tomography, and near-infrared spectroscopy. Often these patients exhibit similar (multiple) plaques beyond the culprit lesion. These remote plaques can be assessed noninvasively by computed tomographic angiography and MRI and also using invasive imaging. The detection of these remote plaques is not only feasible but also in natural history studies have been associated with clinical coronary events. Different systemic pharmacological treatments have been studied (mostly statins) with modest success and, therefore, newer approaches are being tested. Local treatment for such lesions is in its infancy and larger, prospective, and randomized trials are needed. This review will describe the pathological and imaging findings in culprit lesions of patients with acute coronary syndrome and the assessment of remote plaques. In addition, the pharmacological and local treatment options will be reviewed.
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Affiliation(s)
- Hector M Garcia-Garcia
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ik-Kyung Jang
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick W Serruys
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jason C Kovacic
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zahi A Fayad
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY.
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129
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Tortuosity of coronary bifurcation as a potential local risk factor for atherosclerosis: CFD steady state study based on in vivo dynamic CT measurements. Ann Biomed Eng 2014; 43:82-93. [PMID: 24986333 DOI: 10.1007/s10439-014-1056-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
Abstract
The purpose of the present study was to determine whether in vivo bifurcation geometric factors would permit prediction of the risk of atherosclerosis. It is worldwide accepted that low or oscillatory wall shear stress (WSS) is a robust hemodynamic factor in the development of atherosclerotic plaque and has a strong correlation with the local site of plaque deposition. However, it still remains unclear how coronary bifurcation geometries are correlated with such hemodynamic forces. Computational fluid dynamics simulations were performed on left main (LM) coronary bifurcation geometries derived from CT of eight patients without significant atherosclerosis. WSS amplitudes were accurately quantified at two high risk zones of atherosclerosis, namely at proximal left anterior descending artery (LAD) and at proximal left circumflex artery (LCx), and also at three high WSS concentration sites near the bifurcation. Statistical analysis was used to highlight relationships between WSS amplitudes calculated at these five zones of interest and various geometric factors. The tortuosity index of the LM-LAD segment appears to be an emergent geometric factor in determining the low WSS amplitude at proximal LAD. Strong correlations were found between the high WSS amplitudes calculated at the endothelial regions close to the flow divider. This study not only demonstrated that CT imaging studies of local risk factor for atherosclerosis could be clinically performed, but also showed that tortuosity of LM-LAD coronary branch could be used as a surrogate marker for the onset of atherosclerosis.
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Brugaletta S, Sabaté M. Assessment of plaque composition by intravascular ultrasound and near-infrared spectroscopy: from PROSPECT I to PROSPECT II. Circ J 2014; 78:1531-9. [PMID: 24931516 DOI: 10.1253/circj.cj-14-0496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atherosclerosis is the main cause of coronary artery disease (CAD), which is today the leading cause of death worldwide and will continue to be the first in the world in 2030. Vulnerable coronary plaques are usually characterized by a high content of necrotic core, a thin inflamed fibrous cap (intense accumulation of macrophages) and scarce presence of smooth muscle cells. None of these characteristics can be estimated by coronary angiography, which on the contrary underestimates the magnitude of atherosclerotic burden, particularly in earlier stage disease when positive vascular remodeling may allow "normal" lumen caliber despite substantial vascular wall plaque. The recognition of the ubiquity of substantial but non-flow limiting lesions that may be at high risk for subsequent plaque rupture has resulted in a paradigm shift in thinking about the pathophysiology of CAD, with the focus no longer solely on the degree of arterial luminal narrowing. This growing need for more information about coronary atherosclerosis in order to identify patients and lesions at risk for complications during PCI and for future adverse cardiac events has been the primary impetus for the development of novel intracoronary imaging methods able to detect plaque composition, in particular presence of a necrotic core/lipid pool, such as intravascular ultrasound virtual histology and near-infrared spectroscopy. These imaging technologies and their clinical and clinical/research applications are discussed in detail.
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Abstract
Atherosclerosis causes clinical disease through luminal narrowing or by precipitating thrombi that obstruct blood flow to the heart (coronary heart disease), brain (ischemic stroke), or lower extremities (peripheral vascular disease). The most common of these manifestations is coronary heart disease, including stable angina pectoris and the acute coronary syndromes. Atherosclerosis is a lipoprotein-driven disease that leads to plaque formation at specific sites of the arterial tree through intimal inflammation, necrosis, fibrosis, and calcification. After decades of indolent progression, such plaques may suddenly cause life-threatening coronary thrombosis presenting as an acute coronary syndrome. Most often, the culprit morphology is plaque rupture with exposure of highly thrombogenic, red cell–rich necrotic core material. The permissive structural requirement for this to occur is an extremely thin fibrous cap, and thus, ruptures occur mainly among lesions defined as thin-cap fibroatheromas. Also common are thrombi forming on lesions without rupture (plaque erosion), most often on pathological intimal thickening or fibroatheromas. However, the mechanisms involved in plaque erosion remain largely unknown, although coronary spasm is suspected. The calcified nodule has been suggested as a rare cause of coronary thrombosis in highly calcified and tortious arteries in older individuals. To characterize the severity and prognosis of plaques, several terms are used. Plaque burden denotes the extent of disease, whereas plaque activity is an ambiguous term, which may refer to one of several processes that characterize progression. Plaque vulnerability describes the short-term risk of precipitating symptomatic thrombosis. In this review, we discuss mechanisms of atherosclerotic plaque initiation and progression; how plaques suddenly precipitate life-threatening thrombi; and the concepts of plaque burden, activity, and vulnerability.
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Santoro F, Tarantino N, Pellegrino PL, Caivano M, Lopizzo A, Di Biase M, Brunetti ND. Cardiovascular sequelae of radiation therapy. Clin Res Cardiol 2014; 103:955-67. [DOI: 10.1007/s00392-014-0718-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/15/2014] [Indexed: 01/13/2023]
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Obaid DR, Calvert PA, Gopalan D, Parker RA, West NEJ, Goddard M, Rudd JHF, Bennett MR. Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: a prospective study with tissue validation. J Cardiovasc Comput Tomogr 2014; 8:230-7. [PMID: 24939072 PMCID: PMC4070076 DOI: 10.1016/j.jcct.2014.04.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/25/2014] [Accepted: 04/22/2014] [Indexed: 12/02/2022]
Abstract
Background Identifying vulnerable coronary plaque with coronary CT angiography is limited by overlap between attenuation of necrotic core and fibrous plaque. Using x-rays with differing energies alters attenuation values of these components, depending on their material composition. Objectives We sought to determine whether dual-energy CT (DECT) improves plaque component discrimination compared with single-energy CT (SECT). Methods Twenty patients underwent DECT and virtual histology intravascular ultrasound (VH-IVUS). Attenuation changes at 100 and 140 kV for each plaque component were defined, using 1088 plaque areas co-registered with VH-IVUS. Hounsfield unit thresholds that best detected necrotic core were derived for SECT (conventional attenuation values) and for DECT (using dual-energy indices, defined as difference in Hounsfield unit values at the 2 voltages/their sum). Sensitivity of SECT and DECT to detect plaque components was determined in 77 segments from 7 postmortem coronary arteries. Finally, we examined 60 plaques in vivo to determine feasibility and sensitivity of clinical DECT to detect VH-IVUS–defined necrotic core. Results In contrast to conventional SECT, mean dual-energy indices of necrotic core and fibrous tissue were significantly different with minimal overlap of ranges (necrotic core, 0.007 [95% CI, –0.001 to 0.016]; fibrous tissue, 0.028 [95% CI, 0.016–0.050]; P < .0001). DECT increased diagnostic accuracy to detect necrotic core in postmortem arteries (sensitivity, 64%; specificity, 98%) compared with SECT (sensitivity, 50%; specificity, 94%). DECT sensitivity to detect necrotic core was lower when analyzed in vivo, although still better than SECT (45% vs 39%). Conclusions DECT improves the differentiation of necrotic core and fibrous plaque in ex vivo postmortem arteries. However, much of this improvement is lost when translated to in vivo imaging because of a reduction in image quality.
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Affiliation(s)
- Daniel R Obaid
- Division of Cardiovascular Medicine, University of Cambridge, ACCI, Hills Road, Cambridge, CB2 0QQ, UK; Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, UK
| | - Patrick A Calvert
- Division of Cardiovascular Medicine, University of Cambridge, ACCI, Hills Road, Cambridge, CB2 0QQ, UK; Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, UK
| | - Deepa Gopalan
- Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, UK
| | - Richard A Parker
- Centre for Applied Medical Statistics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Nick E J West
- Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, UK
| | - Martin Goddard
- Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, ACCI, Hills Road, Cambridge, CB2 0QQ, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, ACCI, Hills Road, Cambridge, CB2 0QQ, UK.
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Clinical Outcome of Nonculprit Plaque Ruptures in Patients With Acute Coronary Syndrome in the PROSPECT Study. JACC Cardiovasc Imaging 2014; 7:397-405. [DOI: 10.1016/j.jcmg.2013.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/22/2022]
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Discrete event simulation model of sudden cardiac death predicts high impact of preventive interventions. Sci Rep 2014; 3:1771. [PMID: 23648451 PMCID: PMC3646271 DOI: 10.1038/srep01771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/12/2013] [Indexed: 11/08/2022] Open
Abstract
Sudden Cardiac Death (SCD) is responsible for at least 180,000 deaths a year and incurs an average cost of $286 billion annually in the United States alone. Herein, we present a novel discrete event simulation model of SCD, which quantifies the chains of events associated with the formation, growth, and rupture of atheroma plaques, and the subsequent formation of clots, thrombosis and on-set of arrhythmias within a population. The predictions generated by the model are in good agreement both with results obtained from pathological examinations on the frequencies of three major types of atheroma, and with epidemiological data on the prevalence and risk of SCD. These model predictions allow for identification of interventions and importantly for the optimal time of intervention leading to high potential impact on SCD risk reduction (up to 8-fold reduction in the number of SCDs in the population) as well as the increase in life expectancy.
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Santos-Gallego CG, Picatoste B, Badimón JJ. Pathophysiology of Acute Coronary Syndrome. Curr Atheroscler Rep 2014; 16:401. [DOI: 10.1007/s11883-014-0401-9] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mintz GS. Beyond greyscale IVUS assessment of progression/regression: it should be simple, but it's not. Eur Heart J Cardiovasc Imaging 2014; 15:378-9. [DOI: 10.1093/ehjci/jet291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Cimmino G, Conte S, Morello A, D’Elia S, Marchese V, Golino P. The complex puzzle underlying the pathophysiology of acute coronary syndromes: from molecular basis to clinical manifestations. Expert Rev Cardiovasc Ther 2014; 10:1533-43. [DOI: 10.1586/erc.12.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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141
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Pancoronary plaque vulnerability in patients with acute coronary syndrome and ruptured culprit plaque: a 3-vessel optical coherence tomography study. Am Heart J 2014; 167:59-67. [PMID: 24332143 DOI: 10.1016/j.ahj.2013.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 10/04/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies described different clinical and underlying plaque characteristics between patients with and without plaque rupture presenting with acute coronary syndrome (ACS). In light of the systemic nature of atherosclerosis, we hypothesized that nonculprit plaques might also express different morphological features in these 2 groups of patients. METHODS Thirty-eight patients with ACS who underwent 3-vessel optical coherence tomography imaging were identified from the Massachusetts General Hospital Optical Coherence Tomography Registry. Based on culprit plaque morphology, the study population was divided into 2 groups: patients with plaque rupture at the culprit lesion (group 1) and patients with nonruptured plaque at the culprit lesion (group 2). Prevalence and features of nonculprit plaques were compared between the 2 groups. RESULTS A total of 118 nonculprit plaques were analyzed. Patients in group 1 (n = 17) had nonculprit plaques with higher prevalence of thin-cap fibroatheroma (52.9% vs 19.0%, P = .029) and disruption (35.3% vs 4.8%, P = .016) compared with patients in group 2 (n = 21). Nonculprit plaques in group 1 showed wider maximum lipid arc (198.9° ± 41.7° vs 170.2° ± 41.9°, P = .003), greater lipid length (7.8 ± 4.4 mm vs 5.1 ± 2.4 mm, P = .003), higher lipid index (1196.9 ± 700.5 vs 747.7 ± 377.3, P = .001), and thinner fibrous cap (107.0 ± 56.5 μm vs 137.3 ± 69.8 μm, P = .035) compared with those in group 2. CONCLUSIONS The present study showed distinctive features of nonculprit plaques between patients with ACS caused by plaque rupture and patients with ACS caused by nonruptured plaques. Patients with plaque rupture had increased pancoronary vulnerability in nonculprit plaques, suggesting that a more aggressive treatment paradigm aiming at the stabilization of vulnerable plaques may offer additional benefit to these patients.
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142
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Nozue T, Yamamoto S, Tohyama S, Fukui K, Umezawa S, Onishi Y, Kunishima T, Sato A, Nozato T, Miyake S, Takeyama Y, Morino Y, Yamauchi T, Muramatsu T, Hibi K, Terashima M, Michishita I. Comparison of the effects of pitavastatin versus pravastatin on coronary artery plaque phenotype assessed by tissue characterization using serial virtual histology intravascular ultrasound. Heart Vessels 2013; 30:36-44. [DOI: 10.1007/s00380-013-0453-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/29/2013] [Indexed: 11/25/2022]
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Nadkarni SK. Optical measurement of arterial mechanical properties: from atherosclerotic plaque initiation to rupture. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:121507. [PMID: 24296995 PMCID: PMC4696609 DOI: 10.1117/1.jbo.18.12.121507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 05/19/2023]
Abstract
During the pathogenesis of coronary atherosclerosis, from lesion initiation to rupture, arterial mechanical properties are altered by a number of cellular, molecular, and hemodynamic processes. There is growing recognition that mechanical factors may actively drive vascular cell signaling and regulate atherosclerosis disease progression. In advanced plaques, the mechanical properties of the atheroma influence stress distributions in the fibrous cap and mediate plaque rupture resulting in acute coronary events. This review paper explores current optical technologies that provide information on the mechanical properties of arterial tissue to advance our understanding of the mechanical factors involved in atherosclerosis development leading to plaque rupture. The optical approaches discussed include optical microrheology and traction force microscopy that probe the mechanical behavior of single cell and extracellular matrix components, and intravascular imaging modalities including laser speckle rheology, optical coherence elastography, and polarization-sensitive optical coherence tomography to measure the mechanical properties of advanced coronary lesions. Given the wealth of information that these techniques can provide, optical imaging modalities are poised to play an increasingly significant role in elucidating the mechanical aspects of coronary atherosclerosis in the future.
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Affiliation(s)
- Seemantini K. Nadkarni
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114
- Address all correspondence to: Seemantini K. Nadkarni, Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114. Tel: (617)-724-1381; Fax: (617)-7264103; E-mail:
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144
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Robertson C, Heidari AE, Chen Z, George SC. Mechanical analysis of arterial plaques in native geometry with OCT wall motion analysis. J Biomech 2013; 47:755-8. [PMID: 24388166 DOI: 10.1016/j.jbiomech.2013.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/02/2013] [Accepted: 11/06/2013] [Indexed: 12/01/2022]
Abstract
The mechanical behavior of an atherosclerotic plaque may encode information about the type, composition, and vulnerability to rupture. Human arterial segments with varying plaque burden were analyzed ex vivo with optical coherence tomography (OCT) to determine plaque type and to determine compliance during pulsatile inflation in their native geometry. Calcifications and lipid filled plaques showed markedly different compliance when analyzed with OCT wall motion analysis. There was also a trend towards increased circumferential variation in arterial compliance with increasing plaque burden.
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Affiliation(s)
- Claire Robertson
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA
| | - Andrew E Heidari
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA; Beckman Laser Institute, University of California, Irvine, CA 92617, USA
| | - Zhongping Chen
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA; Beckman Laser Institute, University of California, Irvine, CA 92617, USA
| | - Steven C George
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA; Department of Chemical Engineering, University of California, Irvine, CA 92617, USA; Department of Medicine, University of California, Irvine, CA 92617, USA.
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Phinikaridou A, Andia ME, Lacerda S, Lorrio S, Makowski MR, Botnar RM. Molecular MRI of atherosclerosis. Molecules 2013; 18:14042-69. [PMID: 24232739 PMCID: PMC6270261 DOI: 10.3390/molecules181114042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 11/22/2022] Open
Abstract
Despite advances in prevention, risk assessment and treatment, coronary artery disease (CAD) remains the leading cause of morbidity and mortality in Western countries. The lion's share is due to acute coronary syndromes (ACS), which are predominantly triggered by plaque rupture or erosion and subsequent coronary thrombosis. As the majority of vulnerable plaques does not cause a significant stenosis, due to expansive remodeling, and are rather defined by their composition and biological activity, detection of vulnerable plaques with x-ray angiography has shown little success. Non-invasive vulnerable plaque detection by identifying biological features that have been associated with plaque progression, destabilization and rupture may therefore be more appropriate and may allow earlier detection, more aggressive treatment and monitoring of treatment response. MR molecular imaging with target specific molecular probes has shown great promise for the noninvasive in vivo visualization of biological processes at the molecular and cellular level in animals and humans. Compared to other imaging modalities; MRI can provide excellent spatial resolution; high soft tissue contrast and has the ability to simultaneously image anatomy; function as well as biological tissue composition and activity.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Marcelo E. Andia
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 8331150, Chile
| | - Sara Lacerda
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Silvia Lorrio
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Marcus R. Makowski
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Department of Radiology, Charite, Berlin 10117, Germany
| | - René M. Botnar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Wellcome Trust and ESPRC Medical Engineering Center, King’s College London, London SE1 7EH, UK
- BHF Centre of Excellence, King’s College London, London SE1 7EH, UK
- NIHR Biomedical Research Centre, King’s College London, London SE1 7EH, UK
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Timmins LH, Suever JD, Eshtehardi P, McDaniel MC, Oshinski JN, Samady H, Giddens DP. Framework to co-register longitudinal virtual histology-intravascular ultrasound data in the circumferential direction. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1989-1996. [PMID: 23797242 DOI: 10.1109/tmi.2013.2269275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Considerable efforts have been directed at identifying prognostic markers for rapidly progressing coronary atherosclerotic lesions that may advance into a high-risk (vulnerable) state. Intravascular ultrasound (IVUS) has become a valuable clinical tool to study the natural history of coronary artery disease (CAD). While prospectively IVUS studies have provided tremendous insight on CAD progression, and its association with independent markers (e.g., wall shear stress), they are limited by the inability to examine the focal association between spatially heterogeneous variables (in both circumferential and axial directions). Herein, we present a framework to automatically co-register longitudinal (in-time) virtual histology-intravascular ultrasound (VH-IVUS) imaging data in the circumferential direction (i.e., rotate follow-up image so circumferential basis coincides with corresponding baseline image). Multivariate normalized cross correlation was performed on paired images (n = 636) from five patients using three independent VH-IVUS defined parameters: artery thickness, VH-IVUS defined plaque constituents, and VH-IVUS perivascular imaging data. Results exhibited high correlation between co-registration rotation angles determined automatically versus manually by an expert reader ( r(2) = 0.90). Furthermore, no significant difference between automatic and manual co-registration angles was observed ( 91.31 ±1.04(°) and 91.07 ±1.04(°), respectively; p = 0.48) and Bland-Altman analysis yielded excellent agreement ( bias = 0.24(°), 95% CI +/- 16.33(°)). In conclusion, we have developed, verified, and validated an algorithm that automatically co-registers VH-IVUS imaging data that will allow for the focal examination of CAD progression.
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Koskinas KC, Chatzizisis YS, Papafaklis MI, Coskun AU, Baker AB, Jarolim P, Antoniadis A, Edelman ER, Stone PH, Feldman CL. Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs. Int J Cardiol 2013; 169:394-401. [PMID: 24148915 DOI: 10.1016/j.ijcard.2013.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/05/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Systemic risk factors and local hemodynamic factors both contribute to coronary atherosclerosis, but their possibly synergistic inter-relationship remains unknown. The purpose of this natural history study was to investigate the combined in-vivo effect of varying levels of systemic hypercholesterolemia and local endothelial shear stress (ESS) on subsequent plaque progression and histological composition. METHODS Diabetic, hyperlipidemic swine with higher systemic total cholesterol (TC) (n=4) and relatively lower TC levels (n=5) underwent three-vessel intravascular ultrasound (IVUS) at 3-5 consecutive time-points in-vivo. ESS was calculated serially using computational fluid dynamics. 3-D reconstructed coronary arteries were divided into 3mm-long segments (n=595), which were stratified according to higher vs. relatively lower TC and low (<1.2Pa) vs. higher local ESS (≥1.2Pa). Arteries were harvested at 9months, and a subset of segments (n=114) underwent histopathologic analyses. RESULTS Change of plaque volume (ΔPV) by IVUS over time was most pronounced in low-ESS segments from higher-TC animals. Notably, higher-ESS segments from higher-TC animals had greater ΔPV compared to low-ESS segments from lower-TC animals (p<0.001). The time-averaged ESS in segments that resulted in significant plaque increased with increasing TC levels (slope: 0.24Pa/100mg/dl; r=0.80; p<0.01). At follow-up, low-ESS segments from higher-TC animals had the highest mRNA levels of lipoprotein receptors and inflammatory mediators and, consequently, the greatest lipid accumulation and inflammation. CONCLUSIONS This study redefines the principle concept that "low" ESS promotes coronary plaque growth and vulnerability by demonstrating that: (i.) the pro-atherogenic threshold of low ESS is not uniform, but cholesterol-dependent; and (ii.) the atherogenic effects of local low ESS are amplified, and the athero-protective effects of higher ESS may be outweighed, by increasing cholesterol levels. Intense hypercholesterolemia and very low ESS are synergistic in favoring rapid atheroma progression and high-risk composition.
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Affiliation(s)
- Konstantinos C Koskinas
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Harvard-MIT Division of Health Sciences & Technology, Massachusetts Institute of Technology, Cambridge, MA, United States
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Biomechanics of atherosclerotic coronary plaque: site, stability and in vivo elasticity modeling. Ann Biomed Eng 2013; 42:269-79. [PMID: 24043605 DOI: 10.1007/s10439-013-0888-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Coronary atheroma develop in local sites that are widely variable among patients and are considerably variable in their vulnerability for rupture. This article summarizes studies conducted by our collaborative laboratories on predictive biomechanical modeling of coronary plaques. It aims to give insights into the role of biomechanics in the development and localization of atherosclerosis, the morphologic features that determine vulnerable plaque stability, and emerging in vivo imaging techniques that may detect and characterize vulnerable plaque. Composite biomechanical and hemodynamic factors that influence the actual site of development of plaques have been studied. Plaque vulnerability, in vivo, is more challenging to assess. Important steps have been made in defining the biomechanical factors that are predictive of plaque rupture and the likelihood of this occurring if characteristic features are known. A critical key in defining plaque vulnerability is the accurate quantification of both the morphology and the mechanical properties of the diseased arteries. Recently, an early IVUS based palpography technique developed to assess local strain, elasticity and mechanical instabilities has been successfully revisited and improved to account for complex plaque geometries. This is based on an initial best estimation of the plaque components' contours, allowing subsequent iteration for elastic modulus assessment as a basis for plaque stability determination. The improved method has also been preliminarily evaluated in patients with successful histologic correlation. Further clinical evaluation and refinement are on the horizon.
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149
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Tan HC, Poh KK. New Insights into Mechanisms of Acute Myocardial Infarction: A Journey of 100 Years. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n9p425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Huay Cheem Tan
- National University Heart Center, National University Health System, Singapore
| | - Kian Keong Poh
- National University Heart Center, National University Health System, Singapore
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150
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Zhu YY, Nguyen TT, Buxton BF, Hare DL, Hayward PA. Regression of coronary disease after bypass surgery: Urban myth or common finding? J Thorac Cardiovasc Surg 2013; 148:53-9. [PMID: 24035380 DOI: 10.1016/j.jtcvs.2013.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/01/2013] [Accepted: 07/11/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Coronary artery disease has been viewed as a relentless, progressive disease. We sought to describe the prevalence and distribution of regression of native vessel disease in coronary artery bypass patients and characterize its relationship with bypass grafting. METHODS Among 619 patients who underwent bypass surgery in a radial artery trial, 405 had follow-up angiography available a mean of 6.2 ± 3.1 years (range, 0-14) after surgery. The percentage of diameter stenosis of each major native coronary vessel was reported by 3 cardiac specialists and classified into grades of nonflow limiting (0%-39%), moderate (40%-69%), flow limiting (70%-80%), severely stenosed (81%-99%), and occluded (100%). Native vessel disease regression was defined as decrease in 1 or more grades of stenosis between the pre- and postoperative angiograms. RESULTS A total of 1742 native coronary arteries had preoperative stenosis of at least 40% and were included in the present analysis, receiving 753 arterial grafts and 391 saphenous vein grafts. Overall, the prevalence of disease regression was 19.7%, and 45% of patients demonstrated regression in 1 or more vessels. The presence of an arterial graft increased the likelihood of disease regression (21.3% compared with 16% for venous bypassed vessels, P = .012) as did the location in the left circulation (22.6% compared with 13.9% for the right circulation, P < .001) and having a flow-limiting (≥70%) lesion (21.9% compared with 9.8% for moderate lesions, P < .001). CONCLUSIONS Native coronary artery disease regression after coronary artery bypass grafting is common and affected by conduit type, vessel location, and lesion severity. Surgeons must consider these factors when assessing the requirement for bypass grafts in a borderline lesion.
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Affiliation(s)
- Ying Yan Zhu
- School of Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Trong T Nguyen
- School of Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Brian F Buxton
- Department of Cardiac Surgery, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Philip A Hayward
- Department of Cardiac Surgery, Austin Health, Heidelberg, Melbourne, Victoria, Australia.
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