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Early detection and invasive passivation of future culprit lesions: a future potential or an unrealistic pursuit of chimeras? Am Heart J 2013; 165:869-881.e4. [PMID: 23708157 DOI: 10.1016/j.ahj.2013.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/18/2013] [Indexed: 11/22/2022]
Abstract
New advances in image and signal processing have allowed the development of numerous invasive and noninvasive imaging modalities that have revealed details of plaque pathology and allowed us to study in vivo the atherosclerotic evolution. Recent natural history of atherosclerosis studies permitted us to evaluate changes in the compositional and morphological characteristics of the plaque and identify predictors of future events. The idea of being able to identify future culprit lesions and passivate these plaques has gradually matured, and small scale studies have provided proofs about the feasibility of this concept. This review article summarizes the recent advances in the study of atherosclerosis, cites the current evidence, highlights our limitations in understanding the evolution of the plaque and in predicting plaque destabilization, and discusses the potentiality of an early invasive sealing of future culprit lesions.
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Koskinas KC, Sukhova GK, Baker AB, Papafaklis MI, Chatzizisis YS, Coskun AU, Quillard T, Jonas M, Maynard C, Antoniadis AP, Shi GP, Libby P, Edelman ER, Feldman CL, Stone PH. Thin-capped atheromata with reduced collagen content in pigs develop in coronary arterial regions exposed to persistently low endothelial shear stress. Arterioscler Thromb Vasc Biol 2013; 33:1494-504. [PMID: 23640495 DOI: 10.1161/atvbaha.112.300827] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The mechanisms promoting the focal formation of rupture-prone coronary plaques in vivo remain incompletely understood. This study tested the hypothesis that coronary regions exposed to low endothelial shear stress (ESS) favor subsequent development of collagen-poor, thin-capped plaques. APPROACH AND RESULTS Coronary angiography and 3-vessel intravascular ultrasound were serially performed at 5 consecutive time points in vivo in 5 diabetic, hypercholesterolemic pigs. ESS was calculated along the course of each artery with computational fluid dynamics at all 5 time points. At follow-up, 184 arterial segments with previously identified in vivo ESS underwent histopathologic analysis. Compared with other plaque types, eccentric thin-capped atheromata developed more in segments that experienced lower ESS during their evolution. Compared with lesions with higher preceding ESS, segments persistently exposed to low ESS (<1.2 Pa) exhibited reduced intimal smooth muscle cell content; marked intimal smooth muscle cell phenotypic modulation; attenuated procollagen-I gene expression; increased gene and protein expression of the interstitial collagenases matrix-metalloproteinase-1, -8, -13, and -14; increased collagenolytic activity; reduced collagen content; and marked thinning of the fibrous cap. CONCLUSIONS Eccentric thin-capped atheromata, lesions particularly prone to rupture, form more frequently in coronary regions exposed to low ESS throughout their evolution. By promoting an imbalance of attenuated synthesis and augmented collagen breakdown, low ESS favors the focal evolution of early lesions toward plaques with reduced collagen content and thin fibrous caps-2 critical determinants of coronary plaque vulnerability.
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Affiliation(s)
- Konstantinos C Koskinas
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Guo J, Maehara A, Guo N, Ashida K, Chirumamilla A, Shang Y, Pu J, Sanidas E, Moses JW, Leon MB, Weisz G, Stone GW, Mintz GS, Ochiai M. Virtual histology intravascular ultrasound comparison of coronary chronic total occlusions versus non-occlusive lesions. Int J Cardiovasc Imaging 2013; 29:1249-54. [PMID: 23609550 DOI: 10.1007/s10554-013-0222-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Guo
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10022, USA
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205
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Exploring coronary atherosclerosis with intravascular imaging. Int J Cardiol 2013; 168:670-9. [PMID: 23571162 DOI: 10.1016/j.ijcard.2013.03.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/19/2013] [Accepted: 03/17/2013] [Indexed: 11/22/2022]
Abstract
Coronary angiography has been widely used for five decades to evaluate a range of vascular pathologies and triage patients to therapeutic interventions. The inability to directly visualize the artery wall with conventional angiographic techniques has stimulated development of a number of intravascular imaging modalities. These approaches have the potential to provide a more comprehensive characterization of the burden, composition and functionality of atherosclerotic plaque, neointimal hyperplasia and allograft vasculopathy that develop within coronary arteries. The ability to use these modalities in vivo and in a serial fashion has provided a greater insight into the factors that underlie the disease process and guide therapeutic interventions.
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206
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Wilensky RL. In Search of the Elusive Vulnerable Plaque. J Am Coll Cardiol 2013; 61:1052-3. [DOI: 10.1016/j.jacc.2012.12.013] [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] [Received: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 11/16/2022]
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207
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Cascón-Pérez JD, de la Torre-Hernández JM, Ruiz-Abellón MC, Martínez-Pascual M, Mármol-Lozano R, López-Candel J, Cano P, Fernández C, Ramos JL, Villegas M, Picó-Aracil F. Characteristics of culprit atheromatous plaques obtained in vivo by intravascular ultrasound radiofrequency analysis: results from the CULPLAC study. Am Heart J 2013; 165:400-7. [PMID: 23453110 DOI: 10.1016/j.ahj.2012.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We used virtual histology-intravascular ultrasound (VH-IVUS) to investigate the characteristics of culprit lesions in acute coronary syndromes (ACS). BACKGROUND Autopsy studies of patients who died of ACS have shown that culprit atheromatous plaques almost always contain a large lipid-necrotic core covered by a ruptured thin fibrous cap. There are no studies of sufficient size that have assessed the in vivo characterization of plaques responsible for ACS. METHODS Patients undergoing angiography for stable ischemic heart disease and ACS (with and without ST-segment elevation) were enrolled in a prospective study. Lesions in patients with stable angina were classified as stable and those in patients with ACS as culprit or nonculprit. RESULTS The study included 189 patients: VH-IVUS was used to assess 253 lesions (73 stable, 82 nonculprit, and 98 culprit lesions). The thin-cap fibroatheroma phenotype (VH-TCFA) was more frequent among lesions in patients with ACS (55.1% in culprit lesions, 36.6% in nonculprit lesions and 14.4% in stable lesions; P = .007). The arc of the VH-TCFA exposed to the vessel lumen was significantly greater in culprit lesions than in nonculprit lesions (122.28° ± 58 vs 89.46° ± 52; respectively; P = .007). Multivariate analysis showed that VH-TCFA (OR 2.1; P = .033), calcified nodules (OR 2.1; P = .046), positive remodeling (OR 3.5; P < .001) and necrotic core volume (OR 1.02;P = .009) were independently associated with a clinically identified culprit lesion. CONCLUSIONS Plaque phenotype, rather than the proportion of each tissue, appears to be associated with plaque instability. VH-TCFA, particularly subtype IV, is associated with lesions responsible for ACS.
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208
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Motreff P, Rioufol G, Finet G. Seventy-four-month follow-up of coronary vulnerable plaques by serial gray-scale intravascular ultrasound. Circulation 2013; 126:2878-9. [PMID: 23230317 DOI: 10.1161/circulationaha.112.132449] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Pascal Motreff
- Interventional Cardiology Department, Hospices Civils de Lyon, Bron, France
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209
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An IVUS image-based approach for improvement of coronary plaque characterization. Comput Biol Med 2013; 43:268-80. [PMID: 23410676 DOI: 10.1016/j.compbiomed.2012.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 12/09/2012] [Accepted: 12/27/2012] [Indexed: 11/21/2022]
Abstract
Virtual Histology-Intravascular Ultrasound (VH-IVUS) is widely used for studying atherosclerosis plaque composition. However, one of the main limitations of the VH-IVUS relates to its dependence to the Electrocardiogram (ECG)-gated acquisition. To overcome this limitation, this paper proposes a robust image-based approach for characterization of the plaques using IVUS images. The proposed method consists of three main steps of (1) shadow detection: as an efficient preprocessing step to identify and remove acoustic shadow regions; (2) feature extraction: a combination of gray-scale based features and textural descriptors; and (3) classification: to classify each pixel into one of the three classes (calcium, necrotic core and fibro-fatty). In order to evaluate the efficiency of the proposed algorithm two in-vivo and ex-vivo data sets are considered. The kappa values of 0.639 on in-vivo and 0.628 on ex-vivo tests with VH-IVUS and the histology images labeled by the experts respectively indicate the effectiveness of the proposed algorithm.
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210
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Patel D, Hamamdzic D, Llano R, Patel D, Cheng L, Fenning RS, Bannan K, Wilensky RL. Subsequent development of fibroatheromas with inflamed fibrous caps can be predicted by intracoronary near infrared spectroscopy. Arterioscler Thromb Vasc Biol 2013; 33:347-53. [PMID: 23288155 DOI: 10.1161/atvbaha.112.300710] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To prospectively evaluate whether the development of fibroatheromas exhibiting features of potential instability can be detected and predicted by serial invasive imaging. METHODS AND RESULTS Multivessel intravascular ultrasound and near infrared spectroscopy (NIRS) were performed in diabetic/hypercholesterolemic pigs 3, 6, and 9 months after induction. Animals were euthanized at 9 months and histological/immunohistochemical evaluation of the arteries was performed (n=304 arterial segments). Intravascular ultrasound demonstrated, over time, a progressive increase in plaque + media and necrotic core areas and positive vascular remodeling. By histology, NIRS+ lesions were significantly more likely to be a high-risk fibroatheroma (P=0.0001) containing larger plaque (P<0.0001) and necrotic core areas (P<0.0019) and thinner fibrous caps (P=0.04). NIRS + fibroatheromas possessed a greater concentration of inflammatory cells demonstrating protease activity (P=0.006), and proliferating (P=0.016), and apoptotic cells (P=0.04) within the fibrous cap. Eighty-eight percent of NIRS+ lesions at 3 and 6 months subsequently developed into a fibroatheroma at 9 months (P<0.01). By multivariate analysis NIRS positivity at 6 months predicted the subsequent presence of a fibroatheroma at 9 months (P=0.005; odds ratio, 2.71). CONCLUSIONS The future development of inflamed fibroatheromas with thinner fibrous caps, greater plaque, and necrotic core areas, and posessing characteristics of increased plaque instability were detected by intravascular ultrasound/NIRS imaging.
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Affiliation(s)
- Dhavalkumar Patel
- Cardiovascular Division, Hospital of the University of Pennsylvania and Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
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211
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Ruiz-García J, Lerman A, Weisz G, Maehara A, Mintz GS, Fahy M, Xu K, Lansky AJ, Cristea E, Farah TG, Teles R, Botker HE, Templin B, Zhang Z, de Bruyne B, Serruys PW, Stone GW. Age- and gender-related changes in plaque composition in patients with acute coronary syndrome: the PROSPECT study. EUROINTERVENTION 2012; 8:929-38. [DOI: 10.4244/eijv8i8a142] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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212
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Yun KH, Mintz GS, Farhat N, Marso SP, Taglieri N, Verheye S, Foster MC, Margolis MP, Templin B, Xu K, Dressler O, Mehran R, Stone GW, Maehara A. Relation between angiographic lesion severity, vulnerable plaque morphology and future adverse cardiac events (from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree study). Am J Cardiol 2012; 110:471-7. [PMID: 22579346 DOI: 10.1016/j.amjcard.2012.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 04/17/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
Previous angiographic studies have suggested that the future risk for major adverse cardiovascular events (MACEs) is related to coronary stenosis severity. The aim of this study was to use the grayscale and virtual histology (VH)-intravascular ultrasound (IVUS) data from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study to identify underlying lesion morphologic characteristics that might explain these findings. In PROSPECT, patients presenting with acute coronary syndromes in whom percutaneous coronary intervention was successful underwent 3-vessel grayscale and VH-IVUS and were followed for a median of 3.4 years for the incidence of MACEs. Overall, 3,115 nonculprit lesions detected by IVUS were divided into quartiles according to baseline angiographic diameter stenosis. From the first to fourth quartiles, there were increases in the prevalence of lesions with IVUS minimum luminal areas ≤ 4 mm(2), IVUS plaque burden ≥ 70%, and VH-IVUS thin-cap fibroatheroma (13.4%, 22.0%, 24.2%, and 30.3%, respectively, p <0.001), along with an increased frequency of plaque ruptures and greater necrotic core volumes. The incidence of lesions with plaque burden ≥ 70%, minimum luminal area ≤ 4 mm(2), and VH thin-cap fibroatheroma was highest in the fourth quartile (0%, 0.4%, 0.4%, and 2.8% in the first through fourth quartiles, respectively, p <0.001). Three-year MACE rates were also highest in the fourth quartile (0.3%, 0.7%, 1.3%, and 5.1%, respectively, p <0.001). In conclusion, increasing angiographic diameter stenosis was associated with an increased frequency of grayscale and VH-IVUS lesion morphologic features that have been associated with adverse events and that may, in part, explain why future MACEs were related to baseline lesion severity.
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213
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Affiliation(s)
- Gregg W. Stone
- From the Columbia University Medical Center, New York-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY
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214
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Kim SW, Hong YJ, Mintz GS, Lee SY, Doh JH, Lim SH, Kang HJ, Rha SW, Kim JS, Lee WS, Oh SJ, Lee S, Hahn JY, Lee JB, Bae JH, Hur SH, Han SH, Jeong MH, Kim YJ. Relation of ruptured plaque culprit lesion phenotype and outcomes in patients with ST elevation acute myocardial infarction. Am J Cardiol 2012; 109:794-9. [PMID: 22196783 DOI: 10.1016/j.amjcard.2011.10.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 12/01/2022]
Abstract
We used virtual histology intravascular ultrasound (VH-IVUS) to assess culprit plaque rupture in 172 patients with ST-segment elevation acute myocardial infarction. VH-IVUS-defined thin-capped fibroatheroma (VH-TCFA) had necrotic core (NC) > 10% of plaque area, plaque burden > 40%, and NC in contact with the lumen for ≥ 3 image slices. Ruptured plaques were present in 72 patients, 61% of which were located in the proximal 30 mm of a coronary artery. Thirty-five were classified as VH-TCFA and 37 as non-VH-TCFA. Vessel size, lesion length, plaque burden, minimal lumen area, and frequency of positive remodeling were similar in VH-TCFA and non-VH-TCFA. However, the NC areas within the rupture sites of VH-TCFAs were larger compared to non-VH-TCFAs (p = 0.002), while fibrofatty plaque areas were larger in non-VH-TCFAs (p < 0.0001). Ruptured plaque cavity size was correlated with distal reference lumen area (r = 0.521, p = 0.00002), minimum lumen area (r = 0.595, p < 0.0001), and plaque area (r = 0.267, p = 0.033). Sensitivity and specificity curve analysis showed that a minimum lumen area of 3.5 mm2, a distal reference lumen area of 7.5 mm2, and a maximum NC area of 35% best predicted plaque rupture. Although VH-TCFA (35 of 72) was the most frequent phenotype of plaque rupture in ST-segment elevation myocardial infarction, plaque rupture also occurred in non-VH-TCFA: pathologic intimal thickening (8 of 72), thick-capped fibroatheroma (1 of 72), and fibrotic (14 of 72) and fibrocalcified (14 of 72) plaque. In conclusion, not all culprit plaque ruptures in patients with ST-segment elevation myocardial infarction occur as a result of TCFA rupture; a prominent fibrofatty plaque, especially in a proximal vessel, may be another form of vulnerable plaque. Further study should identify additional factors causing plaque rupture.
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Abstract
In the United States alone, more than 400,000 Americans die annually from coronary artery disease and more than 1,000,000 suffer acute coronary events, i.e., myocardial infarction and sudden cardiac death.1 Considering the aging of our population and increasing incidence of diabetes and obesity, the morbidity from coronary artery disease, and its associated costs, will place an increasing, substantial burden on our society.2 Between 2010 and 2030, total direct medical costs spent in the US for cardiovascular diseases are projected to triple from 273 to 818 billion dollars.2 Although effective treatments are available and considerable efforts are ongoing to identify new strategies for the prevention of coronary events, predicting such events in an individual has been challenging.3 In hopes of improving our ability to determine the risk of coronary events, it is prudent to review our knowledge of factors that lead to acute coronary events.
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217
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Sanidas EA, Mintz GS, Maehara A, Cristea E, Wennerblom B, Iñiguez A, Fajadet J, Fahy M, Dressler O, Weisz G, Templin B, Zhang Z, Lansky AJ, de Bruyne B, Serruys P, Stone GW. Adverse Cardiovascular Events Arising From Atherosclerotic Lesions With and Without Angiographic Disease Progression. JACC Cardiovasc Imaging 2012; 5:S95-S105. [DOI: 10.1016/j.jcmg.2011.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/06/2011] [Accepted: 08/18/2011] [Indexed: 10/28/2022]
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Falk E, Wilensky RL. Prediction of Coronary Events by Intravascular Imaging⁎⁎Editorials published in JACC: Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Imaging or the American College of Cardiology. JACC Cardiovasc Imaging 2012; 5:S38-41. [DOI: 10.1016/j.jcmg.2012.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 11/27/2022]
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Brener SJ, Mintz GS, Cristea E, Weisz G, Maehara A, McPherson JA, Marso SP, Farhat N, Botker HE, Dressler O, Xu K, Templin B, Zhang Z, Lansky AJ, de Bruyne B, Serruys PW, Stone GW. Characteristics and Clinical Significance of Angiographically Mild Lesions in Acute Coronary Syndromes. JACC Cardiovasc Imaging 2012; 5:S86-94. [DOI: 10.1016/j.jcmg.2011.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 11/25/2022]
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Stone GW, Maehara A, Mintz GS. The reality of vulnerable plaque detection. JACC Cardiovasc Imaging 2011; 4:902-4. [PMID: 21835383 DOI: 10.1016/j.jcmg.2011.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 06/16/2011] [Indexed: 10/17/2022]
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221
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Zimmerman SK, Vacek JL. Imaging techniques in acute coronary syndromes: a review. ISRN CARDIOLOGY 2011; 2011:359127. [PMID: 22347639 PMCID: PMC3262520 DOI: 10.5402/2011/359127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/11/2011] [Indexed: 12/31/2022]
Abstract
Coronary heart disease (CHD) remains the leading cause of death in the United States. National review of Emergency Department (ED) visits from 2007 to 2008 reveals that 9% are for chest pain. Of these patients, 13% had acute coronary syndromes (ACSs) (Antman et al., 2004). Plaque rupture with thrombus formation is the most frequent cause of ACS, and identifying patients prior to this event remains important for any clinician caring for these patients. There has been an increasing amount of research and technological advancement in improving the diagnosis of patients presenting with ACS. Low-to-intermediate risk patients are the subgroup that has a delay in definitive treatment for ACS, and a push for methods to more easily and accurately identify the patients within this group that would benefit from an early invasive strategy has arisen. Multiple imaging modalities have been studied regarding the ability to detect ischemia or wall motion abnormalities (WMAs), and an understanding of some of the currently available noninvasive and invasive imaging techniques is important for any clinician caring for ACS patients.
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Affiliation(s)
- Stanley K Zimmerman
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, 1001 Eaton Mail Stop 3006, Kansas City, KS 66160, USA
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222
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Hirohata A, Yamamoto K, Miyoshi T, Hatanaka K, Hirohata S, Yamawaki H, Komatsubara I, Hirose E, Kobayashi Y, Ohkawa K, Ohara M, Takafuji H, Sano F, Toyama Y, Kusachi S, Ohe T, Ito H. Four-year clinical outcomes of the OLIVUS-Ex (impact of Olmesartan on progression of coronary atherosclerosis: evaluation by intravascular ultrasound) extension trial. Atherosclerosis 2011; 220:134-8. [PMID: 22119063 DOI: 10.1016/j.atherosclerosis.2011.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 10/04/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND The previous OLIVUS trial reported a positive role in achieving a lower rate of coronary atheroma progression through the administration of olmesartan, an angiotension-II receptor blocking agent (ARB), for stable angina pectoris (SAP) patients requiring percutaneous coronary intervention (PCI). However, the benefits between ARB administration on long-term clinical outcomes and serial atheroma changes by IVUS remain unclear. Thus, we examined the 4-year clinical outcomes from OLIVUS according to treatment strategy with olmesartan. METHODS Serial volumetric IVUS examinations (baseline and 14 months) were performed in 247 patients with hypertension and SAP. When these patients underwent PCI for culprit lesions, IVUS was performed in their non-culprit vessels. Patients were randomly assigned to receive 20-40mg of olmesartan or control, and treated with a combination of β-blockers, calcium channel blockers, glycemic control agents and/or statins per physician's guidance. Four-year clinical outcomes and annual progression rate of atherosclerosis, assessed by serial IVUS, were compared with major adverse cardio- and cerebrovascular events (MACCE). RESULTS Cumulative event-free survival was significantly higher in the olmesartan group than in the control group (p=0.04; log-rank test). By adjusting for validated prognosticators, olmesartan administration was identified as a good predictor of MACCE (p=0.041). On the other hand, patients with adverse events (n=31) had larger annual atheroma progression than the rest of the population (23.8% vs. 2.1%, p<0.001). CONCLUSIONS Olmesartan therapy appears to confer improved long-term clinical outcomes. Atheroma volume changes, assessed by IVUS, seem to be a reliable surrogate for future major adverse cardio- and cerebrovascular events in this study cohort.
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Sanz J, Fuster V. The year in atherothrombosis. J Am Coll Cardiol 2011; 58:779-91. [PMID: 21835312 DOI: 10.1016/j.jacc.2011.03.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 01/13/2023]
Affiliation(s)
- Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York, USA
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Pu J, Mintz GS, Brilakis ES, Banerjee S, Abdel-Karim ARR, Maini B, Biro S, Lee JB, Stone GW, Weisz G, Maehara A. In vivo characterization of coronary plaques: novel findings from comparing greyscale and virtual histology intravascular ultrasound and near-infrared spectroscopy. Eur Heart J 2011; 33:372-83. [DOI: 10.1093/eurheartj/ehr387] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Uemura S, Ishigami KI, Soeda T, Okayama S, Sung JH, Nakagawa H, Somekawa S, Takeda Y, Kawata H, Horii M, Saito Y. Thin-cap fibroatheroma and microchannel findings in optical coherence tomography correlate with subsequent progression of coronary atheromatous plaques. Eur Heart J 2011; 33:78-85. [DOI: 10.1093/eurheartj/ehr284] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Burke B, Budoff MJ. Insights from CTA with Comparison to Modalities of Intravascular Ultrasound Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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227
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Vancraeynest D, Pasquet A, Roelants V, Gerber BL, Vanoverschelde JLJ. Imaging the vulnerable plaque. J Am Coll Cardiol 2011; 57:1961-79. [PMID: 21565634 DOI: 10.1016/j.jacc.2011.02.018] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 12/27/2022]
Abstract
Cardiovascular diseases are still the primary causes of mortality in the United States and in Western Europe. Arterial thrombosis is triggered by a ruptured atherosclerotic plaque and precipitates an acute vascular event, which is responsible for the high mortality rate. These rupture-prone plaques are called "vulnerable plaques." During the past decades, much effort has been put toward accurately detecting the presence of vulnerable plaques with different imaging techniques. In this review, we provide an overview of the currently available invasive and noninvasive imaging modalities used to detect vulnerable plaques. We will discuss the upcoming challenges in translating these techniques into clinical practice and in assigning them their exact place in the decision-making process.
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Affiliation(s)
- David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Cliniques, Université Catholique de Louvain, Brussels, Belgium
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228
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von Birgelen C, Hartmann M. Beyond the lumen border: on the use of intravascular ultrasound in the left main coronary artery. EUROINTERVENTION 2011; 7:300-2. [PMID: 21729830 DOI: 10.4244/eijv7i3a52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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229
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Assessment of Coronary Atherosclerosis Progression and Regression at Bifurcations Using Combined IVUS and OCT. JACC Cardiovasc Imaging 2011; 4:774-80. [DOI: 10.1016/j.jcmg.2011.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 04/19/2011] [Indexed: 11/20/2022]
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230
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de Feijter PJ, Nieman K. Failure of CT coronary imaging to identify plaque erosion: a resetting of expectations. Eur Heart J 2011; 32:2736-8. [DOI: 10.1093/eurheartj/ehr201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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231
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[Dynamic nature of coronary plaques and clinical outcomes in diabetic patients: is change in itself bad?]. Rev Esp Cardiol 2011; 64:549-50. [PMID: 21620549 DOI: 10.1016/j.recesp.2011.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 03/19/2011] [Indexed: 11/21/2022]
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232
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Fall K, Maehara A, Mintz GS. Intravascular Imaging in Patients with Acute Coronary Syndromes and Unstable Coronary Plaques. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9089-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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233
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Comparison of neointimal morphology of in-stent restenosis with sirolimus-eluting stents versus bare metal stents: virtual histology-intravascular ultrasound analysis. Cardiovasc Interv Ther 2011; 26:186-92. [DOI: 10.1007/s12928-011-0051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/28/2010] [Indexed: 10/18/2022]
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234
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Buja LM. Vascular Responses to Percutaneous Coronary Intervention With Bare-Metal Stents and Drug-Eluting Stents. J Am Coll Cardiol 2011; 57:1323-6. [DOI: 10.1016/j.jacc.2010.11.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 11/21/2010] [Indexed: 11/30/2022]
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235
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Ultrasound and light: friend or foe? On the role of intravascular ultrasound in the era of optical coherence tomography. Int J Cardiovasc Imaging 2011; 27:209-14. [PMID: 21337025 PMCID: PMC3078313 DOI: 10.1007/s10554-011-9797-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/06/2011] [Indexed: 11/15/2022]
Abstract
More than 20 years after its introduction, intravascular ultrasound (IVUS) has outlived many other intracoronary techniques. IVUS was useful to solve many interventional problems and assisted us in understanding the dynamics of atherosclerosis. It serves as an established imaging endpoint in large progression-regression trial and as an important workhorse in many catheterization laboratories. Nowadays, increasingly complex lesions are treated with drug-eluting stents. The application of IVUS during such interventions can be very useful. Recently, optical coherence tomography (OCT), a light-based imaging technique, has entered the clinical arena. The “omnipresence” of OCT during scientific sessions and live courses with PCI may raise in many the question: Does IVUS have a future in the “era of OCT”? Three review articles, highlighted by this editorial, demonstrate the broad spectrum of current IVUS applications and underline the significant role of IVUS during the last two decades. OCT, the much younger technique, still has to prove its value. Yet OCT is likely to take over some of the current indications of IVUS as a research tool. In addition, OCT is currently gaining clinical significance for stent optimization during complex interventional procedures. Nevertheless, there is little doubt that IVUS still has a major role in studies on coronary atherosclerosis and for guidance of coronary stenting. Thus, ultrasound and light—are they friend or foe? In fact, both methods are good in their own rights. They are complementary rather than competitive. Moreover, in combination, at least for certain indications, they could be even better.
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236
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Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve. Int J Cardiovasc Imaging 2011; 28:221-8. [PMID: 21336551 DOI: 10.1007/s10554-011-9816-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 01/20/2011] [Indexed: 01/07/2023]
Abstract
Fractional flow reserve (FFR) is an index of the physiological significance of a coronary stenosis. Patients who have lesions with a FFR of >0.80, even optimally treated with medication, have however a MACE rate ranging from 8 to 21%. Coronary plaques at high risk of rupture and clinical events can be also identified by virtual histology intravascular ultrasound (IVUS-VH) as plaques with high amount of necrotic core (NC) abutting the lumen. Aim of this exploratory study was to investigate whether the geometry and composition of lesions with FFR ≤ 0.80 were different from their counterparts. Fifty-five consecutive patients in whom FFR was clinically indicated on a moderate angiographic lesion, received also an imaging investigation on the same lesion with IVUS-VH. Data on plaque geometry and composition was analyzed. Patients were subdivided in two groups according to the value of FFR (> or ≤0.80). Lesions with a FFR ≤ 0.80 (n = 17) showed a slightly larger plaque burden than those with FFR > 0.80 (n = 38) (54.6 ± 0.7% vs. 51.7 ± 0.7% P = 0.1). In addition, they tend to have less content of necrotic core than their counterparts (14.2 ± 8% vs. 19.2 ± 10.2%, P = 0.08). No difference was found in the distribution of NC-rich plaques (fibroatheroma and thin-capped fibroatheroma) between groups (82% in FFR ≤ 0.80 vs. 79% in FFR > 0.80, P = 0.5). Although FFR ≤ 0.80 lesions have larger plaque size, they do not differ in composition from the ones with FFR > 0.80. Further exploration in a large prospective study is needed to study whether the lesions with FFR > 0.80 that are NC rich are the ones associated with the presence of clinical events at follow-up.
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237
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Bourantas CV, Garg S, Naka KK, Thury A, Hoye A, Michalis LK. Focus on the research utility of intravascular ultrasound - comparison with other invasive modalities. Cardiovasc Ultrasound 2011; 9:2. [PMID: 21276268 PMCID: PMC3039561 DOI: 10.1186/1476-7120-9-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/30/2011] [Indexed: 01/08/2023] Open
Abstract
Intravascular ultrasound (IVUS) is an invasive modality which provides cross-sectional images of a coronary artery. In these images both the lumen and outer vessel wall can be identified and accurate estimations of their dimensions and of the plaque burden can be obtained. In addition, further processing of the IVUS backscatter signal helps in the characterization of the type of the plaque and thus it has been used to study the natural history of the atherosclerotic evolution. On the other hand its indigenous limitations do not allow IVUS to assess accurately stent struts coverage, existence of thrombus or exact site of plaque rupture and to identify some of the features associated with increased plaque vulnerability. In order this information to be obtained, other modalities such as optical coherence tomography, angioscopy, near infrared spectroscopy and intravascular magnetic resonance imaging have either been utilized or are under evaluation. The aim of this review article is to present the current utilities of IVUS in research and to discuss its advantages and disadvantages over the other imaging techniques.
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238
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Puri R, Worthley MI, Nicholls SJ. Intravascular imaging of vulnerable coronary plaque: current and future concepts. Nat Rev Cardiol 2011; 8:131-9. [PMID: 21263456 DOI: 10.1038/nrcardio.2010.210] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Advances in coronary imaging are needed to enable the early detection of plaque segments considered to be 'vulnerable' for causing clinical events. Pathological studies have contributed to our current understanding of these vulnerable or unstable segments of plaque. Intravascular ultrasonography (IVUS) has provided insights into the morphology of atherosclerosis, the mediators of plaque progression and the factors associated with acute coronary syndrome (ACS). In addition, the demonstration of pancoronary arterial instability has highlighted that ACS involves a multifocal disease process. Various second-generation intravascular imaging technologies-employing advanced processing of ultrasound radiofrequency backscatter signals, light-based imaging, spectroscopic imaging and molecular targeting-possess inherent advantages for the identification of meaningful surrogates of plaque instability. The fusion of these imaging technologies within a single imaging catheter is likely to allow for greater synergism in image quality and early disease detection. However, natural-history studies to validate the use of these novel imaging tools for enhanced risk prediction are needed before these strategies can be incorporated into mainstream clinical practice.
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Affiliation(s)
- Rishi Puri
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, North Terrace, SA, Australia
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239
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Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, Parise H, Templin B, White R, Zhang Z, Serruys PW. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364:226-35. [PMID: 21247313 DOI: 10.1056/nejmoa1002358] [Citation(s) in RCA: 2291] [Impact Index Per Article: 176.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood. METHODS In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years. RESULTS The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm(2) or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P=0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001). CONCLUSIONS In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography. (Funded by Abbott Vascular and Volcano; ClinicalTrials.gov number, NCT00180466.).
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Affiliation(s)
- Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA.
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Kubo T, Nakamura N, Matsuo Y, Okumoto Y, Wu X, Choi SY, Komukai K, Tanimoto T, Ino Y, Kitabata H, Kimura K, Mizukoshi M, Imanishi T, Akagi H, Yamamoto T, Akasaka T. Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-Cap Fibroatheroma. Int Heart J 2011; 52:175-9. [DOI: 10.1536/ihj.52.175] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
- Department of Cardiovascular Medicine, Social Insurance Kinan Hospital
| | - Nobuo Nakamura
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University
- Department of Cardiovascular Medicine, Social Insurance Kinan Hospital
| | - Yasushi Okumoto
- Department of Cardiovascular Medicine, Social Insurance Kinan Hospital
| | - XiaoFan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine
| | - Kenichi Komukai
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Keizo Kimura
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Masato Mizukoshi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hideharu Akagi
- Department of Cardiovascular Medicine, Social Insurance Kinan Hospital
| | - Tadao Yamamoto
- Department of Cardiovascular Medicine, Social Insurance Kinan Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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241
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DeMaria AN, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall J, Hlatky M, Lew WY, Lima JA, Maisel AS, Narayan SM, Nissen S, Sahn DJ, Tsimikas S. Highlights of the Year in JACC 2010. J Am Coll Cardiol 2011; 57:480-514. [DOI: 10.1016/j.jacc.2010.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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242
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Brar SS, Mintz GS, Maehara A, Stone GW. Applications of grayscale and radiofrequency intravascular ultrasound to image atherosclerotic plaque. J Nucl Cardiol 2010; 17:913-27. [PMID: 20706816 DOI: 10.1007/s12350-010-9280-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Somjot S Brar
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, CA, USA
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243
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Blankstein R, Ferencik M. The vulnerable plaque: Can it be detected with Cardiac CT? Atherosclerosis 2010; 211:386-9. [PMID: 20619414 DOI: 10.1016/j.atherosclerosis.2010.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 06/08/2010] [Indexed: 12/14/2022]
Affiliation(s)
- Ron Blankstein
- Non-invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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244
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Conti CR. Finding the vulnerable plaque. Clin Cardiol 2010; 33:320-1. [PMID: 20556800 PMCID: PMC6653725 DOI: 10.1002/clc.20809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
At a recent Transcatheter Therapeutics meeting in San Francisco the PROSPECT Trial was presented by Dr. Greg Stone. Prospect stands for Providing Regional Observations to Study Predictors of Events in the Coronary Tree. This was a natural history study of atherosclerosis using multi-modality intracoronary imaging to prospectively identify vulnerable plaque. More on this later.
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Intravascular Ultrasound Virtual Histology Derived Thin Cap Fibroatheroma. J Am Coll Cardiol 2010; 55:1598-9. [DOI: 10.1016/j.jacc.2009.10.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/20/2009] [Indexed: 11/19/2022]
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