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Cardiovascular risk in rheumatoid arthritis: How to lower the risk? Atherosclerosis 2013; 231:163-72. [DOI: 10.1016/j.atherosclerosis.2013.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 08/30/2013] [Accepted: 09/08/2013] [Indexed: 12/21/2022]
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252
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Kanber B, Hartshorne TC, Horsfield MA, Naylor AR, Robinson TG, Ramnarine KV. Wall motion in the stenotic carotid artery: association with greyscale plaque characteristics, the degree of stenosis and cerebrovascular symptoms. Cardiovasc Ultrasound 2013; 11:37. [PMID: 24139162 PMCID: PMC3818684 DOI: 10.1186/1476-7120-11-37] [Citation(s) in RCA: 9] [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: 09/05/2013] [Accepted: 10/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background Systolic dilation of the atherosclerotic carotid artery depends on several factors including arterial compliance and the haemodynamic environment. The purpose of this study was to quantify wall motion in stenotic carotid arteries and investigate any associations with the ultrasound greyscale plaque characteristics, the degree of stenosis, and the presence of cerebrovascular symptoms. Methods Variations in the lumen diameters of 61 stenotic carotid arteries (stenosis range 10%-95%) from 47 patients were measured before the proximal shoulder of the atherosclerotic plaque using ultrasound image sequences over several cardiac cycles. Absolute and percentage diameter changes from diastole to systole were calculated and their relationship to the degree of stenosis, greyscale plaque characteristics, and the presence of ipsilateral hemispheric symptoms were studied. Results The mean absolute diameter change from diastole to systole was 0.45 mm (s.d. 0.17), and the mean percentage diameter change was 6.9% (s.d. 3.1%). Absolute and percentage diameter changes did not have a statistically significant relationship to the degree of stenosis, greyscale plaque characteristics, or the presence of ipsilateral hemispheric symptoms (p > 0.05). Parameters significantly correlated with the presence of symptoms were the degree of stenosis (p = 0.01), plaque greyscale median (p = 0.02) and the plaque surface irregularity index (p = 0.02). Conclusions Our study confirmed the degree of stenosis, plaque greyscale median and our surface irregularity index were significant predictors of symptoms, but found no significant correlation between diameter changes of stenosed carotid arteries and the presence of ipsilateral hemispheric symptoms.
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Affiliation(s)
| | | | | | | | | | - Kumar V Ramnarine
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW UK.
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253
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Vrijenhoek JEP, Den Ruijter HM, De Borst GJ, de Kleijn DPV, De Vries JPPM, Bots ML, Van de Weg SM, Vink A, Moll FL, Pasterkamp G. Sex is associated with the presence of atherosclerotic plaque hemorrhage and modifies the relation between plaque hemorrhage and cardiovascular outcome. Stroke 2013; 44:3318-23. [PMID: 24130138 DOI: 10.1161/strokeaha.113.002633] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease. The presence of local PH in the carotid plaque predicts future cardiovascular events in any vascular territory. We investigated the prevalence of local PH and the predictive value of PH for the occurrence of cardiovascular events in men and women separately. METHODS Atherosclerotic plaques from 1422 patients (969 men, 453 women) who underwent carotid endarterectomy were analyzed histologically for the presence of PH. Patients were monitored for 3 years for cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, vascular death, and vascular intervention). RESULTS Plaques from men showed a significantly higher prevalence of PH compared with women (67% versus 54%; P<0.001). In 1353 patients with available follow-up data, with a median duration of 2.9 years, 270 events had occurred in men (29%) and 94 in women (22%). Stratified by presence of PH, the event rate was 32% in men with PH versus 23% in men without PH, and 23% in women with PH versus 21% in women without PH. A multivariable Cox proportional hazards model found a significant interaction between sex and PH. PH was significantly associated with events in men (adjusted hazard ratio, 1.9; 95% CI, 1.2-2.8) but not in women (adjusted hazard ratio, 1.0; 95% CI, 0.6-1.7). CONCLUSIONS Atherosclerotic carotid plaques obtained from men reveal a higher prevalence of PH compared with women. Local PH is strongly related to secondary manifestations of cardiovascular disease in men but not in women.
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Affiliation(s)
- Joyce E P Vrijenhoek
- From the Experimental Cardiology Laboratory (J.E.P.V., H.M.D.R., D.P.V.d.K., S.M.V.d.W., G.P.), Julius Center of Health Sciences and Primary Care (H.M.D.R., M.L.B.), and Departments of Vascular Surgery (J.E.P.V., G.J.D.B., F.L.M.) and Pathology (A.V.), University Medical Center, Utrecht, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.E.P.V., D.P.V.d.K.); Department of Surgery and Cardiovascular Research Institute, National University (NU) & National University Hospital (NUH), Singapore (D.P.V.d.K.); and Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.D.V.)
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254
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van den Oord SCH, Akkus Z, Roeters van Lennep JE, Bosch JG, van der Steen AFW, Sijbrands EJG, Schinkel AFL. Assessment of subclinical atherosclerosis and intraplaque neovascularization using quantitative contrast-enhanced ultrasound in patients with familial hypercholesterolemia. Atherosclerosis 2013; 231:107-13. [PMID: 24125419 DOI: 10.1016/j.atherosclerosis.2013.08.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Patients with heterozygous familial hypercholesterolemia (FH) are at severely increased risk of developing atherosclerosis at relatively young age. The aim of this study was to assess the prevalence of subclinical atherosclerosis and intraplaque neovascularization (IPN) in patients with FH, using contrast-enhanced ultrasound (CEUS) of the carotid arteries. METHODS The study population consisted of 69 consecutive asymptomatic patients with FH (48% women, mean age 55 ± 8 years). All patients underwent carotid ultrasound to evaluate the presence and severity of carotid atherosclerosis, and CEUS to assess IPN. IPN was assessed in near wall plaques using a semi-quantitative grading scale and semi-automated quantification software. RESULTS Carotid plaque was present in 62 patients (90%). A total of 49 patients had plaques that were eligible for the assessment of IPN: 7 patients (14%) had no IPN, 39 (80%) had mild to moderate IPN and 3 (6%) had severe IPN. Semi-automated quantification software showed no statistical significant difference in the amount of IPN between patients > 50 years and patients ≤ 50 years and between patients with a defective low-density lipoprotein receptor (LDLR) mutation and patients with a negative LDLR mutation. Plaques with irregular or ulcerated surface had significantly more IPN than plaques with a smooth surface (p < 0.05). CONCLUSION Carotid ultrasound demonstrated atherosclerotic plaque in 90% of asymptomatic patients with FH without known atherosclerosis. IPN assessed with CEUS, was present in 86% of these patients. Irregular and ulcerated plaques exhibited significantly more IPN than plaques with a smooth surface.
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Affiliation(s)
- Stijn C H van den Oord
- Dept. of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Dept. of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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255
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Willems S, Quax PHA, de Borst GJ, de Vries JPPM, Moll FL, de Kleijn DPV, Hoefer IE, Pasterkamp G. Soluble ST2 levels are not associated with secondary cardiovascular events and vulnerable plaque phenotype in patients with carotid artery stenosis. Atherosclerosis 2013; 231:48-53. [PMID: 24125409 DOI: 10.1016/j.atherosclerosis.2013.08.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 08/15/2013] [Accepted: 08/23/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Soluble ST2 (sST2), a novel biomarker predictive for heart disease, has recently been shown associated with the progression of atherosclerotic disease in a mouse model. The present study was designed to assess sST2 plasma levels in patients scheduled for carotid endarterectomy and relate it with the occurrence of adverse cardiovascular events during follow-up. In addition, sST2 levels were associated to patient clinical data and atherosclerotic plaque characteristics. METHODS AND RESULTS Plasma sST2 levels were measured in 391 patients who underwent carotid endarterectomy and were subsequently followed for 3 years. Primary composite endpoint was the occurrence of an adverse cardiovascular event. At baseline, no differences were observed in sST2 levels between asymptomatic (n = 75) and symptomatic (n = 316) patients (85 [49-122] versus 90 [58-137] pg/ml, p = 0.263). Soluble ST2 plasma levels did not differ between patients who experienced a secondary manifestation of cardiovascular disease and patients who remained free of symptoms (90 [60-129] versus 88 [46-140] pg/ml, p = 0.519). There was no association between sST2 levels and any of the following plaque characteristics: size of a lipid core, degree of calcification, number of macrophages or smooth muscle cells, amount of collagen and number of microvessels. CONCLUSIONS Soluble ST2 plasma levels have no predictive value for future cardiovascular events in patients with significant carotid artery stenosis. In addition, we did not observe an association between plasma sST2 levels and the histopathological features of a rupture prone plaque. This study does not provide supportive evidence that sST2 reflects a progressive state of advanced atherosclerotic disease.
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Affiliation(s)
- Sanne Willems
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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256
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Biasiolli L, Lindsay AC, Chai JT, Choudhury RP, Robson MD. In-vivo quantitative T2 mapping of carotid arteries in atherosclerotic patients: segmentation and T2 measurement of plaque components. J Cardiovasc Magn Reson 2013; 15:69. [PMID: 23953780 PMCID: PMC3751854 DOI: 10.1186/1532-429x-15-69] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/08/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Atherosclerotic plaques in carotid arteries can be characterized in-vivo by multicontrast cardiovascular magnetic resonance (CMR), which has been thoroughly validated with histology. However, the non-quantitative nature of multicontrast CMR and the need for extensive post-acquisition interpretation limit the widespread clinical application of in-vivo CMR plaque characterization. Quantitative T2 mapping is a promising alternative since it can provide absolute physical measurements of plaque components that can be standardized among different CMR systems and widely adopted in multi-centre studies. The purpose of this study was to investigate the use of in-vivo T2 mapping for atherosclerotic plaque characterization by performing American Heart Association (AHA) plaque type classification, segmenting carotid T2 maps and measuring in-vivo T2 values of plaque components. METHODS The carotid arteries of 15 atherosclerotic patients (11 males, 71 ± 10 years) were imaged at 3 T using the conventional multicontrast protocol and Multiple-Spin-Echo (Multi-SE). T2 maps of carotid arteries were generated by mono-exponential fitting to the series of images acquired by Multi-SE using nonlinear least-squares regression. Two reviewers independently classified carotid plaque types following the CMR-modified AHA scheme, one using multicontrast CMR and the other using T2 maps and time-of-flight (TOF) angiography. A semi-automated method based on Bayes classifiers segmented the T2 maps of carotid arteries into 4 classes: calcification, lipid-rich necrotic core (LRNC), fibrous tissue and recent IPH. Mean ± SD of the T2 values of voxels classified as LRNC, fibrous tissue and recent IPH were calculated. RESULTS In 37 images of carotid arteries from 15 patients, AHA plaque type classified by multicontrast CMR and by T2 maps (+ TOF) showed good agreement (76% of matching classifications and Cohen's κ = 0.68). The T2 maps of 14 normal arteries were used to measure T2 of tunica intima and media (T2 = 54 ± 13 ms). From 11865 voxels in the T2 maps of 15 arteries with advanced atherosclerosis, 2394 voxels were classified by the segmentation algorithm as LRNC (T2 = 37 ± 5 ms) and 7511 voxels as fibrous tissue (T2 = 56 ± 9 ms); 192 voxels were identified as calcification and one recent IPH (236 voxels, T2 = 107 ± 25 ms) was detected on T2 maps and confirmed by multicontrast CMR. CONCLUSIONS This carotid CMR study shows the potential of in-vivo T2 mapping for atherosclerotic plaque characterization. Agreement between AHA plaque types classified by T2 maps (+TOF) and by conventional multicontrast CMR was good, and T2 measured in-vivo in LRNC, fibrous tissue and recent IPH demonstrated the ability to discriminate plaque components on T2 maps.
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Affiliation(s)
- Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Oxford Acute Vascular Imaging Centre (AVIC), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Alistair C Lindsay
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Joshua T Chai
- Oxford Acute Vascular Imaging Centre (AVIC), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Robin P Choudhury
- Oxford Acute Vascular Imaging Centre (AVIC), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Matthew D Robson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Oxford Acute Vascular Imaging Centre (AVIC), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Abstract
PURPOSE OF REVIEW Improving serum levels of HDL and its subfractions, as well as, oxidative/inflammatory properties has become a fundamental aim in today's atherosclerosis research. Efforts to reach this goal are paralleled by achievements in drug development toward decreasing serum LDL levels and oxidative status. RECENT FINDINGS Paraoxonase1 (PON1) is an HDL-associated enzyme that is deemed responsible for many of the HDL's antiatherogenic and cardioprotective characteristics. PON1 is highly sensitive to variations in its milieu, and endogenous compounds (fatty acids, phospholipids), nutritional ingredients (flavonoids and other antioxidants), and environmental elements (reactive nitrogen and oxygen species, metals, surfactants), significantly affect the enzyme's activities. PON1 was shown to be responsible for some of the HDL antiatherogenic characteristics such as HDL-mediated cholesterol efflux from macrophages, and the inhibition of LDL oxidation. SUMMARY The present review summarizes the recent literature related to various elements in PON1's milieu that regulate its activities, with an emphasis on its interrelation with components of the human carotid atherosclerotic lesion (plaque) which are in constant contact with circulating HDL-associated PON1.
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Affiliation(s)
- Michael Aviram
- Technion Rappaport Faculty of Medicine, and Rambam Medical Center, Haifa, Israel
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258
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Menegazzo L, Albiero M, Millioni R, Tolin S, Arrigoni G, Poncina N, Tessari P, Avogaro A, Fadini GP. Circulating myeloid calcifying cells have antiangiogenic activity via thrombospondin-1 overexpression. FASEB J 2013; 27:4355-65. [PMID: 23901071 DOI: 10.1096/fj.12-223719] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myeloid calcifying cells (MCCs) represent a subpopulation of human monocytes with procalcific potential and are characterized by coexpression of osteocalcin (OC) and bone alkaline phosphatase (BAP). Herein, an in-depth proteomic investigation of MCCs based on fluorescence-activated cell sorting, protein extraction and digestion, isobaric tag for relative and absolute quantitation labeling, fractionation, and analysis on matrix-assisted laser desorption/ionization-time of flight/time of flight and LTQ Orbitrap mass spectrometers identified and quantified more than 700 proteins and revealed pathways activated in OC(+)BAP(+) MCCs compared with those in OC(-)BAP(-) cells. Among proteins referable to angiogenesis, the thrombospondin-1 pathway was markedly up-regulated in MCCs vs. control cells. Up-regulation of the thrombospondin-1 pathway was confirmed by a genome-wide transcriptional analysis. Using in vitro and in vivo angiogenesis assays, we found that freshly isolated MCCs and cultured MCCs display an antiangiogenic function by means of both paracrine activity (conditioned medium) and altered spatial localization in cocultures with endothelial cells. Thrombospondin-1 inhibition by antibody-mediated neutralization or gene knockdown restored the angiogenic activity of OC(+)BAP(+) MCCs toward normal values and abolished the antiangiogenic effects of MCC conditioned medium. These data indicate that circulating MCCs exert antiangiogenic activity by virtue of their overexpression of thrombospondin-1. The study highlights the successful identification and validation of a pathogenic pathway by a gold standard proteomic/transcriptomic analysis of blood cells.
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Affiliation(s)
- Lisa Menegazzo
- 2Department of Medicine, Division of Metabolic Diseases, University Hospital of Padova, Via Giustiniani 2, 35100 Padova, Italy.
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259
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Saam T, Hetterich H, Hoffmann V, Yuan C, Dichgans M, Poppert H, Koeppel T, Hoffmann U, Reiser MF, Bamberg F. Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol 2013; 62:1081-1091. [PMID: 23850912 DOI: 10.1016/j.jacc.2013.06.015] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/20/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to conduct a systematic review and meta-analysis to determine precise estimates of the predictive value of carotid intraplaque hemorrhage (IPH) as determined by magnetic resonance imaging (MRI) for cerebrovascular events. BACKGROUND There is emerging evidence that MR-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. However, available data are based on smaller samples with heterogeneous source populations despite a promising value for noninvasive risk stratification. METHODS We searched PubMed, EMBASE, and the Cochrane Library through September 2012 for studies that followed >35 individuals after baseline MRI. Independent observers abstracted information on populations, MR techniques, outcomes, and study quality. Risk estimates of the presence of IPH for cerebrovascular events were derived in random effects regression analysis, and causes of heterogeneity were determined in meta-regression analysis. RESULTS We identified 8 eligible studies including 689 participants who underwent carotid MRI. The prevalence of IPH at baseline was high (49.0%). Over a median follow-up of 19.6 months, a total of 108 cerebrovascular events occurred (15.7% event rate). The presence of IPH was associated with an ∼6-fold higher risk for events (hazard ratio [HR]: 5.69; 95% confidence interval [CI]: 2.98 to 10.87). The annualized event rate in subjects with detectable IPH was 17.71% compared with 2.43% in patients without IPH. Meta-regression analysis showed symptomatic subjects had higher risks as compared with asymptomatic subjects (HR: 11.71, 95% CI: 5.17 to 26.48 vs. HR: 3.50, 95% CI: 2.59 to 4.73, p = 0.0065), Also, differences were observed for sex and sample size (all p < 0.01), with moderate visual publication bias due to missing smaller sample-size studies (p = 0.18). CONCLUSIONS Presence of IPH on MRI strongly predicts cerebrovascular events. Homogenization of future studies is warranted to allow for sufficient assessment of level of evidence for intervention trials.
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Affiliation(s)
- Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Verena Hoffmann
- Institute of Biomedical Epidemiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Thomas Koeppel
- Division of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Bleijerveld OB, Zhang YN, Beldar S, Hoefer IE, Sze SK, Pasterkamp G, de Kleijn DPV. Proteomics of plaques and novel sources of potential biomarkers for atherosclerosis. Proteomics Clin Appl 2013; 7:490-503. [DOI: 10.1002/prca.201200119] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/07/2013] [Accepted: 03/30/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Onno B. Bleijerveld
- Laboratory of Experimental Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Ya-Nan Zhang
- Surgery & Cardiovascular Research Institute; National University (NUS) & National University Hospital (NUH); Singapore
| | - Serap Beldar
- School of Biological Sciences; Nanyang Technological University; Singapore
| | - Imo E. Hoefer
- Laboratory of Experimental Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Siu K. Sze
- School of Biological Sciences; Nanyang Technological University; Singapore
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Dominique P. V. de Kleijn
- Laboratory of Experimental Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
- Surgery & Cardiovascular Research Institute; National University (NUS) & National University Hospital (NUH); Singapore
- Interuniversity Cardiology Institute of the Netherlands; Utrecht the Netherlands
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261
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Hjelmgren O, Holdfeldt P, Johansson L, Fagerberg B, Prahl U, Schmidt C, Bergström G. Identification of Vascularised Carotid Plaques Using a Standardised and Reproducible Technique to Measure Ultrasound Contrast Uptake. Eur J Vasc Endovasc Surg 2013; 46:21-8. [DOI: 10.1016/j.ejvs.2013.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/26/2013] [Indexed: 01/06/2023]
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Biological mechanisms of microvessel formation in advanced atherosclerosis: The big Five. Trends Cardiovasc Med 2013; 23:153-64. [DOI: 10.1016/j.tcm.2012.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 12/19/2022]
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Willems S, Vink A, Bot I, Quax PHA, de Borst GJ, de Vries JPPM, van de Weg SM, Moll FL, Kuiper J, Kovanen PT, de Kleijn DPV, Hoefer IE, Pasterkamp G. Mast cells in human carotid atherosclerotic plaques are associated with intraplaque microvessel density and the occurrence of future cardiovascular events. Eur Heart J 2013; 34:3699-706. [PMID: 23756333 DOI: 10.1093/eurheartj/eht186] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Human autopsy, animal, and cell culture studies together have merged in a concept suggesting participation of mast cells (MCs) in the generation of atherosclerotic plaques. More specifically, these studies have suggested MC-induced intraplaque neovascularization as one mechanism by which MCs may render the plaques vulnerable. The present study was designed to assess the association between MC numbers and neovascularization in human atherosclerotic plaques, and to relate the abundance of plaque MCs to the occurrence of adverse cardiovascular events during the follow-up. METHODS AND RESULTS Atherosclerotic plaques of 270 patients suffering from carotid artery stenosis were stained for the presence of MCs (MC tryptase). Furthermore, during a follow-up of 3 years, cardiovascular-related endpoints were assessed in 253 patients. On average a high number of MCs were observed per plaque cross-section [median 108 (55-233) cells per section]. Plaques with high MC numbers revealed an unstable lipid-rich inflammatory phenotype and were associated with symptomatic patients. In addition, MC numbers were positively associated with microvessel density (r = 0.416, P < 0.001). Patients with high intraplaque MC numbers showed significantly more cardiovascular events during the follow-up (58/142 vs. 31/111 events, P = 0.029). In a multivariate analysis with correction for the main risk factors of cardiovascular diseases, MCs remained independently associated with adverse cardiovascular events (P = 0.025). CONCLUSION Mast cells are highly prevalent in human carotid atherosclerotic lesions and associated with plaque microvessel density. Furthermore, intraplaque MC numbers associate with future cardiovascular events.
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Affiliation(s)
- Sanne Willems
- Experimental Cardiology Laboratory (room G02.523), University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
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Hosseini AA, Kandiyil N, Macsweeney STS, Altaf N, Auer DP. Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke. Ann Neurol 2013; 73:774-84. [PMID: 23463579 PMCID: PMC3824333 DOI: 10.1002/ana.23876] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/23/2013] [Accepted: 02/22/2013] [Indexed: 12/02/2022]
Abstract
Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). Interpretation MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup. ANN NEUROL 2013;73:774–784
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Affiliation(s)
- Akram A Hosseini
- Division of Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Campus, Nottingham, United Kingdom
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Veerbeek JH, Smit JG, Koster MP, Uiterweer EDP, van Rijn BB, Koenen SV, Franx A. Maternal Cardiovascular Risk Profile After Placental Abruption. Hypertension 2013; 61:1297-301. [DOI: 10.1161/hypertensionaha.111.00930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jan H.W. Veerbeek
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Janine G. Smit
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Maria P.H. Koster
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Emiel D. Post Uiterweer
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Bas B. van Rijn
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Steven V. Koenen
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Arie Franx
- From the University Medical Center Utrecht, Division of Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands (J.H.W.V., J.G.S., M.P.H.K., E.D.P.U., B.B.v.R., S.V.K., A.F.); and Princess Anne Hospital, Obstetrics and Gynaecology, Division of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
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266
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Rozalski R, Migdalski A, Gackowski D, Guz J, Siomek A, Foksinski M, Szpila A, Zarakowska E, Majer M, Jawien A, Olinski R. Does morphology of carotid plaque depend on patient's oxidative stress? Clin Biochem 2013; 46:1030-1035. [PMID: 23726810 DOI: 10.1016/j.clinbiochem.2013.05.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/24/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study explored the relationship between oxidative stress biomarkers and stability of carotid plaque. We decided to analyze the broad range of parameters describing oxidative stress in patients with carotid stenosis. DESIGN AND METHODS 124 consecutive patients undergoing carotid endarterectomy were enrolled in the study group. The control group consisted of 49 patients without symptoms of atherosclerosis. The stability of carotid plaques was assessed using GSM (gray-scale median) scoring system and the study group was divided into three subgroups according to echogenicity of the plaque. The following parameters of oxidative stress/DNA damage were analyzed: i) urinary excretion of the products of oxidative DNA damage repair; ii) the background level of 8-oxo-7,8-dihydro-2'-deoxyguanosine in leukocytes' DNA and in atherosclerotic plaques; and iii) the concentrations of antioxidant vitamins, uric acid and C-reactive protein in plasma. RESULTS Oxidative stress (described by redox status) was higher in the patient group than in the control group. There is a correlation between oxidative stress of the patients and stability of the plaque, echolucent plaques (GSM<25) being associated with the highest antioxidant level and lowest excretion of DNA repair markers. CONCLUSIONS The plaque formation/morphology may depend on local environment and is independent of oxidative stress/inflammation observed on the level of the whole body.
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Affiliation(s)
- Rafal Rozalski
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland.
| | - Arkadiusz Migdalski
- Department of Surgery, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Daniel Gackowski
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Jolanta Guz
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Agnieszka Siomek
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Marek Foksinski
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Anna Szpila
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Ewelina Zarakowska
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Marcin Majer
- Department of Angiology, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Arkadiusz Jawien
- Department of Surgery, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
| | - Ryszard Olinski
- Department of Clinical Biochemistry, Nicolaus Copernicus University in Torun, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
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267
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Grimm JM, Schindler A, Freilinger T, Cyran CC, Bamberg F, Yuan C, Reiser MF, Dichgans M, Freilinger C, Nikolaou K, Saam T. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaques using parallel imaging and 3 T black-blood in vivo CMR. J Cardiovasc Magn Reson 2013; 15:44. [PMID: 23705576 PMCID: PMC3693990 DOI: 10.1186/1532-429x-15-44] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients. METHODS In this prospective monocentric observational study 34 patients (24 males; 70 ±9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, necrotic core and hemorrhage were determined in both carotid arteries in consensus by two reviewers who were blinded to clinical information. McNemar and Wilcoxon's signed rank tests were use for statistical comparison. A p-value <0.05 was considered statistically significant. RESULTS Symptomatic plaques showed a higher prevalence of AHA-LT6 (67.7% vs. 11.8%; p < 0.001; odds ratio = 12.5), ruptured fibrous caps (44.1% vs. 2.9%; p < 0.001; odds ratio = 15.0), juxtaluminal thrombus (26.5 vs. 0%; p < 0.01; odds ratio = 7.3) and intraplaque hemorrhage (58.6% vs. 11.8%; p = 0.01; odds ratio = 3.8). Necrotic core and hemorrhage areas were greater in symptomatic plaques (14.1 mm2 vs. 5.5 mm2 and 13.6 mm2 vs. 5.3 mm2; p < 0.01, respectively). CONCLUSION 3 T bb-CMR is able to differentiate between symptomatic and asymptomatic carotid plaques, demonstrating the potential of bb-CMR to differentiate between stable and vulnerable lesions and ultimately to identify patients with low versus high risk for cardiovascular complications. Best predictors of the symptomatic side were a ruptured fibrous cap, AHA-LT 6, juxtaluminal hemorrhage/thrombus, and intraplaque hemorrhage.
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Affiliation(s)
- Jochen M Grimm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Tobias Freilinger
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-UniversityHospital, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Fabian Bamberg
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Chun Yuan
- Department of Radiology, University of WashingtonSchool of Medicine, Seattle, USA
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-UniversityHospital, Munich, Germany
| | - Caroline Freilinger
- Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
- Institute of Clinical Radiology, University of Munich, Pettenkoferstr 8a, Munich, 80336, Germany
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268
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Identifying a high risk cardiovascular phenotype by carotid MRI-depicted intraplaque hemorrhage. Int J Cardiovasc Imaging 2013; 29:1477-83. [DOI: 10.1007/s10554-013-0229-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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269
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Maresca D, Renaud G, van Soest G, Li X, Zhou Q, Shung KK, de Jong N, van der Steen AFW. Contrast-enhanced intravascular ultrasound pulse sequences for bandwidth-limited transducers. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:706-13. [PMID: 23384459 PMCID: PMC3760231 DOI: 10.1016/j.ultrasmedbio.2012.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/06/2012] [Accepted: 10/31/2012] [Indexed: 05/03/2023]
Abstract
We demonstrate two methods for vasa vasorum imaging using contrast-enhanced intravascular ultrasound, which can be performed using commercial catheters. Plaque neovascularization was recognized as an independent marker of coronary artery plaque vulnerability. IVUS-based methods to image the microvessels available to date require high bandwidth (-6 dB relative frequency bandwidth >70%), which are not routinely available commercially. We explored the potential of ultraharmonic imaging and chirp reversal imaging for vasa vasorum imaging. In vitro recordings were performed on a tissue-mimicking phantom using a commercial ultrasound contrast agent and a transducer with a center frequency of 34 MHz and a -6 dB relative bandwidth of 56%. Acoustic peak pressures <500 kPa were used. A tissue-mimicking phantom with channels down to 200 μm in diameter was successfully imaged by the two contrast detection sequences while the smallest channel stayed invisible in conventional intravascular ultrasound images. Ultraharmonic imaging provided the best contrast agent detection.
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Affiliation(s)
- David Maresca
- Biomedical Engineering, Thorax Centre, Erasmus University Medical Centre, Rotterdam, the Netherlands.
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270
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Sun J, Song Y, Chen H, Kerwin WS, Hippe DS, Dong L, Chen M, Zhou C, Hatsukami TS, Yuan C. Adventitial perfusion and intraplaque hemorrhage: a dynamic contrast-enhanced MRI study in the carotid artery. Stroke 2013; 44:1031-6. [PMID: 23471271 DOI: 10.1161/strokeaha.111.000435] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Autopsy studies have suggested a relationship between intraplaque hemorrhage (IPH) and vasa vasorum, which arise primarily from the adventitia. Adventitial vasa vasorum can be characterized in the carotid arteries by estimating perfusion parameters via dynamic contrast-enhanced MRI. The purpose of this investigation was to use dynamic contrast-enhanced MRI to test in vivo in a clinical population whether adventitial perfusion, indicative of vasa vasorum microstructure, is associated with IPH. METHODS Symptomatic patients with carotid plaque ipsilateral to the ischemic event underwent bilateral carotid artery MRI examination, which included multicontrast sequences for detecting IPH and a dynamic contrast-enhanced MRI sequence for characterizing adventitial perfusion. Kinetic modeling of the dynamic contrast-enhanced MRI time series was performed to estimate adventitial vp (fractional plasma volume, reflecting local blood supply) and K(trans) (transfer constant, reflecting vessel surface area, and permeability). RESULTS From the 27 patients (22 men; 69 ± 10 years of age) recruited, adventitial perfusion parameters were obtained in 50 arteries. The presence of IPH was associated with a significantly higher value in adventitial K(trans) (0.142 ± 0.042 vs 0.112 ± 0.029 min(-1); P<0.001) but not in vp (0.163 ± 0.064 vs 0.149 ± 0.062; P=0.338). This relationship remained after adjusting for symptomatic status, degree of stenosis, and other confounding factors. CONCLUSIONS This study demonstrated an independent pathophysiological link between the adventitia and IPH and related it to the microstructure of adventitial vasa vasorum. Adventitial perfusion imaging may be useful in studying plaque pathogenesis, but further examination through prospective studies is needed.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, WA 98109, USA
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271
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den Hartog AG, Achterberg S, Moll FL, Kappelle LJ, Visseren FLJ, van der Graaf Y, Algra A, de Borst GJ. Asymptomatic carotid artery stenosis and the risk of ischemic stroke according to subtype in patients with clinical manifest arterial disease. Stroke 2013; 44:1002-7. [PMID: 23404720 DOI: 10.1161/strokeaha.111.669267] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Because best medical treatment is improving, the risk of stroke in asymptomatic carotid artery stenosis (ACAS) may decline. We evaluated the risk of ischemic stroke and stratified it according to stroke subtype in patients with ACAS during long-term follow-up. METHODS In total, 4319 consecutive patients in the Second Manifestations of Arterial disease study with clinically manifest arterial disease or specific risk factors, but without a history of cerebrovascular disease, were included. Degree of stenosis was evaluated with duplex ultrasound scanning. Strokes during follow-up were classified according to subtype. Cox-proportional hazard-regression models were used to evaluate the relationship between ACAS and future stroke. RESULTS We identified 293 (6.8%) patients with ACAS 50% to 99%, of whom 193 had 70% to 99% stenosis. In these subgroups, mean follow-up was 6.2 and 6.0 years, respectively. In total, 94 ischemic strokes occurred, of which 8 in ACAS 50% to 99% patients. The any territory annual ischemic stroke risk was 0.4% in 50% to 99% ACAS and 0.5% per year for 70% to 99% ACAS patients. The risk of ischemic stroke was not significantly increased in patients with ACAS 70% to 99% (hazard ratio, 1.5; 95% confidence interval, 0.7-3.5). Patients with ACAS 50% to 99% and ACAS 70% to 99% tended to have nonsignificantly more large vessel disease strokes (hazard ratio, 1.5; 95% confidence interval, 0.5-4.2 and hazard ratio, 1.7; 95% confidence interval, 0.5-5.6). CONCLUSIONS Patients with clinically manifest arterial disease or type 2 diabetes mellitus have a low risk of developing ischemic stroke, irrespective of its subtype and independent of the degree of ACAS stenosis.
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Affiliation(s)
- Anne G den Hartog
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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272
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Vaya J. The association between biomarkers in the blood and carotid plaque composition-focusing on oxidized lipids, oxysterols and plaque status. Biochem Pharmacol 2013; 86:15-8. [PMID: 23395697 DOI: 10.1016/j.bcp.2013.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 01/24/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
Human atherosclerotic plaque is composed of a large mixture of elements, predominantly lipids and oxidized lipids, lipid-loaded macrophages and smooth muscle cells, forming foam cells. Plaque contents undergo dynamic changes during the plaque's progression, being in a constant interaction with the circulating blood. During the mutual interaction between blood and plaque and the specific biochemical processes occurring in both, specific molecules can be generated in the serum which might provide information on plaque status. This information, mostly on plaque vulnerability, is highly important for making appropriate treatment decisions before neurological symptoms appear. The present review summarizes plaque contents, mostly lipids, oxidized lipids, oxidized products of cholesterol (oxysterols), and covers the recent literature on their association with biomarkers in the blood and on the possibility of using them for providing information on plaque status.
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Affiliation(s)
- Jacob Vaya
- Department of Oxidative Stress and Human Diseases, MIGAL - Galilee Research Institute, Kiryat Shmona 11016, Israel; Tel Hai College, Israel.
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273
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High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques. J Vasc Surg 2013; 57:1046-1051.e2. [PMID: 23375613 DOI: 10.1016/j.jvs.2012.10.088] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/05/2012] [Accepted: 10/14/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Carotid magnetic resonance imaging (MRI) may be a useful tool in characterizing carotid plaque vulnerability, but large studies are still lacking. The purpose of this study was to assess carotid MRI features of vulnerable plaque in a large study and the changes in carotid plaque morphology with respect to time since the neurological event. METHODS We included 161 patients with carotid plaque more than 3 mm thick. All patients underwent carotid MRI to obtain 3-T high-resolution magnetic resonance sequences. Large lipid core, intraplaque hemorrhage (IPH), fibrous cap rupture (FCR), and gadolinium enhancement (GE) were assessed and classified as present or absent. Prevalences of these features were then compared between symptomatic and asymptomatic patients and time since stroke. RESULTS Seven patients were excluded because of poor image quality. Of the remaining 154 patients, 52 were symptomatic and 102 were asymptomatic. The prevalences of IPH (39 vs 16%; P = .002), FCR (30 vs 9%; P = .001), and GE (75 vs 55%; P = .015) were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (odds ratio, 2.6; P = .023) and FCR (odds ratio, 2.8; P = .038) were still significantly higher. The prevalence of IPH was significantly higher in symptomatic patients with plaque regardless of the time since the neurological event. For FCR, the difference between symptomatic and asymptomatic patients was significant only during the first 15 days after the neurological event. CONCLUSIONS Carotid MRI can identify plaque features that are associated with symptomatic presentation and may be indicative of plaque vulnerability. These features may ultimately be used in the management of extracranial carotid stenosis.
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274
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Semb AG, Rollefstad S, Provan SA, Kvien TK, Stranden E, Olsen IC, Hisdal J. Carotid plaque characteristics and disease activity in rheumatoid arthritis. J Rheumatol 2013; 40:359-68. [PMID: 23322468 DOI: 10.3899/jrheum.120621] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Carotid plaques (CP) are predictive of acute coronary syndrome in patients with rheumatoid arthritis (RA), suggesting that atherosclerotic plaques in these patients are vulnerable. The objective of our study was to characterize vulnerability of CP in patients with RA compared to a control population, and between RA patients with different levels of disease activity. METHODS Ultrasound examination of carotid arteries was performed in 152 patients with RA and 89 controls. CP echolucency was evaluated by the Gray-Scale Median (GSM) technique. Lower GSM values indicate higher vulnerability of plaques. CP characteristics were compared between RA patients with active disease and in remission, and between patients and controls. All analyses were performed with adjustment for confounding factors (sex, age, smoking, and blood pressure). Poisson regression analysis was used for count data, mixed modeling for GSM and area per plaque, and analysis of covariance for minimum GSM value per patient. RESULTS Patients with RA more frequently had CP (median 2, range 0, 4) compared with controls (median 1, range 0, 3; p < 0.001), after adjustment for age and sex. Patients with active RA disease according to the Clinical Disease Activity Index (CDAI) had lower median GSM (p = 0.03), minimum GSM (p = 0.03), and a larger CP area (although the latter finding was not significant; p = 0.27), compared with patients with RA in remission. These findings were not confirmed for other disease measures (Simplified Disease Activity Index, Disease Activity Score-28, C-reactive protein, erythrocyte sedimentation rate). CONCLUSION Patients with RA had more CP compared with controls and patients in CDAI remission, and controls had more stable CP than patients with active disease; these findings point to the importance of achieving remission in RA.
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Affiliation(s)
- Anne G Semb
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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275
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den Hartog A, Bovens S, Koning W, Hendrikse J, Luijten P, Moll F, Pasterkamp G, de Borst G. Current Status of Clinical Magnetic Resonance Imaging for Plaque Characterisation in Patients with Carotid Artery Stenosis. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2012.10.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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276
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Scholtes VPW, Johnson JL, Jenkins N, Sala-Newby GB, de Vries JPPM, de Borst GJ, de Kleijn DPV, Moll FL, Pasterkamp G, Newby AC. Carotid atherosclerotic plaque matrix metalloproteinase-12-positive macrophage subpopulation predicts adverse outcome after endarterectomy. J Am Heart Assoc 2012; 1:e001040. [PMID: 23316311 PMCID: PMC3540663 DOI: 10.1161/jaha.112.001040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/27/2012] [Indexed: 12/19/2022]
Abstract
Background Matrix metalloproteinase-12 (MMP-12) promotes atherosclerosis in animal models. MMP-12 is expressed in only a subset of foam-cell macrophages (FCMs) in human plaques. We investigated whether the prevalence of this MMP-12–expressing subpopulation is a prognostic indicator of adverse outcome in patients after carotid endarterectomy (CEA). Methods and Results Serial sections of culprit lesions from 236 patients who underwent CEA and had undergone 3 years of clinical follow-up were stained immunocytochemically for MMP-12 and for CD68, and the MMP-12/CD68 ratio was used to quantify the MMP-12–expressing subpopulation. A high MMP-12/CD68 ratio correlated with a high content of lipid and total macrophages and a low content of vascular smooth muscle cells, as well as with MMP-8 (R=0.211, P=0.001), MMP-9 (R=0.251, P<0.001), and cleaved caspase-3 (R=0.142, P=0.036) activity measured in a neighboring segment. Dual immunohistochemical examination confirmed the location of MMP-12 in a subpopulation of MMP-8– and MMP-9–positive FCMs, whereas all apoptotic FCMs were MMP-12 positive. Patients who yielded plaques within the highest quartile compared with the lowest quartile of MMP-12/CD68 ratio had a 2.4-fold (hazard ratio, 2.4; 95% CI, 1.1- to 5.1-fold; adjusted P=0.027) increased risk of major adverse cardiovascular event and a 3.4-fold (3.4; 1.2- to 9.6-fold, P=0.024) increased risk for stroke. Conclusions The prevalence of an MMP-12–positive subset of FCMs is a prognostic marker for adverse clinical outcome after CEA.
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Otsuka F, Fuster V, Narula J, Virmani R. Omnipresent Atherosclerotic Disease: Time to Depart From Analysis of Individual Vascular Beds. ACTA ACUST UNITED AC 2012; 79:641-53. [DOI: 10.1002/msj.21353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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278
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Hoogi A, Akkus Z, van den Oord SCH, ten Kate GL, Schinkel AFL, Bosch JG, de Jong N, Adam D, van der Steen AFW. Quantitative analysis of ultrasound contrast flow behavior in carotid plaque neovasculature. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:2072-2083. [PMID: 23062375 DOI: 10.1016/j.ultrasmedbio.2012.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/27/2012] [Accepted: 08/01/2012] [Indexed: 06/01/2023]
Abstract
Intraplaque neovascularization is considered as an important indication for plaque vulnerability. We propose a semiautomatic algorithm for quantification of neovasculature, thus, enabling assessment of plaque vulnerability. The algorithm detects and tracks contrast spots using multidimensional dynamic programming. Classification of contrast tracks into blood vessels and artifacts was performed. The results were compared with manual tracking, visual classification and maximal intensity projection. In 28 plaques, 97% of the contrast spots were detected. In 89% of the objects, the automatic tracking determined the contrast motion with an average distance of less than 0.5 mm from the manual marking. Furthermore, 75% were correctly classified into artifacts and vessels. The automated neovascularization grading agreed within 1 grade with visual analysis in 91% of the cases, which was comparable to the interobserver variability of visual grading. These results show that the method can successfully quantify features that are linked to vulnerability of the carotid plaque.
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Affiliation(s)
- Assaf Hoogi
- Thoraxcenter Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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279
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Kandiyil N, Altaf N, Hosseini AA, MacSweeney ST, Auer DP. Lower prevalence of carotid plaque hemorrhage in women, and its mediator effect on sex differences in recurrent cerebrovascular events. PLoS One 2012; 7:e47319. [PMID: 23110067 PMCID: PMC3482217 DOI: 10.1371/journal.pone.0047319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 09/14/2012] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Women are at lower risk of stroke, and appear to benefit less from carotid endarterectomy (CEA) than men. We hypothesised that this is due to more benign carotid disease in women mediating a lower risk of recurrent cerebrovascular events. To test this, we investigated sex differences in the prevalence of MRI detectable plaque hemorrhage (MRI PH) as an index of plaque instability, and secondly whether MRI PH mediates sex differences in the rate of cerebrovascular recurrence. Methods Prevalence of PH between sexes was analysed in a single centre pooled cohort of 176 patients with recently symptomatic, significant carotid stenosis (106 severe [≥70%], 70 moderate [50–69%]) who underwent prospective carotid MRI scanning for identification of MRI PH. Further, a meta-analysis of published evidence was undertaken. Recurrent events were noted during clinical follow up for survival analysis. Results Women with symptomatic carotid stenosis (50%≥) were less likely to have plaque hemorrhage (PH) than men (46% vs. 70%) with an adjusted OR of 0.23 [95% CI 0.10–0.50, P<0.0001] controlling for other known vascular risk factors. This negative association was only significant for the severe stenosis subgroup (adjusted OR 0.18, 95% CI 0.067–0.50) not the moderate degree stenosis. Female sex in this subgroup also predicted a longer time to recurrent cerebral ischemic events (HR 0.38 95% CI 0.15–0.98, P = 0.045). Further addition of MRI PH or smoking abolished the sex effects with only MRI PH exerting a direct effect. Meta-analysis confirmed a protective effect of female sex on development of PH: unadjusted OR for presence of PH = 0.54 (95% CI 0.45–0.67, p<0.00001). Conclusions MRI PH is significantly less prevalent in women. Women with MRI PH and severe stenosis have a similar risk as men for recurrent cerebrovascular events. MRI PH thus allows overcoming the sex bias in selection for CEA.
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Affiliation(s)
- Neghal Kandiyil
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Nishath Altaf
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Akram A. Hosseini
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Shane T. MacSweeney
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Dorothee P. Auer
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
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280
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den Hartog AG, Bovens SM, Koning W, Hendrikse J, Pasterkamp G, Moll FL, de Borst GJ. PLACD-7T Study: Atherosclerotic Carotid Plaque Components Correlated with Cerebral Damage at 7 Tesla Magnetic Resonance Imaging. Curr Cardiol Rev 2012; 7:28-34. [PMID: 22294972 PMCID: PMC3131713 DOI: 10.2174/157340311795677743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 11/22/2022] Open
Abstract
Introduction: In patients with carotid artery stenosis histological plaque composition is associated with plaque stability and with presenting symptomatology. Preferentially, plaque vulnerability should be taken into account in pre-operative work-up of patients with severe carotid artery stenosis. However, currently no appropriate and conclusive (non-) invasive technique to differentiate between the high and low risk carotid artery plaque in vivo is available. We propose that 7 Tesla human high resolution MRI scanning will visualize carotid plaque characteristics more precisely and will enable correlation of these specific components with cerebral damage. Study objective: The aim of the PlaCD-7T study is 1: to correlate 7T imaging with carotid plaque histology (gold standard); and 2: to correlate plaque characteristics with cerebral damage ((clinically silent) cerebral (micro) infarcts or bleeds) on 7 Tesla high resolution (HR) MRI. Design: We propose a single center prospective study for either symptomatic or asymptomatic patients with haemodynamic significant (70%) stenosis of at least one of the carotid arteries. The Athero-Express (AE) biobank histological analysis will be derived according to standard protocol. Patients included in the AE and our prospective study will undergo a pre-operative 7 Tesla HR-MRI scan of both the head and neck area. Discussion: We hypothesize that the 7 Tesla MRI scanner will allow early identification of high risk carotid plaques being associated with micro infarcted cerebral areas, and will thus be able to identify patients with a high risk of periprocedural stroke, by identification of surrogate measures of increased cardiovascular risk.
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Affiliation(s)
- A G den Hartog
- Departments of Vascular Surgery, Utrecht, the Netherlands, Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
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281
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W van Lammeren G, L Moll F, Borst GJD, de Kleijn DPV, P M de Vries JP, Pasterkamp G. Atherosclerotic plaque biomarkers: beyond the horizon of the vulnerable plaque. Curr Cardiol Rev 2012; 7:22-7. [PMID: 22294971 PMCID: PMC3131712 DOI: 10.2174/157340311795677680] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local plaque vulnerability, leading to thrombus formation and cardiovascular events. Due to the burden of cardiovascular disease, identification of patients at risk for cardiovascular events and treatment stratification is needed. The predictive power of classical risk factors is limited, especially in patients with manifest atherosclerosis. Imaging modalities have focused on the characteristics of the vulnerable plaque. However, it has become evident that not all so-called vulnerable plaques lead to rupture and subsequent thrombosis. The latter obviously limits the positive predictive value for imaging assessment of plaques and patients at risk. Serum biomarkers have also been studied extensively, but have very limited application in a clinical setting for risk stratification. In line with the important relation between vulnerable plaques and cardiovascular events, plaque biomarker studies have been initiated. These longitudinal studies are based on the concept, that a vulnerable plaque contains predictive information for future cardiovascular events, also in other territories of the vascular tree. Results look promising and plaque markers can be used to develop imaging modalities to identify patients at risk, or to monitor treatment effect. Plaque biomarker studies do not challenge the definition of the vulnerable plaque, but use its concept in favor of prediction improvement for vascular patients.
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Affiliation(s)
- Guus W van Lammeren
- Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands
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282
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Koole D, Heyligers J, Moll FL, Pasterkamp G. Intraplaque neovascularization and hemorrhage. J Cardiovasc Med (Hagerstown) 2012; 13:635-9. [DOI: 10.2459/jcm.0b013e3283590cd2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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283
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Michel JB, Delbosc S, Ho-Tin-Noé B, Leseche G, Nicoletti A, Meilhac O, Martin-Ventura JL. From intraplaque haemorrhages to plaque vulnerability. J Cardiovasc Med (Hagerstown) 2012; 13:628-34. [DOI: 10.2459/jcm.0b013e328357face] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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284
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Fadini GP, Rattazzi M, Matsumoto T, Asahara T, Khosla S. Emerging role of circulating calcifying cells in the bone-vascular axis. Circulation 2012; 125:2772-81. [PMID: 22665885 DOI: 10.1161/circulationaha.112.090860] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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285
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Stone PH, Saito S, Takahashi S, Makita Y, Nakamura S, Kawasaki T, Takahashi A, Katsuki T, Nakamura S, Namiki A, Hirohata A, Matsumura T, Yamazaki S, Yokoi H, Tanaka S, Otsuji S, Yoshimachi F, Honye J, Harwood D, Reitman M, Coskun AU, Papafaklis MI, Feldman CL. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study. Circulation 2012; 126:172-81. [PMID: 22723305 DOI: 10.1161/circulationaha.112.096438] [Citation(s) in RCA: 464] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159.
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Affiliation(s)
- Peter H Stone
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
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286
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van Lammeren G, den Hartog A, Pasterkamp G, Vink A, de Vries JP, Moll F, de Borst G. Asymptomatic Carotid Artery Stenosis: Identification of Subgroups with Different Underlying Plaque Characteristics. Eur J Vasc Endovasc Surg 2012; 43:632-6. [DOI: 10.1016/j.ejvs.2012.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/21/2012] [Indexed: 11/29/2022]
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287
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Platelets enter atherosclerotic plaque via intraplaque microvascular leakage and intraplaque hemorrhage: A histopathological study in carotid plaques. Atherosclerosis 2012; 222:355-9. [DOI: 10.1016/j.atherosclerosis.2012.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/20/2012] [Accepted: 03/07/2012] [Indexed: 11/21/2022]
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288
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Folkersen L, Persson J, Ekstrand J, Agardh HE, Hansson GK, Gabrielsen A, Hedin U, Paulsson-Berne G. Prediction of ischemic events on the basis of transcriptomic and genomic profiling in patients undergoing carotid endarterectomy. Mol Med 2012; 18:669-75. [PMID: 22371308 DOI: 10.2119/molmed.2011.00479] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/23/2012] [Indexed: 12/16/2022] Open
Abstract
Classic risk factors, including age, smoking, serum cholesterol, diabetes and blood pressure, constitute the basis of present risk prediction models but fail to identify all individuals at risk. The objective of this study was to investigate if genomic and transcriptional patterns improve prediction of ischemic events in patients with established carotid artery disease. Genotype and gene expression profiles were obtained from carotid plaque tissue (n = 126) and peripheral blood mononuclear cells (n = 97) of patients undergoing carotid endarterectomy. Patients were followed for an average of 44 months, and 25 ischemic events occurred (18 ischemic strokes and 7 myocardial infarctions). Blinded leave-one-out cross-validation on Cox regression coefficients was used to assign gene expression-based risk scores to each patient. When compared with classic risk factors, addition of carotid plaque gene expression-based risk score improved the prediction of future ischemic events from an area under the curve (AUC) of 0.66 to an AUC of 0.79. The inclusion of gene expression risk score from peripheral blood mononuclear cells or from 25 established myocardial infarction risk single nucleotide polymorphisms only exhibited marginal effects on the prediction of ischemic events. Prediction of ischemic events is improved by inclusion of gene expression profiling from carotid endarterectomy tissue compared with prediction on the basis of classic risk markers alone in patients with atherosclerosis. The method may be developed to identify subjects at very high risk of ischemic events.
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Affiliation(s)
- Lasse Folkersen
- Center for Molecular Medicine, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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289
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Pfenniger A, van der Laan SW, Foglia B, Dunoyer-Geindre S, Haefliger JA, Winnik S, Mach F, Pasterkamp G, James RW, Kwak BR. Lack of association between connexin40 polymorphisms and coronary artery disease. Atherosclerosis 2012; 222:148-53. [PMID: 22405441 DOI: 10.1016/j.atherosclerosis.2012.01.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/23/2012] [Accepted: 01/30/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cx40 is a gap junction protein important for cell-cell communication in the endothelium. Polymorphisms in the promoter region of the human Cx40 gene, -44G>A and +71A>G, were shown to reduce Cx40 transcription by half. As mice with an endothelial-specific deletion of Cx40 are more susceptible to atherosclerosis, this study was designed to discover a correlation between these polymorphisms and atherosclerosis in European populations. METHODS AND RESULTS 803 patients referred to the Geneva University Hospitals for elective coronary angiography were divided according to the number of significantly stenosed vessels (from 0 to 3) and were genotyped for the Cx40 polymorphisms. Genotype distribution in the control group was -44GG/+71AA=59.8%, -44AG/+71AG=35.1% and -44AA/+71GG=5.2%. Surprisingly, this distribution was similar in the CAD group, with -44GG/+71AA=58.5%, -44AG/+71AG=37.6% and -44AA/+71GG=3.8% (p=0.67). Moreover, no significant association between histological carotid plaque composition of culprit lesions and Cx40 polymorphisms could be detected in 583 Dutch patients of the Athero-Express study. CONCLUSIONS Despite a clear antiatherogenic role of Cx40 in mice, our study could not detect an association of Cx40 promoter polymorphisms and CAD in human. Moreover, a correlation with atherosclerotic plaque stability or hypertension could not be demonstrated either. Connexin polymorphisms affecting channel function may be of greater importance for cardiovascular disease than polymorphisms affecting the expression level of the protein.
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Affiliation(s)
- Anna Pfenniger
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Switzerland.
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290
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Rensing K, von der Thüsen J, Weijers E, Houttuijn Bloemendaal F, van Lammeren G, Vink A, van der Wal A, van Hinsbergh V, van der Loos C, Stroes E, Koolwijk P, Twickler T. Endothelial insulin receptor expression in human atherosclerotic plaques: Linking micro- and macrovascular disease in diabetes? Atherosclerosis 2012; 222:208-15. [DOI: 10.1016/j.atherosclerosis.2012.01.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/20/2012] [Accepted: 01/21/2012] [Indexed: 10/14/2022]
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291
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Riccioni G, Speranza L, Pesce M, Cusenza S, D'Orazio N, Glade MJ. Novel phytonutrient contributors to antioxidant protection against cardiovascular disease. Nutrition 2012; 28:605-10. [PMID: 22480801 DOI: 10.1016/j.nut.2011.11.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 11/25/2011] [Accepted: 11/25/2011] [Indexed: 11/26/2022]
Abstract
The associations linking endothelial inflammation, endothelial oxidative stress, and atherogenesis and the potential for dietary phytonutrients to decrease the impact of these associations were assessed. A detailed literature review was conducted and summarized. A large body of scientific evidence describes the interactions among endothelial inflammation, endothelial oxidative stress, and atherogenesis. A growing body of research indicates that several dietary phytonutrients (astaxanthin, lycopene, lutein, and glabridin) can decrease the risk for atherosclerosis by decreasing endothelial inflammation and oxidative stress. The consumption of foods or dietary supplements that provide astaxanthin, lycopene, lutein, and glabridin can ameliorate endothelial inflammation and oxidative stress, retard atherogenesis, and decrease the risk for atherogenic cardiovascular disease.
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Affiliation(s)
- Graziano Riccioni
- Cardiology Unit, San Camillo de Lellis Hospital, Manfredonia, Foggia, Italy.
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292
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Abstract
Leukocyte-derived microparticles (LMPs) may originate from neutrophils, monocytes/macrophages, and lymphocytes. They express markers from their parental cells and harbor membrane and cytoplasmic proteins as well as bioactive lipids implicated in a variety of mechanisms, maintaining or disrupting vascular homeostasis. When they carry tissue factor or coagulation inhibitors, they participate in hemostasis and pathological thrombosis. Both proinflammatory and anti-inflammatory processes can be affected by LMPs, thus ensuring an appropriate inflammatory response. LMPs also play a dual role in the endothelium by either improving the endothelial function or inducing an endothelial dysfunction. LMPs are implicated in all stages of atherosclerosis. They circulate at a high level in the bloodstream of patients with high atherothrombotic risk, such as smokers, diabetics, and subjects with obstructive sleep apnea, where their prolonged contact with the vessel wall may contribute to its overall deterioration. Numbering microparticles, including LMPs, might be useful in predicting cardiovascular events. LMPs modify the endothelial function and promote the recruitment of inflammatory cells in the vascular wall, necessary processes for the progression of the atherosclerotic lesion. In addition, LMPs favor the neovascularization within the vulnerable plaque and, in the ruptured plaque, they take part in coagulation and platelet activation. Finally, LMPs participate in angiogenesis. They might represent a novel therapeutic tool to reset the angiogenic switch in pathologies with altered angiogenesis. Additional studies are needed to further investigate the role of LMPs in cardiovascular diseases. However, large-scale studies are currently difficult to set up because microparticle measurement still requires elaborate techniques which lack standardization.
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Affiliation(s)
- Anne Angelillo-Scherrer
- Service and Central Laboratory of Hematology, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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293
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Herder C, Peeters W, Zierer A, de Kleijn DPV, Moll FL, Karakas M, Roden M, Meisinger C, Thorand B, Pasterkamp G, Koenig W. TGF-β1 content in atherosclerotic plaques, TGF-β1 serum concentrations and incident coronary events. Eur J Clin Invest 2012; 42:329-37. [PMID: 21950567 DOI: 10.1111/j.1365-2362.2011.02587.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND We tested the hypothesis that high TGF-β1 content in atherosclerotic plaques and high TGF-β1 serum levels are associated with lower risk of coronary events in two independent prospective studies. MATERIALS AND METHODS In the prospective Athero-Express biobank study, total TGF-β1 plaque levels were measured in 632 atherosclerotic lesions from patients who underwent carotid endarterectomy. In a population-based case-cohort study within the Monitoring of trends and determinants in cardiovascular disease (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) Augsburg studies, baseline total TGF-β1 serum levels were measured in 333 individuals with and 1728 without incident coronary events. RESULTS Patients with TGF-β1 content in their plaques above the study median did not have a lower risk of coronary events than patients with lower TGF-β1 levels [adjusted HR (95% CI) 1·46 (0·83-2·53); P = 0·16; mean follow-up 2·6 ± 0·7 years] in the Athero-Express biobank study. Cox proportional hazard models adjusting for age, sex, body mass index, metabolic factors, lifestyle factors and survey did not reveal a significant association between TGF-β1 serum levels and incident coronary events [HR (95% CI) for increasing TGF-β1 tertiles 1·0, 1·22 (0·88-1·68), 1·13 (0·82-1·57); P = 0·47; mean follow-up: 10·8 ± 4·6 years] in the MONICA/KORA Augsburg studies. CONCLUSION Our results indicate that high TGF-β1 content in human atherosclerotic plaques and high serum levels of TGF-β1 are not associated with reduced risk of coronary events.
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Affiliation(s)
- Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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294
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Bogiatzi C, Cocker MS, Beanlands R, Spence JD. Identifying high-risk asymptomatic carotid stenosis. ACTA ACUST UNITED AC 2012; 6:139-51. [DOI: 10.1517/17530059.2012.662954] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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295
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Pasterkamp G, van der Steen A. Intraplaque Hemorrhage: An Imaging Marker for Atherosclerotic Plaque Destabilization? Arterioscler Thromb Vasc Biol 2012; 32:167-8. [DOI: 10.1161/atvbaha.111.241414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Gerard Pasterkamp
- From the Experimental Cardiology Laboratory (G.P.), University Medical Centre Utrecht, Utrecht; Biomedical Engineering (A.F.W.v.d.S.), Thorax Centre, Erasmus MC, Rotterdam, The Netherlands
| | - A.F.W. van der Steen
- From the Experimental Cardiology Laboratory (G.P.), University Medical Centre Utrecht, Utrecht; Biomedical Engineering (A.F.W.v.d.S.), Thorax Centre, Erasmus MC, Rotterdam, The Netherlands
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296
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Turc G, Oppenheim C, Naggara O, Eker OF, Calvet D, Lacour JC, Crozier S, Guegan-Massardier E, Hénon H, Neau JP, Toussaint JF, Mas JL, Méder JF, Touzé E. Relationships Between Recent Intraplaque Hemorrhage and Stroke Risk Factors in Patients With Carotid Stenosis. Arterioscler Thromb Vasc Biol 2012; 32:492-9. [DOI: 10.1161/atvbaha.111.239335] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Intraplaque hemorrhage (IPH) is an emerging marker of plaque instability. However, little is known about the relationships between IPH and traditional risk factors and whether these relationships differ between symptomatic and asymptomatic disease.
Methods and Results—
Two hundred thirty-four patients with symptomatic (n=114) or asymptomatic (n=120) carotid stenosis underwent high-resolution plaque magnetic resonance imaging. Seventy-five patients had recent IPH (symptomatic, 33%; asymptomatic, 31%). In symptomatic stenosis, recent IPH was independently associated with degree of stenosis (odds ratio [OR]=4.21, 1.61–10.98 for North American Symptomatic Carotid Endarterectomy Trial >35%; OR=2.92, 1.18–7.24 for European Carotid Surgery Trial >60%), qualifying event (OR=4.13; 1.11–15.32 for stroke or hemispheric transient ischemic attack ≥1 hour versus transient ischemic attack <1 hour or ocular symptoms), time from ischemic event (OR=6.65, 1.56–28.35 for ≤2 weeks; OR=2.24, 0.87–5.81 for 2–12 weeks versus >12 weeks;
P
for trend=0.03). In asymptomatic stenosis, IPH was only associated with stenosis severity >70% by ECST (OR=6.65; 1.95–22.73) but not by the NASCET method.
Conclusion—
Our findings support the potential link between recent IPH and risk of ipsilateral stroke in symptomatic disease but also imply that prognostic studies should adjust for known stroke risk factors in multivariate analyses. In asymptomatic stenosis, the potential predictive value of recent IPH is less likely to be confounded by stroke risk factors.
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Affiliation(s)
- Guillaume Turc
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Catherine Oppenheim
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Olivier Naggara
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Omer F. Eker
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - David Calvet
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Christophe Lacour
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Sophie Crozier
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Evelyne Guegan-Massardier
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Hilde Hénon
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Philippe Neau
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-François Toussaint
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Louis Mas
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-François Méder
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Emmanuel Touzé
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
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297
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Malaud E, Piquer D, Merle D, Molina L, Guerrier L, Boschetti E, Saussine M, Marty-Ané C, Albat B, Fareh J. Carotid atherosclerotic plaques: Proteomics study after a low-abundance protein enrichment step. Electrophoresis 2012; 33:470-82. [DOI: 10.1002/elps.201100395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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298
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Yoon W, Kim SK, Park MS, Chae HJ, Kang HK. Safety of protected carotid artery stenting in patients with severe carotid artery stenosis and carotid intraplaque hemorrhage. AJNR Am J Neuroradiol 2012; 33:1027-31. [PMID: 22241385 DOI: 10.3174/ajnr.a2911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid IPH can be detected with MR imaging. The aim of this study was to determine the safety of CAS using an emboli protection device in patients with severe carotid artery stenosis and MR imaging-depicted carotid IPH. MATERIALS AND METHODS We retrospectively reviewed a prospective data base that included 91 consecutive patients with severe carotid stenosis and high-risk features who were treated with CAS by using an emboli protection device. Seventy-eight of the included patients underwent prestenting 3D TOF MRA. IPH was defined as the presence of high signal intensity within the carotid plaque, greater than 150% of the signal intensity of the adjacent neck muscle on TOF source images. The primary outcome measure was the combined incidence of stroke, MI, and death within 30 days of CAS. Associations between IPH and the primary outcome were investigated. RESULTS IPH was detected on TOF MRA in 30 patients. Symptomatic patients were more common in the IPH group than in the non-IPH group (66.7% vs 41.7%; P = .032). Overall, 30-day stroke, MI, or death rates were 6.6%. There was no significant difference in the primary outcome between the IPH and non-IPH groups (10% and 6.25%, respectively; hazard ratio for IPH, 1.151; 95% CI, 0.035 to 37.500; P = .937). A logistic regression showed there was no independent variable associated with the primary outcome. CONCLUSIONS The results of this study indicate that protected CAS seems to be safe in patients with severe carotid stenosis and IPH.
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Affiliation(s)
- W Yoon
- Departments of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
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299
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Loizou CP, Petroudi S, Pattichis CS, Pantziaris M, Kasparis T, Nicolaides A. Segmentation of atherosclerotic carotid plaque in ultrasound video. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:53-56. [PMID: 23365830 DOI: 10.1109/embc.2012.6345869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The degree of stenosis of the common carotid artery (CCA) but also the characteristics of the arterial wall including plaque size, composition and elasticity represent important predictors used in the assessment of the risk for future cardiovascular events. This paper proposes and evaluates an integrated system for the segmentation of atherosclerotic carotid plaque in ultrasound video of the CCA based on normalization, speckle reduction filtering (with the hybrid median filter) and parametric active contours. The algorithm is initialized in the first video frame of the cardiac cycle with human assistance and the moving atherosclerotic plaque borders are tracked and segmented in the subsequent frames. The algorithm is evaluated on 10 real CCA digitized videos from B-mode longitudinal ultrasound segments and is compared with the manual segmentations of an expert, for every 20 frames in a time span of 3-5 seconds, covering in general 2 cardiac cycles. The segmentation results are very satisfactory with a true negative fraction (TNF) of 79.3%, a true-positive fraction (TPF) of 78.12%, a false-positive fraction (FPF) of 6.7% and a false-negative fraction (FNF) of 19.6% between the ground truth and the presented plaque segmentations, a Williams index (KI) of 80.3%, an overlap index of 71.5%, a specificity of 0.88±0.09, a precision of 0.86±0.10 and an effectiveness measure of 0.77±0.09. The results show that integrated system investigated in this study could be successfully used for the automated video segmentation of the carotid plaque.
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Affiliation(s)
- C P Loizou
- Department of Computer Science, Intercollege, Limassol, Cyprus.
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300
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Qiao Y, Etesami M, Astor BC, Zeiler SR, Trout HH, Wasserman BA. Carotid plaque neovascularization and hemorrhage detected by MR imaging are associated with recent cerebrovascular ischemic events. AJNR Am J Neuroradiol 2011; 33:755-60. [PMID: 22194363 DOI: 10.3174/ajnr.a2863] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pathologic studies suggest that neovascularization and hemorrhage are important features of plaque vulnerability for disruption. Our aim was to determine the associations of these features in carotid plaques with previous cerebrovascular ischemic events by using high-resolution CE-MRI. MATERIALS AND METHODS Forty-seven patients (36 men; mean age 72.5 ± 10 years) underwent CE-MRI and MRA examinations for carotid plaque at 3T. IPH presence was recorded. Neovascularity was categorized by the degree of adventitial enhancement (0, absent; 1, <50%; 2, ≥50%). Reader variability was assessed by using weighted κ. Associations with events were determined by using multivariable logistic regression. RESULTS Intra- and inter-reader agreement for grading adventitial enhancement were good to excellent. IPH was present in 49% of patients and was associated with events (P = .03). Patients grouped by categories 0, 1, and 2 adventitial enhancement had increasing frequencies of events (14% category 0, 48% category 1, 65% category 2; P = .02). Events were associated with IPH (OR, 10.18; 95% CI, 1.42-72.21) and adventitial enhancement (compared with category 0: OR, 14.90, 95% CI, 0.98-225.93 for category 1; OR, 51.17, 95% CI, 3.4-469.8 for category 2) after controlling for age, sex, cardiovascular risk factors, wall thickness, and stenosis. Stenosis was not associated with events. CONCLUSIONS Adventitial enhancement and IPH are independently associated with previous events and may provide important insight into stroke risk not achievable by stenosis.
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Affiliation(s)
- Y Qiao
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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