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Gogas BD, Farooq V, Serruys PW, Garcìa-Garcìa HM. Assessment of coronary atherosclerosis by IVUS and IVUS-based imaging modalities: progression and regression studies, tissue composition and beyond. Int J Cardiovasc Imaging 2011; 27:225-37. [PMID: 21373888 PMCID: PMC3078316 DOI: 10.1007/s10554-010-9791-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/30/2010] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease remains the leading cause of mortality, morbidity and disability in the developed world, predominantly affecting the adult population. In the early 1990s coronary heart disease (CHD) was established as affecting one in two men and one in three women by the age of forty. Despite the dramatic progress in the field of cardiovascular medicine in terms of diagnosis and treatment of heart disease, modest improvements have only been achieved when the reduction of cardiovascular mortality and morbidity indices are assessed. To better understand coronary atherosclerosis, new imaging modalities have been introduced. These novel imaging modalities have been used in two ways: (1) for the characterization of plaque types; (2) for the assessment of the progression and regression of tissue types. These two aspects will be discussed in this review.
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Affiliation(s)
- Bill D Gogas
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, z120 Erasmus MC Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands
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252
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Medina A, Martín P, Suárez de Lezo J, Nóvoa J, Melián F, Hernández E, Suárez de Lezo J, Pan M, Burgos L, Amador C, Morera O, García A. Estudio ultrasónico de prevalencia de placa en la carina en lesiones que afectan a una bifurcación coronaria. Implicaciones en el tratamiento con stent provisional. Rev Esp Cardiol 2011; 64:43-50. [DOI: 10.1016/j.recesp.2010.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 07/26/2010] [Indexed: 11/29/2022]
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253
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Finn AV, Kolodgie FD, Nakano M, Virmani R. The differences between neovascularization of chronic total occlusion and intraplaque angiogenesis. JACC Cardiovasc Imaging 2010; 3:806-10. [PMID: 20705259 DOI: 10.1016/j.jcmg.2010.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 03/15/2010] [Indexed: 11/29/2022]
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254
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255
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Garcia-Garcia HM, Costa MA, Serruys PW. Imaging of coronary atherosclerosis: intravascular ultrasound. Eur Heart J 2010; 31:2456-69. [DOI: 10.1093/eurheartj/ehq280] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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256
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Astor BC, Sharrett AR, Coresh J, Chambless LE, Wasserman BA. Remodeling of carotid arteries detected with MR imaging: atherosclerosis risk in communities carotid MRI study. Radiology 2010; 256:879-86. [PMID: 20651061 DOI: 10.1148/radiol.10091162] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the extent of thickening of the carotid arterial walls that may be accommodated by outward remodeling. MATERIALS AND METHODS Institutional review board approval was obtained at each participating site, and informed consent was obtained from each participant. All study sites conducted this study in compliance with HIPAA requirements. A total of 2066 participants (age range, 60-85 years) from the Atherosclerosis Risk in Communities (ARIC) study were enrolled in the ARIC Carotid MRI Study. Maximum wall thickness and luminal area were measured with gadolinium-enhanced magnetic resonance (MR) imaging in both common carotid arteries (CCAs) and in one internal carotid artery (ICA) 2 mm above the flow divider. Complete data were available for 1064 ICAs and 3348 CCAs. The association of maximum wall thickness with lumen area was evaluated with linear regression, and adjustments were made for participant age, sex, race, height, and height squared. RESULTS In the ICA, lumen area was relatively constant across patients with a wall thickness of 1.38 mm or less. In patients with a wall thickness of more than 1.38 mm, however, lumen area decreased linearly as wall thickness increased. Wall area represented a median of 61.9% of the area circumscribed by the vessel at a maximum wall thickness of 1.50 mm +/- 0.05 (standard deviation) and 75.4% at a maximum wall thickness of 4.0 mm +/- 0.10. In the CCA, lumen area was preserved across wall thicknesses less than 2.06 mm, representing 99% of vessels. CONCLUSION Atherosclerotic thickening in the ICA appears to be accommodated for vessels with a maximum wall thickness of less than 1.5 mm. Beyond this threshold, greater thickness is associated with a smaller lumen. The CCA appears to accommodate a wall thickness of less than 2.0 mm. These estimates indicate that the carotid arteries are able to compensate for a greater degree of thickening than are the coronary arteries.
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Affiliation(s)
- Brad C Astor
- Welch Center for Prevention, Epidemiology and Clinical Research and Departments of Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
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257
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Quantification of vasa vasorum density in multi-slice computed tomographic coronary angiograms: role of computed tomographic image voxel size. J Comput Assist Tomogr 2010; 34:273-8. [PMID: 20351520 DOI: 10.1097/rct.0b013e3181bb0d32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study is motivated by the possibility of using computed tomography (CT) to detect early coronary atherosclerosis by the increased CT values within the arterial wall resulting from vasa vasorum proliferation. METHODS Coronary arteries (n = 5) with early atherosclerotic changes were injected with Microfil and scanned (micro-CT). Noise was added to the CT projection data sets (to represent the radiation exposure of current clinical CT scanners) and then reconstructed to generate 3-dimensional images at different voxel sizes. RESULTS Higher CT values were detected because of contrast agent in vasa vasorum if voxel size was less than (150 microm)(3). Contrast in the main lumen increased the CT values dramatically at voxels greater than (100 microm)(3), whereas CT values of the same specimen without contrast in the main lumen remained constant. CONCLUSIONS Voxel sizes less than (200 microm)(3) are needed to quantitate arterial wall opacification due to vasa vasorum proliferation.
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258
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Koskinas KC, Feldman CL, Chatzizisis YS, Coskun AU, Jonas M, Maynard C, Baker AB, Papafaklis MI, Edelman ER, Stone PH. Natural history of experimental coronary atherosclerosis and vascular remodeling in relation to endothelial shear stress: a serial, in vivo intravascular ultrasound study. Circulation 2010; 121:2092-101. [PMID: 20439786 DOI: 10.1161/circulationaha.109.901678] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The natural history of heterogeneous atherosclerotic plaques and the role of local hemodynamic factors throughout their development are unknown. We performed a serial study to assess the role of endothelial shear stress (ESS) and vascular remodeling in the natural history of coronary atherosclerosis. METHODS AND RESULTS Intravascular ultrasound-based 3-dimensional reconstruction of all major coronary arteries (n=15) was performed serially in vivo in 5 swine 4, 11, 16, 23, and 36 weeks after induction of diabetes mellitus and hyperlipidemia. The reconstructed arteries were divided into 3-mm-long segments (n=304). ESS was calculated in all segments at all time points through the use of computational fluid dynamics. Vascular remodeling was assessed at each time point in all segments containing significant plaque, defined as maximal intima-media thickness >/=0.5 mm, at week 36 (n=220). Plaque started to develop at week 11 and progressively advanced toward heterogeneous, multifocal lesions at all subsequent time points. Low ESS promoted the initiation and subsequent progression of plaques. The local remodeling response changed substantially over time and determined future plaque evolution. Excessive expansive remodeling developed in regions of very low ESS, further exacerbated the low ESS, and was associated with the most marked plaque progression. The combined assessment of ESS, remodeling, and plaque severity enabled the early identification of plaques that evolved to high-risk lesions at week 36. CONCLUSIONS The synergistic effect of local ESS and the remodeling response to plaque formation determine the natural history of individual lesions. Combined in vivo assessment of ESS and remodeling may predict the focal formation of high-risk coronary plaque.
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Affiliation(s)
- Konstantinos C Koskinas
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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259
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Neutrophil adhesion on endothelial cells in a novel asymmetric stenosis model: effect of wall shear stress gradients. Ann Biomed Eng 2010; 38:2791-804. [PMID: 20387119 DOI: 10.1007/s10439-010-0032-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/30/2010] [Indexed: 01/02/2023]
Abstract
Leukocytes play a pivotal role in the progression of atherosclerosis. A novel three-dimensional in vitro asymmetric stenosis model was used to better investigate the role of local hemodynamics in the adhesion of leukocytes to an established plaque. The adhesion of a human promyelocytic cell line (NB4) on a human abdominal aortic endothelial cell (EC) monolayer was quantified. NB4 cells were circulated over TNF-alpha stimulated and nonstimulated ECs for 1 or 6 h at 1.25 or 6.25 dynes/cm(2) and compared to static conditions. Cytokine stimulation increased significantly EC expression of intercellular adhesion molecule and vascular cell adhesion molecule. Under static conditions, neutrophils adhered overall more than under flow, with decreased adhesion with increasing shear. Adhesion was significantly higher in the recirculation region distal to the stenosis than in the inlet. Preshearing the ECs decreased the expression of cell adhesion molecules in inflamed endothelium and significantly decreased adhesion. However, the ratio of adhesion between the recirculation zone and the inlet increased, hence exhibiting an increased regional difference. This work suggests an important role for neutrophil-EC interactions in the atherosclerotic process, especially in wall shear stress gradient regions. This is important clinically, potentially helping to explain plaque stability.
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260
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Hamburg NM, Mott MM, Bigornia SJ, Duess MA, Kluge MA, Hess DT, Apovian CM, Vita JA, Gokce N. Maladaptive enlargement of the brachial artery in severe obesity is reversed with weight loss. Vasc Med 2010; 15:215-22. [PMID: 20375126 DOI: 10.1177/1358863x10362831] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maladaptive peripheral arterial remodeling, which leads to large arteries with low shear stress, may be associated with increased cardiovascular risk. We tested the hypothesis that arterial enlargement in severe obesity represents maladaptive remodeling and that weight reduction would reverse this process. We evaluated brachial arterial diameter and flow using ultrasound in 244 severely obese patients (age 44 +/- 11 years, 80% female, body mass index (BMI) 46 +/- 9 kg/m) at baseline and in a group of 67 subjects who experienced weight loss at 1 year. Higher BMI was associated with larger brachial artery diameter (p = 0.01) and lower shear stress (p = 0.008), indicating maladaptive remodeling. Significant (> or = 10%) weight reduction was associated with a decrease in resting arterial diameter (-0.19 +/- 0.47 mm, p = 0.02) along with a trend toward increased shear stress. Decreased systemic inflammation was associated with weight loss-induced reverse remodeling of the brachial artery. Our findings demonstrate the presence of maladaptive arterial remodeling in advanced obesity that was ameliorated by significant weight loss.
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Affiliation(s)
- Naomi M Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA.
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261
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Glaudemans AWJM, Slart RHJA, Bozzao A, Bonanno E, Arca M, Dierckx RAJO, Signore A. Molecular imaging in atherosclerosis. Eur J Nucl Med Mol Imaging 2010; 37:2381-97. [PMID: 20306036 PMCID: PMC2975909 DOI: 10.1007/s00259-010-1406-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 02/03/2010] [Indexed: 11/02/2022]
Abstract
Atherosclerosis is the major cause of cardiovascular disease, which still has the leading position in morbidity and mortality in the Western world. Many risk factors and pathobiological processes are acting together in the development of atherosclerosis. This leads to different remodelling stages (positive and negative) which are both associated with plaque physiology and clinical presentation. The different remodelling stages of atherosclerosis are explained with their clinical relevance. Recent advances in basic science have established that atherosclerosis is not only a lipid storage disease, but that also inflammation has a fundamental role in all stages of the disease. The molecular events leading to atherosclerosis will be extensively reviewed and described. Further on in this review different modalities and their role in the different stages of atherosclerosis will be discussed. Non-nuclear invasive imaging techniques (intravascular ultrasound, intravascular MRI, intracoronary angioscopy and intravascular optical coherence tomography) and non-nuclear non-invasive imaging techniques (ultrasound with Doppler flow, electron-bean computed tomography, coronary computed tomography angiography, MRI and coronary artery MR angiography) will be reviewed. After that we focus on nuclear imaging techniques for detecting atherosclerotic plaques, divided into three groups: atherosclerotic lesion components, inflammation and thrombosis. This emerging area of nuclear imaging techniques can provide measures of biological activity of atherosclerotic plaques, thereby improving the prediction of clinical events. As we will see in the future perspectives, at present, there is no special tracer that can be called the diagnostic tool to diagnose prospective stroke or infarction in patients. Nevertheless, we expect such a tracer to be developed in the next few years and maybe, theoretically, it could even be used for targeted therapy (in the form of a beta-emitter) to combat cardiovascular disease.
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Affiliation(s)
- Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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262
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Abstract
This article provides a systematic approach to vulnerable plaques. It is divided into 4 sections. The first section is devoted to definition, incidence, anatomic distribution, and clinical presentation. The second section is devoted to plaque composition, setting up the foundations to understand plaque vulnerability. The third section relates to invasive plaque imaging. The fourth section is devoted to therapy, from conservative pharmacologic options to aggressive percutaneous coronary intervention alternatives.
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Affiliation(s)
- Pedro R Moreno
- Zena and Michael A. Wiener Cardiovascular Institute and The Marie-Josee and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, Box 1030, New York, NY 10029, USA.
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263
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Nasir K, Gopal A, Blankstein R, Ahmadi N, Pal R, Khosa F, Shaw LJ, Blumenthal RS, Budoff MJ. Noninvasive assessment of gender differences in coronary plaque composition with multidetector computed tomographic angiography. Am J Cardiol 2010; 105:453-8. [PMID: 20152238 DOI: 10.1016/j.amjcard.2009.09.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 09/28/2009] [Accepted: 09/28/2009] [Indexed: 11/18/2022]
Abstract
To date, sparse data are available with regard to gender differences in plaque morphology and composition. The aim of the present report was to assess the differences in coronary plaque burden and composition in a noninvasive manner between women and men using multidetector computed tomographic angiography. The study population consisted of 416 patients (61 +/- 13 years), with 148 women (36%). A stenosis of >or=70% in at least one coronary segment was found in 11% of women compared to 25% of men (p <0.0001). Overall, women presented with a significantly lower mean number of segments containing calcified plaques (1.43 +/- 2.04 vs 2.25 +/- 2.30, p = 0.004) and mixed plaques (1.67 +/- 1.23 vs 2.25 +/- 2.30, p = 0.05). No such relation was seen with noncalcified plaques (0.72 +/- 1.01 vs 0.86 +/- 1.06, p = 0.21). In addition, the assessment of the overall proportion of the composition of plaque burden revealed relatively more noncalcified (40% vs 28%), less calcified (38% vs 43%), and mixed (23% vs 28%) plaques in women than in men (p <0.0001). On multivariate analysis of the total plaque burden, the women had a 19% (95% confidence interval 11% to 28%, p <0.0001) greater relative distribution of plaque that was noncalcified compared to the men, and the overall plaque burden was less likely to be calcified (p = 0.006) or mixed (p = 0.019). Similar results were seen in younger and older subjects. In conclusion, gender differences exist, not only in the atherosclerotic disease burden, but also in the underlying plaque composition. Women tended to have more exclusively noncalcified plaque and were less likely to have calcified or mixed plaques compared to men. Future studies are needed to elucidate whether these underlying differences in plaque composition might explain the reduced risk of cardiac events in women.
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Affiliation(s)
- Khurram Nasir
- Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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264
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Otake H, Honda Y, Yamasaki M, Tsujino I, Shimohama T, Sakurai R, Hasegawa T, Waseda K, Ako J, Fitzgerald PJ. Vascular Response to Overlapping Everolimus-Eluting Stents - Comparison With Paclitaxel-Eluting Stents -. Circ J 2010; 74:1023-5. [DOI: 10.1253/circj.cj-10-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiromasa Otake
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Yasuhiro Honda
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Masao Yamasaki
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Ichizo Tsujino
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Takao Shimohama
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Ryota Sakurai
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Takao Hasegawa
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Katsuhisa Waseda
- Center for Research in Cardiovascular Interventions, Stanford University
| | - Junya Ako
- Center for Research in Cardiovascular Interventions, Stanford University
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265
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Wu X, Maehara A, Mintz GS, Kubo T, Xu K, Choi SY, He Y, Guo N, Moses JW, Leon MB, De Bruyne B, Serruys PW, Stone GW. Virtual histology intravascular ultrasound analysis of non-culprit attenuated plaques detected by grayscale intravascular ultrasound in patients with acute coronary syndromes. Am J Cardiol 2010; 105:48-53. [PMID: 20102889 DOI: 10.1016/j.amjcard.2009.08.649] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 08/11/2009] [Accepted: 08/11/2009] [Indexed: 11/28/2022]
Abstract
Noncalcific attenuated plaques identified by grayscale intravascular ultrasound (IVUS) are often seen in patients with acute coronary syndromes and have been associated with no reflow and creatine kinase-MB elevation after percutaneous coronary intervention. Histopathology has shown cholesterol clefts, microcalcification, or organized thrombus. One hundred twenty-four vessels in 64 patients with acute coronary syndromes from the PROSPECT trial were identified for inclusion in the present analysis. After excluding 4 vessels with severe calcification, 9 vessels with <40% plaque burden, and 3 vessels with too few (<3) virtual histology (VH)-IVUS frames for analysis, complete grayscale IVUS and VH-IVUS was available for 108 vessels in 64 patients that contained 39 VH-IVUS thin-capped fibroatheromas (VH-TCFA), 40 thick-capped fibroatheromas (VH-ThFA), and 33 pathologic intimal thickening but no fibrotic or fibrocalcific plaques. Overall, there were 47 grayscale IVUS attenuated plaques in 43 vessels. Compared to the minimum luminal sites of the remaining 65 vessels (controls), attenuated plaques contained larger necrotic core areas (1.5 +/- 0.9 vs 0.9 +/- 0.8 mm(2) in controls, p = 0.001). Fibroatheromas (VH-TCFA or VH-ThFA) were more common at the sites of attenuated plaques than at control sites (VH-TCFA 42.5% vs 29.2%, VH-ThFA 53.2% vs 23.1%, pathologic intimal thickening 4.3% vs 47.7%, p <0.0001). In conclusion, grayscale IVUS attenuated plaques are associated with a large amount of VH-IVUS necrotic core and are markers of the presence of fibroatheromas (VH-TCFA or VH-ThFA). This may explain the biologic instability of these lesions.
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Affiliation(s)
- Xiaofan Wu
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
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266
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Kato M, Dote K, Naganuma T, Sasaki S, Ueda K, Okita M, Watanabe Y, Kajikawa M, Yokoyama H, Higashi A. Clinical Predictors of Culprit Plaque Rupture Assessed on Intravascular Ultrasound in Acute Coronary Syndrome. Circ J 2010; 74:1936-42. [DOI: 10.1253/circj.cj-10-0086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Toru Naganuma
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Shota Sasaki
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Kentaro Ueda
- Department of Cardiology, Hiroshima City Asa Hospital
| | - Misa Okita
- Department of Cardiology, Hiroshima City Asa Hospital
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267
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Huang WC, Liu CP, Wu MT, Mar GY, Lin SK, Hsiao SH, Lin SL, Chiou KR. Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography. Eur J Radiol 2010; 73:74-81. [PMID: 19004589 DOI: 10.1016/j.ejrad.2008.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 09/10/2008] [Accepted: 09/23/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Wei-Chun Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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268
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Tavora F, Cresswell N, Li L, Ripple M, Fowler D, Burke A. Sudden coronary death caused by pathologic intimal thickening without atheromatous plaque formation. Cardiovasc Pathol 2009; 20:51-7. [PMID: 19913444 DOI: 10.1016/j.carpath.2009.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/11/2009] [Accepted: 08/20/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Atherosclerotic plaques progress from early lesions with little free cholesterol and lipid to late fibroatheromas with necrotic cores that may rupture. The frequency of severe coronary atherosclerosis without core formation in any artery in sudden coronary death is not known. METHODS We studied 314 hearts from 253 men and 61 women who died suddenly from severe coronary stenosis (≥ 1 epicardial artery with ≥ 75% luminal area narrowing) and with no other cause of death. If no section demonstrated any necrotic core, the designation was nonatheromatous atherosclerosis; if there was ≥ 1 necrotic core, the designation was atheromatous atherosclerosis. Plaques were scored for the presence of calcification, intimal inflammation, and neovasculature on a 5-point scale. Plaque burden was estimated semiquantitatively. RESULTS In 22 men (9%) and 14 women (23%), there were no necrotic cores in any plaque (nonatheromatous atherosclerosis). Fourteen of these 36 nonatheromatous atherosclerosis cases had focal acute thrombus due to erosion (39%). Of the remaining 278 cases (atheromatous atherosclerosis), acute erosions were present in 25 (9%; P<.0001). Sudden death due to nonatheromatous atherosclerosis occurred more frequently in women (P<.001), in Blacks (20%; P=.003), and at a younger age (44± 12 years) than atheromatous atherosclerosis (52 ± 12 years; P=.0003). On multivariate analysis, nonatheromatous atherosclerosis was associated with younger age (P=.001), female gender (P=.004), and Black race (P=.006). CONCLUSIONS Nonatheromatous atherosclerosis constitutes slightly >10% of sudden coronary deaths and is more frequent in young Black women. Nonatheromatous atherosclerosis is a relatively infrequent pathway for coronary plaque progression, leading to severe disease and sudden death that may involve plaque erosion.
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Affiliation(s)
- Fabio Tavora
- Armed Forces Institute of Pathology, Washington, DC, USA
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269
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Shaw LJ, Bugiardini R, Merz CNB. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 2009; 54:1561-75. [PMID: 19833255 PMCID: PMC2789479 DOI: 10.1016/j.jacc.2009.04.098] [Citation(s) in RCA: 473] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/20/2009] [Accepted: 04/27/2009] [Indexed: 12/14/2022]
Abstract
Evolving knowledge regarding sex differences in coronary heart disease is emerging. Given the lower burden of obstructive coronary artery disease (CAD) and preserved systolic function in women, which contrasts with greater rates of myocardial ischemia and near-term mortality compared with men, we propose the term "ischemic heart disease" as appropriate for this discussion specific to women rather than CAD or coronary heart disease (CHD). This paradoxical difference, where women have lower rates of anatomical CAD but more symptoms, ischemia, and adverse outcomes, appears linked to abnormal coronary reactivity that includes microvascular dysfunction. Novel risk factors can improve the Framingham risk score, including inflammatory markers and reproductive hormones, as well as noninvasive imaging and functional capacity measurements. Risk for women with obstructive CAD is increased compared with men, yet women are less likely to receive guideline-indicated therapies. In the setting of non-ST-segment elevation acute myocardial infarction, interventional strategies are equally effective in biomarker-positive women and men, whereas conservative management is indicated for biomarker-negative women. For women with evidence of ischemia but no obstructive CAD, antianginal and anti-ischemic therapies can improve symptoms, endothelial function, and quality of life; however, trials evaluating impact on adverse outcomes are needed. We hypothesize that women experience more adverse outcomes compared with men because obstructive CAD remains the current focus of therapeutic strategies. Continued research is indicated to devise therapeutic regimens to improve symptom burden and reduce risk in women with ischemic heart disease.
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Affiliation(s)
- Leslee J Shaw
- Emory Program in Cardiovascular Outcomes Research and Epidemiology, Emory University School of Medicine, Atlanta, Georgia, USA
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270
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Kramer MCA, Rittersma SZH, de Winter RJ, Ladich ER, Fowler DR, Liang YH, Kutys R, Carter-Monroe N, Kolodgie FD, van der Wal AC, Virmani R. Relationship of thrombus healing to underlying plaque morphology in sudden coronary death. J Am Coll Cardiol 2009; 55:122-32. [PMID: 19818571 DOI: 10.1016/j.jacc.2009.09.007] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/03/2009] [Accepted: 09/07/2009] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to assess differences in thrombus healing between ruptured and eroded plaques, given the natural difference in lesion substrate and that thrombi might exist days to weeks before the presentation of sudden coronary death. BACKGROUND Although the ability to distinguish ruptures and erosions remains a major clinical challenge, in-hospital patients dying with acute myocardial infarction establish that erosions account for 25% of all deaths, where women experience a higher incidence compared with men. METHODS Coronary lesions with thrombi (ruptures, n = 65; erosions, n = 50) received in consultation from the Medical Examiner's Office from 111 sudden death victims were studied. Thrombus healing was classified as early (<1 day) or late stage characterized in phases of lytic (1 to 3 days), infiltrating (4 to 7 days), or healing (>7 days). Morphometric analysis included vessel dimensions, necrotic core size, and macrophage density. RESULTS Late-stage thrombi were identified in 79 of 115 (69%) culprit plaques. Women more frequently had erosion with a greater prevalence of late-stage thrombi (44 of 50, 88%) than ruptures (35 of 65, 54%, p < 0.0001). The internal elastic lamina area and percent stenosis were significantly smaller in erosions compared with ruptures (p < 0.0001 and p = 0.02), where plaque burden was greater (p = 0.008). Although macrophage infiltration in erosions was significantly less than ruptures (p = 0.03), there was no established relationship with thrombus organization. Other parameters of thrombus length and occlusive versus nonocclusive showed no association with healing. CONCLUSIONS Approximately two-thirds of coronary thrombi in sudden coronary deaths are organizing, particularly in young individuals-especially women, who perhaps might require a different strategy of treatment.
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Affiliation(s)
- Miranda C A Kramer
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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271
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Gurfinkel E, Vigliano C, Janavel JV, Fornoni D, Caponi G, Meckert PC, Bertolotti A, Favaloro R, Laguens R. Presence of vulnerable coronary plaques in middle-aged individuals who suffered a brain death. Eur Heart J 2009; 30:2845-53. [DOI: 10.1093/eurheartj/ehp303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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272
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Waseda K, Miyazawa A, Ako J, Hasegawa T, Tsujino I, Sakurai R, Yock PG, Honda Y, Kandzari DE, Leon MB, Fitzgerald PJ. Intravascular Ultrasound Results From the ENDEAVOR IV Trial. JACC Cardiovasc Interv 2009; 2:779-84. [DOI: 10.1016/j.jcin.2009.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 05/06/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
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273
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Hara H, Tsunoda T, Moroi M, Kubota T, Kunimasa T, Shiba M, Wada M, Tsuji T, Iijima R, Nakajima R, Yoshitama T, Nakamura M. Ultrasound attenuation behind coronary atheroma without calcification: Mechanism revealed by autopsy. ACTA ACUST UNITED AC 2009; 8:110-2. [PMID: 16885078 DOI: 10.1080/14628840600637781] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
When performing intravascular ultrasound studies, the backward echo image can show marked attenuation, although there are no calcified deposits and it may be impossible to detect the intraplaque architecture. The pathology underlying this phenomenon was investigated in autopsy specimens. We hypothesize that the mechanism responsible for the attenuation involves micro-calcification and lipid in unstable plaques causing ultrasonic wave reflection and dispersion.
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274
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Kataoka T, Mathew V, Rubinshtein R, Rihal CS, Lennon R, Lerman LO, Lerman A. Association of plaque composition and vessel remodeling in atherosclerotic renal artery stenosis: a comparison with coronary artery disease. JACC Cardiovasc Imaging 2009; 2:327-38. [PMID: 19356579 DOI: 10.1016/j.jcmg.2008.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 08/19/2008] [Accepted: 08/28/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The current study was designed to investigate the relationship between renal arterial structure and vessel remodeling in patients with atherosclerotic renal artery stenosis (RAS), compared with that seen in coronary artery disease (CAD). BACKGROUND The nature and the tissue characterization of atherosclerotic RAS lesions have not been fully explored. METHODS Gray scale and virtual histology (VH) intravascular ultrasound imaging was used to assess 23 lesions in 14 consecutive RAS patients and 20 left main trunk lesions in age-matched CAD patients. Analysis included assessment of vessel area and atherosclerotic plaque area of the main renal artery or left main trunk. Plaque was characterized as fibrous tissue, fibro-fatty tissue, necrotic core, and dense calcium. Remodeling was assessed by means of the remodeling index (RI). RESULTS Positive remodeling (defined as RI > or =1.05) was present in 15 RAS and 9 CAD lesions, whereas intermediate/negative remodeling (RI <1.05) was present in 8 RAS and 11 CAD lesions. VH showed that the fibrous tissue was the most prominent plaque composition, followed by fibro-fatty, necrotic core, and dense calcium in both vascular beds. Greater vascular adaptive enlargement was observed in slices with plaque burden < or =40% compared with plaque burden >40% (p < 0.001 for all). Vessel area had a positive association with the area of all VH components (p < 0.001, for all). VH analysis shows that the most powerful determinant of adaptive vessel enlargement is dense calcium in RAS (p < 0.001), while that is necrotic core in CAD (p < 0.001). Necrotic core and dense calcium areas were greater in lesions with positive remodeling compared with intermediate/negative remodeling (p = 0.03, p = 0.03, respectively, in RAS; p = 0.005, p = 0.03, respectively, in CAD). CONCLUSIONS The current study demonstrates in humans that plaque composition as assessed by VH intravascular ultrasound has an important role of adaptive vessel enlargement, and it is related to renal artery remodeling in RAS in a pattern similar to CAD.
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Affiliation(s)
- Tetsuro Kataoka
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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275
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Tavora FR, Ripple M, Li L, Burke AP. Monocytes and neutrophils expressing myeloperoxidase occur in fibrous caps and thrombi in unstable coronary plaques. BMC Cardiovasc Disord 2009; 9:27. [PMID: 19549340 PMCID: PMC2708130 DOI: 10.1186/1471-2261-9-27] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 06/23/2009] [Indexed: 01/12/2023] Open
Abstract
Background Myeloperoxidase (MPO) -containing macrophages and neutrophils have been described at sites of plaque rupture. The presence of these cells in precursor lesions to acute rupture (thin cap atheroma, or vulnerable plaque) and within thrombi adjacent to ruptures has not been described, nor an association with iron-containing macrophages within unstable plaques. Methods We studied 61 acute ruptures, 15 organizing ruptures, 31 thin cap fibroatheromas, and 28 fibroatheromas from 72 sudden coronary death victims by immunohistochemical and histochemical techniques. Inflammatory cells were typed with anti-CD68 (macrophages), anti-BP-30 (neutrophil bactericidal glycoprotein), and anti-MPO. Iron was localized by Mallory's Prussian blue stain. In selected plaques alpha smooth muscle actin (DAKO, Carpinteria, CA, clone M0851) was performed. Results MPO positive cells were present in 79% of ruptured caps, 28% of thin cap fibroatheroma, and no fibroatheromas; neutrophils were present in 72% of ruptures, 8% of thin cap fibroatheromas, and no fibroatheromas. Iron containing foam cells were present in the caps of 93% of acute ruptures, of 85% of organizing ruptures, 20% of thin cap atheromas, and 10% of fibroatheromas. MPO positive cells were more frequent in occlusive than non-occlusive thrombi adjacent to ruptures (p = .006) and were more numerous in diabetics compared to non-diabetics (p = .002) Conclusion Unstable fibrous caps are more likely to contain MPO-positive cells, neutrophils, and iron-containing macrophages than fibrous caps of stable fibroatheromas. MPO-positive cells in thrombi adjacent to disrupted plaques are associated with occlusive thrombi and are more numerous in diabetic patients.
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Affiliation(s)
- Fabio R Tavora
- Armed Forces Institute of Pathology, Washington, DC 20306, USA.
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276
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Coronary plaque dimensions and composition by intravascular ultrasound radio frequency lesion segment analysis in stable and unstable angina patients. Coron Artery Dis 2009; 20:309-16. [PMID: 19543087 DOI: 10.1097/mca.0b013e32832ac5d3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS We hypothesized that the plaque composition and plaque type classification differs between acute coronary syndrome (ACS) and stable angina (SA) patients. METHODS AND RESULTS We analyzed culprit lesion (CL) and nonculprit lesion (NCL) of ACS patients compared with target lesion (TL) and nontarget lesion (NTL) of SA patients by intravascular ultrasound radio frequency analysis in 874 lesion segments of 424 patients (ACS: 193 patients/SA: 231 patients). Comparing all lesion segments in ACS and SA patients did not show significant differences in absolute or relative plaque composition. However, necrotic core area was larger in CL versus TL (0.9+/-0.7 vs. 0.7+/-0.5 mm, P=0.005) and all plaque components were significantly higher in CL compared with NCL and TL compared with NTL, respectively. A higher amount of thin cap fibroatheroma lesions (15.2 vs. 5.1%, P<0.0001) was detected in ACS compared with SA patients. Fibrocalcific lesions were lower in ACS patients (3 vs. 10.5%, P<0.0001). CONCLUSION The differentiation in CL/NCL of ACS and TL/NTL of SA patients revealed significant differences in plaque composition and plaque types when examined by intravascular ultrasound radiofrequency analysis. However, considerable overlap between plaque characteristics exists for ACS and SA patients.
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277
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Hoshino T, Chow LA, Hsu JJ, Perlowski AA, Abedin M, Tobis J, Tintut Y, Mal AK, Klug WS, Demer LL. Mechanical stress analysis of a rigid inclusion in distensible material: a model of atherosclerotic calcification and plaque vulnerability. Am J Physiol Heart Circ Physiol 2009; 297:H802-10. [PMID: 19542489 DOI: 10.1152/ajpheart.00318.2009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The role of atherosclerotic calcification in plaque rupture remains controversial. In previous analyses using finite element model analysis, circumferential stress was reduced by the inclusion of a calcium deposit in a representative human anatomical configuration. However, a recent report, also using finite element analysis, suggests that microscopic calcium deposits increase plaque stress. We used mathematical models to predict the effects of rigid and liquid inclusions (modeling a calcium deposit and a lipid necrotic core, respectively) in a distensible material (artery wall) on mechanical failure under uniaxial and biaxial loading in a range of configurations. Without inclusions, stress levels were low and uniform. In the analytical model, peak stresses were elevated at the edges of a rigid inclusion. In the finite element model, peak stresses were elevated at the edges of both inclusions, with minimal sensitivity to the wall distensibility and the size and shape of the inclusion. Presence of both a rigid and a soft inclusion enlarged the region of increased wall stress compared with either alone. In some configurations, the rigid inclusion reduced peak stress at the edge of the soft inclusion but simultaneously increased peak stress at the edge of the rigid inclusion and increased the size of the region affected. These findings suggest that the presence of a calcium deposit creates local increases in failure stress, and, depending on relative position to any neighboring lipid pools, it may increase peak stress and the plaque area at risk of mechanical failure.
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Affiliation(s)
- Tetsuya Hoshino
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, California 90095-1679, USA
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278
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Miao C, Chen S, Macedo R, Lai S, Liu K, Li D, Wasserman BA, Vogel-Claussen J, Vogel-Clausen J, Lima JAC, Bluemke DA. Positive remodeling of the coronary arteries detected by magnetic resonance imaging in an asymptomatic population: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2009; 53:1708-15. [PMID: 19406347 DOI: 10.1016/j.jacc.2008.12.063] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 12/11/2008] [Accepted: 12/22/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to assess coronary arterial remodeling as a marker of subclinical atherosclerosis using coronary wall magnetic resonance imaging (MRI) in an asymptomatic population-based cohort. BACKGROUND In early atherosclerosis, compensatory enlargement of both the outer wall of the vessel as well as the lumen, termed compensatory enlargement or positive remodeling, occurs before luminal narrowing. METHODS One hundred seventy-nine participants in the MESA (Multi-Ethnic Study of Atherosclerosis) trial were evaluated using black-blood coronary wall MRI. Coronary cross-sectional area (vessel size), lumen area, and mean wall thickness of the proximal coronary arteries were measured. RESULTS Men had a greater vessel size, lumen area, and mean wall thickness than women (38.3 +/- 11.3 mm2 vs. 32.6 +/- 9.4 mm2, 6.7 +/- 3.2 mm2 vs. 5.3 +/- 2.4 mm2, and 2.0 +/- 0.3 mm vs. 1.9 +/- 0.3 mm, respectively, p < 0.05). No significant coronary artery narrowing was present by magnetic resonance angiography. Overall, coronary vessel size increased 25.9 mm2 per millimeter increase in coronary wall thickness, whereas lumen area increased only slightly at 3.1 mm2 for every millimeter increase in wall thickness (difference in slopes, p < 0.0001). Adjusting for age and sex, participants with an Agatston score >0 were more likely to have wall thickness >2.0 mm (odds ratio: 2.0, 95% confidence interval: 1.01 to 3.84). CONCLUSIONS Coronary wall MRI detected positive arterial remodeling in asymptomatic men and women with subclinical atherosclerosis.
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Affiliation(s)
- Cuilian Miao
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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279
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Ramcharitar S, Gonzalo N, van Geuns RJ, Garcia-Garcia HM, Wykrzykowska JJ, Ligthart JMR, Regar E, Serruys PW. First case of stenting of a vulnerable plaque in the SECRITT I trial—the dawn of a new era? Nat Rev Cardiol 2009; 6:374-8. [DOI: 10.1038/nrcardio.2009.34] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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280
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Desai MY, Schoenhagen P. Emergence of targeted molecular imaging in atherosclerotic cardiovascular disease. Expert Rev Cardiovasc Ther 2009; 7:197-203. [PMID: 19210215 DOI: 10.1586/14779072.7.2.197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Atherosclerosis, a systemic disease, remains one of the leading causes of morbidity and mortality in the world. Our improved understanding of the molecular mechanisms underlying atherosclerotic lesion progression and sudden transformation into unstable plaques, indicate complex interactions of lipid metabolism, inflammatory processes and genetic predisposition. Currently, novel imaging approaches to visualize the process of atherosclerosis, particularly at the molecular level, are actively being developed. Important targets include inflammatory and endothelial cells, as well as apoptosis and angiogenesis. The next decade should solidify the role of targeted molecular imaging in all aspects of cardiovascular medicine.
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Affiliation(s)
- Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-15, Cleveland, OH 44195, USA.
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281
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Adventitial lymphocytic inflammation in human coronary arteries with intimal atherosclerosis. Cardiovasc Pathol 2009; 19:e61-8. [PMID: 19375947 DOI: 10.1016/j.carpath.2009.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/04/2009] [Accepted: 02/09/2009] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The relationship between adventitial inflammation, plaque type, and culprit plaque morphology in the epicardial arterial circulation has not been studied in detail. METHODS We studied semiserial sections of coronary arteries at autopsy from patients dying with severe coronary disease, 81 men (age 50 + or - 12 years) and 13 women (age 52 + or - 13 years). Lesions were classified at 3- to 5-mm segments according to modified AHA criteria. Adventitial lymphocyte aggregates were assessed at every 5-mm interval and graded semiquantitatively. Macrophage density in the adventitial fat and intima was assessed with anti-CD68 staining. RESULTS Adventitial lymphocytic inflammation increased with percent stenosis (P<.0001) and not calcification (P>.2). Hemorrhage into late core, rupture, erosion, and thin caps all had greater adventitial lymphocytic inflammation independent of percent stenosis (P<.0001). Peri-adventitial adipose macrophage density was increased in plaques with atheromas (206 + or - 22 mm(2) vs. 121 + or - 15 mm(2) in fibrous plaques; P=.02) and correlated positively with adventitial lymphocytes (P<.0001) and intimal macrophage content (P<.0001). CONCLUSIONS Features associated with plaque instability are associated with significantly greater degrees of adventitial lymphocytic inflammation, both as lymphocyte aggregates and as adipocyte-derived macrophages. Further study is required to determine the nature of the association between intimal and adventitial lymphocytic inflammation.
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282
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Sipahi I, Tuzcu EM. Candidate mechanisms for regression of coronary atherosclerosis with high-dose statins: insight from intravascular ultrasonography trials. Am J Cardiovasc Drugs 2009; 8:365-71. [PMID: 19159123 DOI: 10.2165/0129784-200808060-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Animal models and serial imaging studies in humans have shown that atherosclerosis is a potentially reversible disease. Several drug classes have been tested to determine whether they can promote reversal of atherosclerosis. Of these, HMG-CoA reductase inhibitors (statins) have been consistently proven to have anti-atherosclerotic effects in large-scale clinical trials. In this article, we review the lipid- and non-lipid-based mechanisms of statin-induced disease regression using the information provided by the recent intravascular ultrasonography trials. We conclude that, despite several potential mechanisms, reduction of low-density lipoprotein cholesterol appears to be the dominant mechanism responsible for regression of atherosclerosis.
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Affiliation(s)
- Ilke Sipahi
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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283
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Turkbey EB, Dombroski DA. Cardiac Magnetic Resonance Imaging: Techniques and Clinical Applications. Semin Roentgenol 2009; 44:67-83. [PMID: 19233083 DOI: 10.1053/j.ro.2008.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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284
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Krasinski A, Chiu B, Fenster A, Parraga G. Magnetic resonance imaging and three-dimensional ultrasound of carotid atherosclerosis: Mapping regional differences. J Magn Reson Imaging 2009; 29:901-8. [DOI: 10.1002/jmri.21709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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285
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Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings. AJR Am J Roentgenol 2009; 192:584-98. [DOI: 10.2214/ajr.08.1178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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286
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Rollano-Hijarrubia E, Manniesing R, Niessen WJ. Selective deblurring for improved calcification visualization and quantification in carotid CT angiography: validation using micro-CT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:446-453. [PMID: 19244016 DOI: 10.1109/tmi.2008.2006529] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Visualization and quantification of small structures with computed tomography (CT) is hampered by the limited spatial resolution of the system. Histogram-based selective deblurring (HiSD) is a deconvolution method that restores small high-density structures, i.e., calcifications, of a CT image, using the high-intensity voxel information of the deconvolved image, while preserving the original hounsfield Units (HUs) in the remaining tissues. In this study, high resolution micro-CT data are used to validate the potential of HiSD to improve calcium visualization and quantification in the carotid arteries on in vivo contrast-enhanced CTA data. The evaluation is performed qualitatively and quantitatively on 15 atherosclerotic plaques obtained from ten different patients. HiSD in combination with vessel segmentation significantly improves calcification visualization and quantification on in vivo contrast-enhanced CT images. Calcification blur is reduced, while avoiding noise amplification and edge-ringing artifacts in the surrounding tissues. Calcification quantification errors are reduced by 23.5% on average.
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Affiliation(s)
- Empar Rollano-Hijarrubia
- Biomedical Imaging Group Rotterdam (BIGR), the Department of Radiology, Erasmus MC-University Medical Center of Rotterdam, 3015 GE Rotterdam, The Netherlands.
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287
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Phinikaridou A, Hallock KJ, Qiao Y, Hamilton JA. A robust rabbit model of human atherosclerosis and atherothrombosis. J Lipid Res 2009; 50:787-97. [PMID: 19141434 DOI: 10.1194/jlr.m800460-jlr200] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Disruption and thrombosis of atherosclerotic plaques cause most acute cardiovascular events, but their systematic study has been hampered by the lack of suitable animal models. To assess the value of a modified rabbit model of atherothrombosis, we performed detailed histology of rabbit aortic plaques. Atherosclerosis was induced with a high cholesterol diet fed 2 weeks prior to and 6 weeks after balloon injury of the aorta, followed by 4 weeks of normal diet. We found six out of eight types of plaques cataloged by the American Heart Association in the rabbit aorta. Vulnerable plaques were defined as those with attached platelet and fibrin-rich thrombi after pharmacological triggering with Russell's viper venom and histamine. Ruptured plaques had, as also described for human plaques: i) marked medial and adventitial changes, including neovascularization and inflammation; ii) cholesterol monohydrate crystals and liquid crystalline cholesterol esters in the intima and the fibrous cap; and iii) inflamed, thin fibrous caps. Increased cholesterol monohydrate area, internal elastic lamina area, positive remodeling, fibrous cap inflammation, adventitia breakdown, and inflammation were independent predictors of plaque disruption. Our findings reveal novel insights into plaque vulnerability and could guide the design of noninvasive imaging approaches for detecting and treating high-risk plaques.
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Affiliation(s)
- Alkystis Phinikaridou
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA, USA
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288
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Kume T, Okura H, Yamada R, Kawamoto T, Watanabe N, Neishi Y, Sadahira Y, Akasaka T, Yoshida K. Frequency and Spatial Distribution of Thin-Cap Fibroatheroma Assessed by 3-Vessel Intravascular Ultrasound and Optical Coherence Tomography An Ex Vivo Validation and an Initial In Vivo Feasibility Study. Circ J 2009; 73:1086-91. [DOI: 10.1253/circj.cj-08-0733] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | | | | | | | | | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School
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289
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Rodriguez Granillo GA. Non-invasive assessment of vulnerable plaque. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:53-66. [PMID: 23495963 DOI: 10.1517/17530050802607357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sudden cardiac death or unheralded acute coronary syndromes are common initial manifestations of coronary atherosclerosis and most such events occur at sites of non-flow limiting coronary atherosclerosis. OBJECTIVE Non-invasive detection of high-risk plaques might provide a means to improve risk stratification in primary and secondary prevention settings. METHODS This review is focused on the potential of multidetector computed tomography coronary angiography (MDCT-CA) to provide the opportunity to identify different aspects of plaque vulnerability throughout the coronary tree in an accurate, fast, safe and non-invasive manner. CONCLUSION Coronary artery calcium scoring, on top of established risk stratification, could potentially be a cost-effective strategy for primary prevention. MDCT-CA allows a non-invasive evaluation of several features commonly seen in vulnerable plaques and has demonstrated an independent prognostic value on a patient basis. The value of the technique itself might result, potentially, in a better estimation of the relative risk of an invidual plaque to rupture.
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Affiliation(s)
- Gastón A Rodriguez Granillo
- Otamendi Hospital, Clínica La Sagrada Familia, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Department of Cardiovascular Imaging, Azcuenaga 870, Buenos Aires, Argentina +54 11 49648740 ; +54 11 49648740 ;
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290
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Inzitari M, Naydeck BL, Newman AB. Coronary artery calcium and physical function in older adults: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2008; 63:1112-8. [PMID: 18948563 DOI: 10.1093/gerona/63.10.1112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In older adults without clinical cardiovascular disease, coronary artery calcium (CAC) is associated with other subclinical vascular diseases, which, in turn, predict physical dysfunction. However, the association between CAC and physical function is unstudied. METHODS In 387 older community-dwellers from the Cardiovascular Health Study without clinical cardiovascular diseases (mean age +/- standard deviation = 78.7 +/- 3.7, 35% men, 22% African Americans), CAC was measured using electron beam tomography, and physical performance was assessed by usual pace gait speed, chair stand, and tandem stand. Differences in physical performance across CAC quartiles were investigated in the whole cohort and by gender. Associations with gait speed (m/s) were assessed in multivariable models using both the continuous form of CAC score (log(CAC)) and quartiles of CAC, adjusting for demographics and comorbidities. RESULTS No differences in physical performance were observed across CAC quartiles in the whole group. In gender-stratified analyses, a significant association was shown among women, who had progressively lower gait speed across CAC quartiles: Those with CAC > 220 walked more than 0.1 m/s slower than those with CAC < 35 (age-adjusted ptrend =.017). After multivariable adjustment, the association remained statistically significant for women in both linear (log(CAC) and gait speed, p =.025) and logistic models: Each of the top three CAC quartiles (35-220, 221-659, and > or = 660) had a more than twofold odds of walking slower than 1 m/s, compared to the lowest CAC quartile (< 35; p =.021). CONCLUSIONS In this sample of older community-dwellers without overt cardiovascular disease, CAC was inversely related to gait speed in women, but not in men.
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Affiliation(s)
- Marco Inzitari
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 130 N. Bellefield St., Room 518, Pittsburgh, PA, USA.
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291
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Gössl M, Mödder UI, Atkinson EJ, Lerman A, Khosla S. Osteocalcin expression by circulating endothelial progenitor cells in patients with coronary atherosclerosis. J Am Coll Cardiol 2008; 52:1314-25. [PMID: 18929243 DOI: 10.1016/j.jacc.2008.07.019] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/02/2008] [Accepted: 07/21/2008] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study was designed to test whether patients with coronary atherosclerosis have increases in circulating endothelial progenitor cells (EPCs) expressing an osteogenic phenotype. BACKGROUND Increasing evidence indicates a link between bone and the vasculature, and bone marrow and circulating osteogenic cells have been identified by staining for the osteoblastic marker, osteocalcin (OCN). Endothelial progenitor cells contribute to vascular repair, but repair of vascular injury may result in calcification. Using cell surface markers (CD34, CD133, kinase insert domain receptor [KDR]) to identify EPCs, we examined whether patients with coronary atherosclerosis had increases in the percentage of EPCs expressing OCN. METHODS We studied 72 patients undergoing invasive coronary assessment: control patients (normal coronary arteries and no endothelial dysfunction, n = 21) versus 2 groups with coronary atherosclerosis-early coronary atherosclerosis (normal coronary arteries but with endothelial dysfunction, n = 22) and late coronary atherosclerosis (severe, multivessel coronary artery disease, n = 29). Peripheral blood mononuclear cells were analyzed using flow cytometry. RESULTS Compared with control patients, patients with early or late coronary atherosclerosis had significant increases (approximately 2-fold) in the percentage of CD34+/KDR+ and CD34+/CD133+/KDR+ cells costaining for OCN. Even larger increases were noted in the early and late coronary atherosclerosis patients in the percentage of CD34+/CD133-/KDR+ cells costaining for OCN (5- and 2-fold, p < 0.001 and 0.05, respectively). CONCLUSIONS A higher percentage of EPCs express OCN in patients with coronary atherosclerosis compared with subjects with normal endothelial function and no structural coronary artery disease. These findings have potential implications for the mechanisms of vascular calcification and for the development of novel markers for coronary atherosclerosis.
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Affiliation(s)
- Mario Gössl
- Division of Cardiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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292
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Gijsen FJH, Wentzel JJ, Thury A, Mastik F, Schaar JA, Schuurbiers JCH, Slager CJ, van der Giessen WJ, de Feyter PJ, van der Steen AFW, Serruys PW. Strain distribution over plaques in human coronary arteries relates to shear stress. Am J Physiol Heart Circ Physiol 2008; 295:H1608-14. [DOI: 10.1152/ajpheart.01081.2007] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Once plaques intrude into the lumen, the shear stress they are exposed to alters with hitherto unknown consequences for plaque composition. We investigated the relationship between shear stress and strain, a marker for plaque composition, in human coronary arteries. We imaged 31 plaques in coronary arteries with angiography and intravascular ultrasound. Computational fluid dynamics was used to obtain shear stress. Palpography was applied to measure strain. Each plaque was divided into four regions: upstream, throat, shoulder, and downstream. Average shear stress and strain were determined in each region. Shear stress in the upstream, shoulder, throat, and downstream region was 2.55 ± 0.89, 2.07 ± 0.98, 2.32 ± 1.11, and 0.67 ± 0.35 Pa, respectively. Shear stress in the downstream region was significantly lower. Strain in the downstream region was also significantly lower than the values in the other regions (0.23 ± 0.08% vs. 0.48 ± 0.15%, 0.43 ± 0.17%, and 0.47 ± 0.12%, for the upstream, shoulder, and throat regions, respectively). Pooling all regions, dividing shear stress per plaque into tertiles, and computing average strain showed a positive correlation; for low, medium, and high shear stress, strain was 0.23 ± 0.10%, 0.40 ± 0.15%, and 0.60 ± 0.18%, respectively. Low strain colocalizes with low shear stress downstream of plaques. Higher strain can be found in all other plaque regions, with the highest strain found in regions exposed to the highest shear stresses. This indicates that high shear stress might destabilize plaques, which could lead to plaque rupture.
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293
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Towler DA. Oxidation, inflammation, and aortic valve calcification peroxide paves an osteogenic path. J Am Coll Cardiol 2008; 52:851-4. [PMID: 18755349 DOI: 10.1016/j.jacc.2008.05.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 05/05/2008] [Accepted: 05/06/2008] [Indexed: 11/20/2022]
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294
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Abstract
OBJECTIVE Vibroacoustography allows imaging of objects on the basis of their acoustic signal emitted during low-frequency (kHz) vibrations produced by 2 intersecting ultrasound beams at slightly different frequencies. This study tested the feasibility of using vibroacoustography to distinguish between normal and calcified femoral arteries in a pig model. MATERIALS AND METHODS Thirteen normal porcine femoral arteries, 7 with experimentally induced arterial calcifications, and 1 control artery injected with saline only were scanned in vivo. Images were obtained at 45 kHz using a 3 MHz confocal transducer. The acoustic emission signal was detected with a hydrophone placed on the animal's limb. Images were reconstructed on the basis of the amplitude of the acoustic emission signal. Vessel patency, vessel dimensions, and the extent of calcified plaques were confirmed in vivo by angiography and conventional ultrasound. Excised arteries were reexamined with vibroacoustography, X-ray radiography, and histology. RESULTS In vivo, vibroacoustography produced high-resolution, speckle-free images with a high level of anatomic detail. Measurements of femoral artery diameter were similar by vibroacoustography and conventional ultrasound (mean difference +/- SD, 0.1 +/- 0.4 mm). Calcified plaque area measured by different methods was comparable (vibroacoustography, in vivo: 1.0 +/- 0.9 cm; vibroacoustography in vitro: 1.1 +/- 0.6 cm2; X-ray radiography: 0.9 +/- 0.6 cm2). The reproducibility of measurements was high. Sensitivity and specificity for detecting calcifications were 100% and 86%, respectively, and positive and negative predictive values were 77% and 100%, respectively. CONCLUSIONS Vibroacoustography provides accurate and reproducible measurements of femoral arteries and vascular calcifications in living animals.
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295
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Daemen MJ. Does atherosclerotic plaque histology predict the risk of restenosis after carotid endarterectomy? NATURE CLINICAL PRACTICE. CARDIOVASCULAR MEDICINE 2008; 5:436-437. [PMID: 18506155 DOI: 10.1038/ncpcardio1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 04/04/2008] [Indexed: 05/26/2023]
Affiliation(s)
- Mat Jap Daemen
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
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296
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Evaluation of characteristics and degree of remodeling in coronary atherosclerotic lesions by 64-detector multislice computed tomography (MSCT). Atherosclerosis 2008; 203:436-41. [PMID: 18775536 DOI: 10.1016/j.atherosclerosis.2008.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 07/17/2008] [Accepted: 07/17/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multislice computed tomography (MSCT) permits reliable imaging of not only the coronary artery lumen but also vessel wall. It is assumed that both lipid-rich plaques and those that display positive remodeling are more prone to rupture and erosion with subsequent coronary events. The purpose of this study was to assess the correlation between the characteristics of coronary arteries by MSCT and several measures of coronary heart disease (CHD) risk. METHODS This study consisted of 424 consecutive participants who received MSCT and coronary angiography (CAG). We assessed coronary artery findings including coronary artery calcification (CAC), degree of remodeling and narrowing of lumen and characteristics including uric acid (UA) and high-sensitivity C-reactive protein (hs-CRP). Statistical analyses were conducted for four subgroups classified by the presence of significant stenosis and positive remodeling. RESULTS Hs-CRP was 2.10+/-2.70mg/L in positive remodeling (+) and stenosis (+) group (PS), 1.05+/-0.97mg/L in positive remodeling (-) and stenosis (+) group (nPS), 0.94+/-0.88mg/L in positive remodeling (+) and stenosis (-) group (PnS) and 0.44+/-0.49mg/L in positive remodeling (-) and stenosis (-) group (nPnS). The results of logistic regression analysis showed that hs-CRP was higher in PS compared with the other groups (p<0.001) and higher in nPS and PnS compared with nPnS (p<0.05). CONCLUSIONS Regardless of significant stenosis, positive remodeling by MSCT correlates to the increase of hs-CRP.
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297
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Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK. In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 2008; 29:1721-8. [PMID: 18577556 DOI: 10.1093/eurheartj/ehn286] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Positive coronary arterial remodelling has been shown to be associated with unstable coronary syndromes and ex vivo histological characteristics of plaque vulnerability such as a large lipid core and high macrophage content. The aim of this study is to evaluate the in vivo association between coronary artery remodelling and underlying plaque characteristics identified by optical coherence tomography (OCT). OCT is a unique imaging modality capable of characterizing these important morphological features of vulnerable plaque. METHODS AND RESULTS OCT and intravascular ultrasound imaging was performed at corresponding sites in patients undergoing catheterization. OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (two or more quadrants) with fibrous cap thickness <65 microm. Remodelling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area. A total of 54 lesions from 48 patients were imaged. Positive remodelling compared with absent or negative remodelling was more commonly associated with lipid-rich plaque (100 vs. 60 vs. 47.4%, P = 0.01), a thin fibrous cap (median 40.2 vs. 51.6 vs. 87 microm, P = 0.003) and the presence of TCFA (80 vs. 38.5 vs. 5.6%, P < 0.001). Fibrous cap macrophage density was also higher in plaques with positive remodelling showing a positive linear correlation with the RI (r = 0.60, P < 0.001). CONCLUSION Coronary plaques with positive remodelling exhibit characteristic features of vulnerable plaque. This may explain the link between positive remodelling and unstable clinical presentations.
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Affiliation(s)
- Owen Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
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298
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Takeuchi H, Morino Y, Matsukage T, Masuda N, Kawamura Y, Kasai S, Hashida T, Fujibayashi D, Tanabe T, Ikari Y. Impact of vascular remodeling on the coronary plaque compositions: an investigation with in vivo tissue characterization using integrated backscatter-intravascular ultrasound. Atherosclerosis 2008; 202:476-82. [PMID: 18606416 DOI: 10.1016/j.atherosclerosis.2008.05.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 05/23/2008] [Accepted: 05/25/2008] [Indexed: 11/26/2022]
Abstract
Recent studies have indicated that positive remodeling is strongly associated with development of acute coronary syndrome (ACS). The aim of this study was to compare plaque composition of vascular remodeling patterns by an established in vivo tissue characterization method using integrated backscatter (IB)-intravascular ultrasound (IVUS). The study population consisted of 41 consecutive patients who received IVUS prior to percutaneous coronary intervention. Remodeling index (RI) was calculated as the external elastic membrane (EEM) area at the minimal lumen area (MLA) site divided by average EEM area at the proximal and distal reference sites. The patients were divided into two groups based on RI: positive remodeling (PR) defined as RI>1 and non-PR as RI<or=1. A total of 21 areas centered at MLA per lesion site were evaluated by IB-IVUS at 1mm intervals. The occupancy rate of four tissue types within atherosclerotic plaques was compared between the two groups. Percent lipid volume in the PR group (n=20) was significantly greater than the non-PR group (n=21) (40.5+/-14.8% vs. 26.4+/-15.9%, p<0.001). In contrast, % fibrous volume in the PR group was significantly lower than the non-PR group (49.9+/-9.4% vs. 56.1+/-9.6%, p=0.042). Percent dense fibrous volume and % calcified volume were slightly but significantly lower in the PR group compared with the non-PR group (dense fibrous: 6.8+/-5.0% vs. 11.6+/-8.4%, p=0.034, calcified: 2.6+/-2.0% vs. 5.1+/-4.4%, p=0.026). In conclusions, PR lesions contain more lipid-rich and less hard plaque components compared with non-PR lesions, which may account for the higher incidence of ACS and plaque vulnerability.
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Affiliation(s)
- Hiroki Takeuchi
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
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299
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Nakazawa G, Tanabe K, Onuma Y, Yachi S, Aoki J, Yamamoto H, Higashikuni Y, Yagishita A, Nakajima H, Hara K. Efficacy of culprit plaque assessment by 64-slice multidetector computed tomography to predict transient no-reflow phenomenon during percutaneous coronary intervention. Am Heart J 2008; 155:1150-7. [PMID: 18513532 DOI: 10.1016/j.ahj.2008.01.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 01/16/2008] [Indexed: 01/23/2023]
Abstract
BACKGROUND It has been reported that multidetector spiral computed tomography (MDCT) allows the classification of coronary plaques by measuring computed tomography (CT) density values. However, the impact of CT density values in culprit lesions on the occurrence of transient no-reflow during percutaneous coronary intervention (PCI) has not been investigated. METHODS The study population consisted of 51 consecutive patients who were diagnosed as having coronary artery disease by 64-slice MDCT before PCI. The CT density values were measured in multiple cross-sectional images along the plaque by 5-pixel regions of interest at multiple sites in the culprit plaque. The measurements were performed by 2 physicians who were unaware of the outcome of PCI. In addition, we describe a new observation noted on MDCT: from the formal resemblance to a ring, we dubbed these images as showing a "signet ring-like appearance." RESULTS Of the total 51 patients, 9 had transient no-reflow during the procedure. There was a significant difference in CT density of the culprit plaque between patients with transient no-reflow and those without (67.0 +/- 10.1 vs 97.8 +/- 37.2 Hounsfield units, P = .018). In addition, a signet ring-like appearance was observed more frequently in patients with transient no-reflow (55.6% vs 16.7%, P = .013). By multivariate analysis, low CT density value and ejection fraction were identified as independent predictors of transient no-reflow. CONCLUSIONS The assessment of plaque characteristics by MDCT might be useful for the prediction of transient no-reflow during PCI.
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Affiliation(s)
- Gaku Nakazawa
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
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300
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Abstract
Plaque rupture precipitates approximately 75% of all fatal coronary thrombi. Therefore, the plaque prone to rupture is the primary focus of this review. The lipid-rich core and fibrous cap are pivotal in the understanding of plaque rupture. Plaque rupture is a localized process within the plaque caused by degradation of a tiny fibrous cap rather than by diffuse inflammation of the plaque. Atherosclerosis is a multifocal disease, but plaques prone to rupture seem to be oligofocal at most.
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Affiliation(s)
- T Thim
- Atherosclerosis Research Unit, Department of Cardiology, Aarhus University Hospital (Skejby), Aarhus, Denmark.
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