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Zhao Y, Xie J. Numerical analysis of blood flow through stenosed microvessels using a multi-phase model. Heliyon 2024; 10:e29843. [PMID: 38694061 PMCID: PMC11058301 DOI: 10.1016/j.heliyon.2024.e29843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
Blood flow in arterioles have attracted considerable research attention due to their clinical implications. However, the fluid structure interaction between red blood cells and plasma in the blood poses formidable difficulty to the computational efforts. In this contribution, we seek to represent the red blood cells in the blood as a continuous non-Newtonian phase and construct a multi-phase model for the blood flow in microvessels. The methods are presented and validated using a channel with sudden expansion. And the resulting blood flow inside a stenosed microvessel is investigated at different inlet velocity amplitudes and hematocrits. It is show that the increase of both inlet velocity amplitude and inlet hematocrit leads to longer and thicker cell-rich layer downstream the stenosis. Besides, it is found that the maximum values of wall shear stress scales up with inlet velocity amplitudes and hematocrits. These results show the validity of the proposed computational model and provide helpful insights into blood flow behaviors inside stenosed vessels.
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Affiliation(s)
- Yuhong Zhao
- Department of Blood Transfusion, The Frist Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Jue Xie
- Department of Blood Transfusion, The Frist Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
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2
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Huang M, Maehara A, Tang D, Zhu J, Wang L, Lv R, Zhu Y, Zhang X, Zhao C, Jia H, Mintz GS. Impact of residual stress on coronary plaque stress/strain calculations using optical coherence tomography image-based multi-layer models. Front Cardiovasc Med 2024; 11:1395257. [PMID: 38725836 PMCID: PMC11079268 DOI: 10.3389/fcvm.2024.1395257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Mechanical stress and strain conditions play an important role in atherosclerosis plaque progression, remodeling and potential rupture and may be used in plaque vulnerability assessment for better clinical diagnosis and treatment decisions. Single layer plaque models without residual stress have been widely used due to unavailability of multi-layer image segmentation method and residual stress data. However, vessel layered structure and residual stress have large impact on stress/strain calculations and should be included in the models. Methods In this study, intravascular optical coherence tomography (OCT) data of coronary plaques from 10 patients were acquired and segmented to obtain the three-layer vessel structure using an in-house automatic segmentation algorithm. Multi- and single-layer 3D thin-slice biomechanical plaque models with and without residual stress were constructed to assess the impact of residual stress on stress/strain calculations. Results Our results showed that residual stress led to a more uniform stress distribution across the vessel wall, with considerable plaque stress/strain decrease on inner wall and increase on vessel out-wall. Multi-layer model with residual stress inclusion reduced inner wall maximum and mean plaque stresses by 38.57% and 59.70%, and increased out-wall maximum and mean plaque stresses by 572.84% and 432.03%. Conclusion These findings demonstrated the importance of multi-layer modeling with residual stress for more accurate plaque stress/strain calculations, which will have great impact in plaque cap stress calculation and plaque rupture risk assessment. Further large-scale studies are needed to validate our findings.
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Affiliation(s)
- Mengde Huang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Rui Lv
- Department of Cardiac Surgery, Shandong Second Provincial General Hospital, Jinan, China
| | - Yanwen Zhu
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Chen Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gary S. Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
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3
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Kumar P, Bhatia M. Coronary Artery Calcium Data and Reporting System (CAC-DRS): A Primer. J Cardiovasc Imaging 2023; 31:1-17. [PMID: 36693339 PMCID: PMC9880346 DOI: 10.4250/jcvi.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 01/26/2023] Open
Abstract
The Coronary Artery Calcium Data and Reporting System (CAC-DRS) is a standardized reporting method for calcium scoring on computed tomography. CAC-DRS is applied on a per-patient basis and represents the total calcium score with the number of vessels involved. There are 4 risk categories ranging from CAC-DRS 0 to CAC-DRS 3. CAC-DRS also provides risk prediction and treatment recommendations for each category. The main strengths of CAC-DRS include a detailed and meaningful representation of CAC, improved communication between physicians, risk stratification, appropriate treatment recommendations, and uniform data collection, which provides a framework for education and research. The major limitations of CAC-DRS include a few missing components, an overly simple visual approach without any standard reference, and treatment recommendations lacking a basis in clinical trials. This consistent yet straightforward method has the potential to systemize CAC scoring in both gated and non-gated scans.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
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4
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Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci 2022; 23:12906. [PMID: 36361701 PMCID: PMC9658900 DOI: 10.3390/ijms232112906] [Citation(s) in RCA: 179] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation. Recruited monocytes differentiate into macrophages which develop pro- or anti-inflammatory properties according to their microenvironment. Atheroma progression or healing is determined by the balance between these functional phenotypes. Macrophages and smooth muscle cells secrete inflammatory cytokines including interleukins IL-1β, IL-12, and IL-6. Within the arterial wall, low-density lipoprotein cholesterol undergoes an oxidation. Additionally, triglyceride-rich lipoproteins and remnant lipoproteins exert pro-inflammatory effects. Macrophages catabolize the oxidized lipoproteins and coalesce into a lipid-rich necrotic core, encapsulated by a collagen fibrous cap, leading to the formation of fibro-atheroma. In the conditions of chronic inflammation, macrophages exert a catabolic effect on the fibrous cap, resulting in a thin-cap fibro-atheroma which makes the plaque vulnerable. However, their morphology may change over time, shifting from high-risk lesions to more stable calcified plaques. In addition to conventional cardiovascular risk factors, an exposure to acute and chronic psychological stress may increase the risk of cardiovascular disease through inflammation mediated by an increased sympathetic output which results in the release of inflammatory cytokines. Inflammation is also the link between ageing and cardiovascular disease through increased clones of leukocytes in peripheral blood. Anti-inflammatory interventions specifically blocking the cytokine pathways reduce the risk of myocardial infarction and stroke, although they increase the risk of infections.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
- Molecular and Clinical Sciences Research Institute, St. George’s University, London UB8 3PH, UK
| | - Sergio Vancheri
- Interventional Neuroradiology Department, Besançon University Hospital, 25000 Besançon, France
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
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5
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Corti A, De Paolis A, Grossman P, Dinh PA, Aikawa E, Weinbaum S, Cardoso L. The effect of plaque morphology, material composition and microcalcifications on the risk of cap rupture: A structural analysis of vulnerable atherosclerotic plaques. Front Cardiovasc Med 2022; 9:1019917. [PMID: 36277774 PMCID: PMC9583261 DOI: 10.3389/fcvm.2022.1019917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background The mechanical rupture of an atheroma cap may initiate a thrombus formation, followed by an acute coronary event and death. Several morphology and tissue composition factors have been identified to play a role on the mechanical stability of an atheroma, including cap thickness, lipid core stiffness, remodeling index, and blood pressure. More recently, the presence of microcalcifications (μCalcs) in the atheroma cap has been demonstrated, but their combined effect with other vulnerability factors has not been fully investigated. Materials and methods We performed numerical simulations on 3D idealized lesions and a microCT-derived human coronary atheroma, to quantitatively analyze the atheroma cap rupture. From the predicted cap stresses, we defined a biomechanics-based vulnerability index (VI) to classify the impact of each risk factor on plaque stability, and developed a predictive model based on their synergistic effect. Results Plaques with low remodeling index and soft lipid cores exhibit higher VI and can shift the location of maximal wall stresses. The VI exponentially rises as the cap becomes thinner, while the presence of a μCalc causes an additional 2.5-fold increase in vulnerability for a spherical inclusion. The human coronary atheroma model had a stable phenotype, but it was transformed into a vulnerable plaque after introducing a single spherical μCalc in its cap. Overall, cap thickness and μCalcs are the two most influential factors of mechanical rupture risk. Conclusions Our findings provide supporting evidence that high risk lesions are non-obstructive plaques with softer (lipid-rich) cores and a thin cap with μCalcs. However, stable plaques may still rupture in the presence of μCalcs.
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Affiliation(s)
- Andrea Corti
- Department of Biomedical Engineering, City College, City University of New York, New York, NY, United States
| | - Annalisa De Paolis
- Department of Biomedical Engineering, City College, City University of New York, New York, NY, United States
| | - Pnina Grossman
- Department of Biomedical Engineering, City College, City University of New York, New York, NY, United States
| | - Phuc A. Dinh
- Department of Biomedical Engineering, City College, City University of New York, New York, NY, United States
| | - Elena Aikawa
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Sheldon Weinbaum
- Department of Biomedical Engineering, City College, City University of New York, New York, NY, United States
| | - Luis Cardoso
- Department of Biomedical Engineering, City College, City University of New York, New York, NY, United States,*Correspondence: Luis Cardoso,
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Buckler AJ, van Wanrooij M, Andersson M, Karlöf E, Matic LP, Hedin U, Gasser TC. Patient-specific biomechanical analysis of atherosclerotic plaques enabled by histologically validated tissue characterization from computed tomography angiography: A case study. J Mech Behav Biomed Mater 2022; 134:105403. [PMID: 36049368 DOI: 10.1016/j.jmbbm.2022.105403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 03/06/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Rupture of unstable atherosclerotic plaques with a large lipid-rich necrotic core and a thin fibrous cap cause myocardial infarction and stroke. Yet it has not been possible to assess this for individual patients. Clinical guidelines still rely on use of luminal narrowing, a poor indicator but one that persists for lack of effective means to do better. We present a case study demonstrating the assessment of biomechanical indices pertaining to plaque rupture risk non-invasively for individual patients enabled by histologically validated tissue characterization. METHODS Routinely acquired clinical images of plaques were analyzed to characterize vascular wall tissues using software validated by histology (ElucidVivo, Elucid Bioimaging Inc.). Based on the tissue distribution, wall stress and strain were then calculated at spatial locations with varied fibrous cap thicknesses at diastolic, mean and systolic blood pressures. RESULTS The von Mises stress of 152 [131, 172] kPa and the equivalent strain of 0.10 [0.08, 0.12] were calculated where the fibrous cap thickness was smallest (560 μm) (95% CI in brackets). The stress at this location was at a level predictive of plaque failure. Stress and strain at locations with larger cap thicknesses were calculated to be lower, demonstrating a clinically relevant range of risk levels. CONCLUSION Patient specific tissue characterization can identify distributions of stress and strain in a clinically relevant range. This capability may be used to identify high-risk lesions and personalize treatment decisions for individual patients with cardiovascular disease and improve prevention of myocardial infarction and stroke.
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Affiliation(s)
- Andrew J Buckler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Elucid Bioimaging Inc., Boston, MA, United States
| | - Max van Wanrooij
- KTH Solid Mechanics, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Måns Andersson
- KTH Solid Mechanics, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Eva Karlöf
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ljubica Perisic Matic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - T Christian Gasser
- KTH Solid Mechanics, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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7
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Carpenter HJ, Ghayesh MH, Zander AC, Li J, Di Giovanni G, Psaltis PJ. Automated Coronary Optical Coherence Tomography Feature Extraction with Application to Three-Dimensional Reconstruction. Tomography 2022; 8:1307-1349. [PMID: 35645394 PMCID: PMC9149962 DOI: 10.3390/tomography8030108] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary optical coherence tomography (OCT) is an intravascular, near-infrared light-based imaging modality capable of reaching axial resolutions of 10-20 µm. This resolution allows for accurate determination of high-risk plaque features, such as thin cap fibroatheroma; however, visualization of morphological features alone still provides unreliable positive predictive capability for plaque progression or future major adverse cardiovascular events (MACE). Biomechanical simulation could assist in this prediction, but this requires extracting morphological features from intravascular imaging to construct accurate three-dimensional (3D) simulations of patients' arteries. Extracting these features is a laborious process, often carried out manually by trained experts. To address this challenge, numerous techniques have emerged to automate these processes while simultaneously overcoming difficulties associated with OCT imaging, such as its limited penetration depth. This systematic review summarizes advances in automated segmentation techniques from the past five years (2016-2021) with a focus on their application to the 3D reconstruction of vessels and their subsequent simulation. We discuss four categories based on the feature being processed, namely: coronary lumen; artery layers; plaque characteristics and subtypes; and stents. Areas for future innovation are also discussed as well as their potential for future translation.
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Affiliation(s)
- Harry J. Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Mergen H. Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Anthony C. Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Jiawen Li
- School of Electrical Electronic Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, SA 5005, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, SA 5005, Australia
| | - Giuseppe Di Giovanni
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (G.D.G.); (P.J.P.)
| | - Peter J. Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (G.D.G.); (P.J.P.)
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
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8
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Crombag G, Aizaz M, Schreuder F, Benali F, van Dam-Nolen D, Liem M, Lucci C, van der Steen A, Daemen M, Mess W, van der Lugt A, Nederkoorn P, Hendrikse J, Hofman P, van Oostenbrugge R, Wildberger J, Kooi M. Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study. AJNR Am J Neuroradiol 2022; 43:265-271. [PMID: 35121587 PMCID: PMC8985675 DOI: 10.3174/ajnr.a7384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS Eighty-eight symptomatic patients with stroke (<70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P < .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P < .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.
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Affiliation(s)
- G.A.J.C. Crombag
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M. Aizaz
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - F.H.B.M. Schreuder
- Department of Neurology & Donders Institute for Brain Cognition & Behaviour (F.H.B.M.S.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - F. Benali
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | | | - M.I. Liem
- Departments of Neurology (M.I.L., P.J.N.)
| | - C. Lucci
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A.F. van der Steen
- Biomedical Engineering (A.F.v.d.S.), Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M.J.A.P. Daemen
- Pathology (M.J.A.P.D.), Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | | | - A. van der Lugt
- Departments of Radiology and Nuclear Medicine (D.H.K.v.D.-N., A.v.d.L.)
| | | | - J. Hendrikse
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - P.A.M. Hofman
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | - R.J. van Oostenbrugge
- Neurology (R.J.v.O.), Maastricht University Medical Center, Maastricht, the Netherlands,CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - J.E. Wildberger
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M.E. Kooi
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
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9
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Lv R, Maehara A, Matsumura M, Wang L, Zhang C, Huang M, Guo X, Samady H, Giddens DP, Zheng J, Mintz GS, Tang D. Using Optical Coherence Tomography and Intravascular Ultrasound Imaging to Quantify Coronary Plaque Cap Stress/Strain and Progression: A Follow-Up Study Using 3D Thin-Layer Models. Front Bioeng Biotechnol 2021; 9:713525. [PMID: 34497800 PMCID: PMC8419245 DOI: 10.3389/fbioe.2021.713525] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate plaque cap thickness quantification and cap stress/strain calculations are of fundamental importance for vulnerable plaque research. To overcome uncertainties due to intravascular ultrasound (IVUS) resolution limitation, IVUS and optical coherence tomography (OCT) coronary plaque image data were combined together to obtain accurate and reliable cap thickness data, stress/strain calculations, and reliable plaque progression predictions. IVUS, OCT, and angiography baseline and follow-up data were collected from nine patients (mean age: 69; m: 5) at Cardiovascular Research Foundation with informed consent obtained. IVUS and OCT slices were coregistered and merged to form IVUS + OCT (IO) slices. A total of 114 matched slices (IVUS and OCT, baseline and follow-up) were obtained, and 3D thin-layer models were constructed to obtain stress and strain values. A generalized linear mixed model (GLMM) and least squares support vector machine (LSSVM) method were used to predict cap thickness change using nine morphological and mechanical risk factors. Prediction accuracies by all combinations (511) of those predictors with both IVUS and IO data were compared to identify optimal predictor(s) with their best accuracies. For the nine patients, the average of minimum cap thickness from IVUS was 0.17 mm, which was 26.08% lower than that from IO data (average = 0.23 mm). Patient variations of the individual errors ranged from ‒58.11 to 20.37%. For maximum cap stress between IO and IVUS, patient variations of the individual errors ranged from ‒30.40 to 46.17%. Patient variations of the individual errors of maximum cap strain values ranged from ‒19.90 to 17.65%. For the GLMM method, the optimal combination predictor using IO data had AUC (area under the ROC curve) = 0.926 and highest accuracy = 90.8%, vs. AUC = 0.783 and accuracy = 74.6% using IVUS data. For the LSSVM method, the best combination predictor using IO data had AUC = 0.838 and accuracy = 75.7%, vs. AUC = 0.780 and accuracy = 69.6% using IVUS data. This preliminary study demonstrated improved plaque cap progression prediction accuracy using accurate cap thickness data from IO slices and the differences in cap thickness, stress/strain values, and prediction results between IVUS and IO data. Large-scale studies are needed to verify our findings.
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Affiliation(s)
- Rui Lv
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Mitsuaki Matsumura
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Caining Zhang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Mengde Huang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Xiaoya Guo
- School of Science, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Don. P. Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, United States
| | - Gary S. Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
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10
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Circulating TNFrII levels predict incidence of ischemic heart disease and total mortality, independently of intima media thickness and pulse wave velocity in male with type 2 diabetes. Heart Vessels 2021; 36:1591-1596. [PMID: 33871700 DOI: 10.1007/s00380-021-01857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
New and clinically useful markers of cardiovascular risk are of great importance in patients with type 2 diabetes since cardiovascular disease is a major cause of death in these patients. We analyzed inflammatory markers and other risk factors for heart disease in 761 patients who participated in the CARDIPP-study, Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care. All participants had type 2 diabetes and were 55-66 years old at recruitment during the years 2005-2008. Patients were followed for incidence of stroke, myocardial infarction, or death from cardiovascular disease until the end of the year 2018 using the national Swedish Cause of Death and Hospitalization Registries. Besides traditional risk-markers for vascular disease, we also measured carotid-femoral pulse-wave velocity and intima-media thickness of carotid arteries. During a median period of 13 years, 165 men and 65 women died or were hospitalized for ischemic heart disease and stroke. TNFrII showed statistically significance as a risk factor for stroke, ischemic heart disease, and total mortality in male patients with diabetes type 2, independently of age, diabetes duration, BMI, Hba1c, systolic blood pressure, triglycerides, IMT and PWV (p = 0.002, HR 2.70, CI 1.42:5.13, p = 0.002). Circulating TNFrII levels failed to present a similar correlation in women (p = 0.48, CI 0.48:4.84). TNFrII stayed significant in males when HDL/LDL-ratio, CRP and smoking were added to the statistical analysis. Our data support the use of serum TNFrII in male type 2 diabetes patients to add independent prognostic information in terms of mortality and heart disease independently of other strong and well-established risk markers including cholesterol, inflammatory cytokines, PWV and IMT.Trial registration: ClinicalTrials.gov NCT01049737.
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Multi-patient study for coronary vulnerable plaque model comparisons: 2D/3D and fluid-structure interaction simulations. Biomech Model Mechanobiol 2021; 20:1383-1397. [PMID: 33759037 PMCID: PMC8298251 DOI: 10.1007/s10237-021-01450-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/07/2021] [Indexed: 12/05/2022]
Abstract
Several image-based computational models have been used to perform mechanical analysis for atherosclerotic plaque progression and vulnerability investigations. However, differences of computational predictions from those models have not been quantified at multi-patient level. In vivo intravascular ultrasound (IVUS) coronary plaque data were acquired from seven patients. Seven 2D/3D models with/without circumferential shrink, cyclic bending and fluid–structure interactions (FSI) were constructed for the seven patients to perform model comparisons and quantify impact of 2D simplification, circumferential shrink, FSI and cyclic bending plaque wall stress/strain (PWS/PWSn) and flow shear stress (FSS) calculations. PWS/PWSn and FSS averages from seven patients (388 slices for 2D and 3D thin-layer models) were used for comparison. Compared to 2D models with shrink process, 2D models without shrink process overestimated PWS by 17.26%. PWS change at location with greatest curvature change from 3D FSI models with/without cyclic bending varied from 15.07% to 49.52% for the seven patients (average = 30.13%). Mean Max-FSS, Min-FSS and Ave-FSS from the flow-only models under maximum pressure condition were 4.02%, 11.29% and 5.45% higher than those from full FSI models with cycle bending, respectively. Mean PWS and PWSn differences between FSI and structure-only models were only 4.38% and 1.78%. Model differences had noticeable patient variations. FSI and flow-only model differences were greater for minimum FSS predictions, notable since low FSS is known to be related to plaque progression. Structure-only models could provide PWS/PWSn calculations as good approximations to FSI models for simplicity and time savings in calculation.
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Greiner C, Grainger S, Farrow S, Davis A, Su JL, Saybolt MD, Wilensky R, Madden S, Sum ST. Robust quantitative assessment of collagen fibers with picrosirius red stain and linearly polarized light as demonstrated on atherosclerotic plaque samples. PLoS One 2021; 16:e0248068. [PMID: 33735190 PMCID: PMC7971522 DOI: 10.1371/journal.pone.0248068] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
Collagen is an important component in maintaining structural integrity and functionality of tissues and is modulated in various biological processes. Its visualization and possible quantification using histopathological stains can be important for understanding disease progression or therapeutic response. Visualization of collagen fiber with the histological stain picrosirius red (PSR) is enhanced with polarized light and quantitative analysis is possible using circular polarizers. However, linear polarizers are more commonly available and easier to optically align. The objective of the present study is to demonstrate a novel image acquisition technique and analysis method using linearly polarized light. The proposed imaging technique is based on image acquisition at multiple slide rotation angles, which are co-registered to form a composite image used for quantitative analysis by pixel intensity or pixel counting. The technique was demonstrated on multiple human coronary samples with varying histopathologies and developed specifically to analyze cap collagen in atherosclerotic plaque. Pixel counting image analysis was found to be reproducible across serial tissue sections and across different users and sufficiently sensitive to detect differences in cap structural integrity that are likely relevant to prediction of rupture risk. The benefit of slide rotation angle under linear polarization to acquire images represents a feasible and practical implementation for expanding the general utility of PSR for quantitative analysis.
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Affiliation(s)
- Cherry Greiner
- Infraredx, Bedford, Massachusetts, United States of America
| | | | | | - Alena Davis
- Cytiva, Marlborough, Massachusetts, United States of America
| | - Jimmy L Su
- Philips Healthcare, Cambridge, Massachusetts, United States of America
| | - Matthew D Saybolt
- Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, United States of America
| | - Robert Wilensky
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sean Madden
- Lumicell, Newton, Massachusetts, United States of America
| | - Stephen T Sum
- Infraredx, Bedford, Massachusetts, United States of America
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Kozuń M, Chwiłkowska A, Pezowicz C, Kobielarz M. Influence of atherosclerosis on anisotropy and incompressibility of the human thoracic aortic wall. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Gijsen FJH, Vis B, Barrett HE, Zadpoor AA, Verhagen HJ, Bos D, van der Steen AFW, Akyildiz AC. Morphometric and Mechanical Analyses of Calcifications and Fibrous Plaque Tissue in Carotid Arteries for Plaque Rupture Risk Assessment. IEEE Trans Biomed Eng 2020; 68:1429-1438. [PMID: 33186100 DOI: 10.1109/tbme.2020.3038038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atherosclerotic plaque rupture in carotid arteries is a major source of cerebrovascular events. Calcifications are highly prevalent in carotid plaques, but their role in plaque rupture remains poorly understood. This work studied the morphometric features of calcifications in carotid plaques and their effect on the stress distribution in the fibrous plaque tissue at the calcification interface, as a potential source of plaque rupture and clinical events. METHODS A comprehensive morphometric analysis of 65 histology cross-sections from 16 carotid plaques was performed to identify the morphology (size and shape) and location of plaque calcifications, and the fibrous tissue fiber organization around them. Calcification-specific finite element models were constructed to examine the fibrous plaque tissue stresses at the calcification interface. Statistical correlation analysis was performed to elucidate the impact of calcification morphology and fibrous tissue organization on interface stresses. RESULTS Hundred-seventy-one calcifications were identified on the histology cross-sections, which showed great variation in morphology. Four distinct patterns of fiber organization in the plaque tissue were observed around the calcification. They were termed as attached, pushed-aside, encircling and random patterns. The stress analyses showed that calcifications are correlated with high interface stresses, which might be comparable to or even above the plaque strength. The stress levels depended on the calcification morphology and fiber organization. Thicker calcification with a circumferential slender shape, located close to the lumen were correlated most prominently to high interface stresses. CONCLUSION Depending on its morphology and the fiber organization around it, a calcification in an atherosclerotic plaque can act as a stress riser and cause high interface stresses. SIGNIFICANCE This study demonstrated the potential of calcifications in atherosclerotic plaques to cause elevated stresses in plaque tissue and provided a biomechanical explanation for the histopathological findings of calcification-associated plaque rupture.
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15
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Danial JSH, Murad F, Saez AJG, Moawad MR, Urrico GS, Vancheri F, Henein MY. Computed Histological Quantification of Atherosclerotic Plaque Microcalcifications. Angiology 2020; 71:916-919. [PMID: 32633543 DOI: 10.1177/0003319720939466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inflammation has a central role in atherosclerotic plaque formation and rupture. Intense macrophage inflammatory activity results in microcalcifications which are strongly associated with plaque vulnerability. Microcalcifications with specific critical size between 5 and 65 μ, located in the fibrous cap producing local mechanical stress on the plaque surface and may directly contribute to plaque rupture. Hence, accurate assessment of microcalcifications size and dimension has significant clinical importance. Current invasive and noninvasive plaque imaging has limited spatial resolution which limits accurate definition of microcalcifications in the atherosclerotic plaques. We describe a new imaging technique with high spatial resolution, based on confocal microscopic analysis, using a dedicated software which allows automatic characterization of microcalcifications and quantitative assessment of their extent and localization.
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Affiliation(s)
- John S H Danial
- Department of Chemistry, 2152University of Cambridge, Cambridge, UK
| | - Fabronia Murad
- Interfaculty Institute of Biochemistry, University of Tuebingen, Tuebingen, Germany
| | | | - Magdy R Moawad
- Speciality Clinical Lead for Vascular Surgery, Ashford and St Peter's Hospitals, Chertsey, UK
| | - Giovanni S Urrico
- Department of Pathology, 455411S. Elia Hospital, Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, 455411S. Elia Hospital, Caltanissetta, Italy
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden.,Department of Fluid Mechanics, Brunel University, Middlesex, UK.,Molecular and Nuclear Research Institute, St George's, University of London, London, UK
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16
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Reith S, Milzi A, Lemma ED, Dettori R, Burgmaier K, Marx N, Burgmaier M. Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study. Cardiovasc Diabetol 2019; 18:122. [PMID: 31551093 PMCID: PMC6760065 DOI: 10.1186/s12933-019-0926-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/11/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. METHODS Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA. RESULTS Minimal (139.8 ± 32.8° vs. 165.6 ± 21.6°, p < 0.001) and mean ICA (164.1 ± 14.3° vs. 176.0 ± 8.4°, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797-0.882, p < 0.001, optimal cut-off 175.9°); younger age (OR 0.95 per year, 95% CI 0.92-0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41-3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68-0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47-25.64, p < 0.001) were determinants of ICA < 175.9°. A lower ICA predicted ACS (OR for 10°-variation 0.25, 95% CI 0.13-0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion's fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. CONCLUSION Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.
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Affiliation(s)
- Sebastian Reith
- Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andrea Milzi
- Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Enrico Domenico Lemma
- Zoological Institute, Department of Cell- and Neurobiology, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Rosalia Dettori
- Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital of Cologne, Cologne, Germany
| | - Nikolaus Marx
- Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Mathias Burgmaier
- Department of Cardiology, Medical Clinic I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Vancheri F, Longo G, Vancheri S, Danial JSH, Henein MY. Coronary Artery Microcalcification: Imaging and Clinical Implications. Diagnostics (Basel) 2019; 9:E125. [PMID: 31547506 PMCID: PMC6963848 DOI: 10.3390/diagnostics9040125] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification.
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Affiliation(s)
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy.
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy.
| | - John S H Danial
- Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK.
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, 901 87 Umea, Sweden.
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK.
- Molecular and Clinical Sciences Research Institute, St George's University, London UB8 3PH, UK.
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18
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Finite element evaluation of artery damage in deployment of polymeric stent with pre- and post-dilation. Biomech Model Mechanobiol 2019; 19:47-60. [PMID: 31317295 PMCID: PMC7005093 DOI: 10.1007/s10237-019-01194-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/21/2019] [Indexed: 12/02/2022]
Abstract
Using finite element method, this paper evaluates damage in an arterial wall and plaque caused by percutaneous coronary intervention. Hyperelastic damage models, calibrated with experimental results, are used to describe stress–stretch responses of arterial layers and plaque; these models are capable to simulate softening behaviour of the tissue due to damage. Abaqus CAE is employed to create the finite element models for the artery wall (with media and adventitia layers), a symmetric uniform plaque, a bioresorbable polymeric stent and a tri-folded expansion balloon. The effect of percutaneous coronary intervention on vessel damage is investigated by simulating the processes of vessel pre-dilation, stent deployment and post-stenting dilation. Energy dissipation density is used to assess the extent of damage in the tissue. Softening of the plaque and the artery, due to the pre-dilation-induced damage, can facilitate the subsequent stent deployment process. The plaque and the artery experienced heterogeneous damage behaviour after the stent deployment, caused by non-uniform deformation. The post-stenting dilation was effective to achieve a full expansion of the stent, but caused additional damage to the artery. The continuous and discontinuous damage models yielded similar results in the percutaneous coronary intervention simulations, while the incorporation of plaque rupture affected the simulated outcomes of stent deployment. The computational evaluation of the artery damage can be potentially used to assess the risk of in-stent restenosis after percutaneous coronary intervention.
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Liu H, Leung T, Wong A, Chen F, Zheng D. The Geometric Effects on the Stress of Arterial Atherosclerotic Plaques: a Computational Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:6948-6951. [PMID: 31947437 DOI: 10.1109/embc.2019.8857885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The rupture of atherosclerotic plaques could cause serious clinical events. The wall shear stress (WSS) and axial plaque stress (APS) could reflect the risk of plaque rupture. This study aimed to quantitatively investigate the geometric effects on WSS and APS using computational fluid dynamics (CFD). METHODS 63 plaque models were developed from three severities (75%, 82%, and 89% in area), three eccentricities (the deviation of plaque throat from the arterial centerline: 0, 0.375 and 0.75mm), and 7 different length combinations of the proximal and distal stenotic segments (2mm-5mm, 3mm-5mm, 4mm-5mm, 5mm-5mm, 5mm-4mm, 5mm-3mm, 5mm-2mm). For each model, CFD simulation was performed to calculate the maximum and area-averaged WSS and APS on the proximal and distal stenotic segments. The multivariate analysis of variance and linear regression analysis were performed to quantitatively investigate the geometry-stress relationship.The results showed that, the severity and eccentricity of a plaque were linearly related to its WSS and APS. APS value on a segment (proximal or distal) of the plaque depended on the segmental length It was also shown that the difference of APS between proximal and distal segments depended exclusively on the difference of length between segments (all p<; 0.05). CONCLUSION The geometry of a plaque influences its WSS and APS. APS and its proximal/distal difference depend on the segmental lengths.
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Karlas A, Fasoula NA, Paul-Yuan K, Reber J, Kallmayer M, Bozhko D, Seeger M, Eckstein HH, Wildgruber M, Ntziachristos V. Cardiovascular optoacoustics: From mice to men - A review. PHOTOACOUSTICS 2019; 14:19-30. [PMID: 31024796 PMCID: PMC6476795 DOI: 10.1016/j.pacs.2019.03.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 05/04/2023]
Abstract
Imaging has become an indispensable tool in the research and clinical management of cardiovascular disease (CVD). An array of imaging technologies is considered for CVD diagnostics and therapeutic assessment, ranging from ultrasonography, X-ray computed tomography and magnetic resonance imaging to nuclear and optical imaging methods. Each method has different operational characteristics and assesses different aspects of CVD pathophysiology; nevertheless, more information is desirable for achieving a comprehensive view of the disease. Optoacoustic (photoacoustic) imaging is an emerging modality promising to offer novel information on CVD parameters by allowing high-resolution imaging of optical contrast several centimeters deep inside tissue. Implemented with illumination at several wavelengths, multi-spectral optoacoustic tomography (MSOT) in particular, is sensitive to oxygenated and deoxygenated hemoglobin, water and lipids allowing imaging of the vasculature, tissue oxygen saturation and metabolic or inflammatory parameters. Progress with fast-tuning lasers, parallel detection and advanced image reconstruction and data-processing algorithms have recently transformed optoacoustics from a laboratory tool to a promising modality for small animal and clinical imaging. We review progress with optoacoustic CVD imaging, highlight the research and diagnostic potential and current applications and discuss the advantages, limitations and possibilities for integration into clinical routine.
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Affiliation(s)
- Angelos Karlas
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Clinic for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Korbinian Paul-Yuan
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Josefine Reber
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Kallmayer
- Clinic for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Dmitry Bozhko
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Markus Seeger
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Moritz Wildgruber
- Institute for Diagnostic and Interventional Radiology, University Hospital rechts der Isar, Munich, Germany
- Institute for Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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Zhang H, Song M, Ruan L, Zhang F, Zhang A, Siedlecki AM, Wan M. Von Mises Strain as a Risk Marker for Vulnerability of Carotid Plaque: Preliminary Clinical Evaluation of Cerebral Infarction. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1221-1233. [PMID: 30824309 DOI: 10.1016/j.ultrasmedbio.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/21/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
Non-invasive assessment of carotid artery plaque vulnerability is a key issue for cerebrovascular disease. This study investigates Von Mises strain imaging in patients by relating Von Mises strain to cerebral infarction presentation. Ultrasonography was performed in patients evaluated for carotid artery stenosis. Strains were estimated by a flow-driven diffusion method and least-squares regression applying Kalman filtering. Von Mises strains ɛVMsys and ɛVMdia were calculated by averaging four or five cardiac cycles in systole and diastole, respectively. Von Mises strain (peak, coefficient of variance, skewness and kurtosis) in patients with cerebral infarction was compared with that in the control group. Higher Von Mises peak strain localized to echolucent areas on B-mode imaging. Higher peak strain was found in patients with cerebral infarction compared with the control group (p = 0.02 for ɛVMdia and p = 0.001 for ɛVMsys). The area under the receiver operating characteristic curve for peak ɛVMsys was 0.761 (p = 0.001) with high sensitivity and specificity. Peak strain also correlated with homocysteine (r = 0.345, p = 0.007, for ɛVMdia; r = 0.287, p = 0.036, for ɛVMsys) and hypersensitive C-reactive protein (r = 0.399, p = 0.043, for ɛVMdia; r = 0.195, p = 0.034, for ɛVMsys) levels. The coefficient of variance, skewness and kurtosis of ɛVMdia or ɛVMsys were also associated with homocysteine levels. In conclusion, this study indicates that peak Von Mises strain is a potential clinical risk marker for carotid plaque vulnerability and cerebral infarction.
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Affiliation(s)
- Hongmei Zhang
- Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, China.
| | - Manman Song
- Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, China
| | - Litao Ruan
- Department of Ultrasound, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Furong Zhang
- Department of Ultrasound, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Aifeng Zhang
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew M Siedlecki
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Mingxi Wan
- Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, China.
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Barrett HE, Van der Heiden K, Farrell E, Gijsen FJH, Akyildiz AC. Calcifications in atherosclerotic plaques and impact on plaque biomechanics. J Biomech 2019; 87:1-12. [PMID: 30904335 DOI: 10.1016/j.jbiomech.2019.03.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/09/2019] [Indexed: 12/13/2022]
Abstract
The catastrophic mechanical rupture of an atherosclerotic plaque is the underlying cause of the majority of cardiovascular events. The infestation of vascular calcification in the plaques creates a mechanically complex tissue composite. Local stress concentrations and plaque tissue strength properties are the governing parameters required to predict plaque ruptures. Advanced imaging techniques have permitted insight into fundamental mechanisms driving the initiating inflammatory-driven vascular calcification of the diseased intima at the (sub-) micron scale and up to the macroscale. Clinical studies have potentiated the biomechanical relevance of calcification through the derivation of links between local plaque rupture and specific macrocalcification geometrical features. The clinical implications of the data presented in this review indicate that the combination of imaging, experimental testing, and computational modelling efforts are crucial to predict the rupture risk for atherosclerotic plaques. Specialised experimental tests and modelling efforts have further enhanced the knowledge base for calcified plaque tissue mechanical properties. However, capturing the temporal instability and rupture causality in the plaque fibrous caps remains elusive. Is it necessary to move our experimental efforts down in scale towards the fundamental (sub-) micron scales in order to interpret the true mechanical behaviour of calcified plaque tissue interactions that is presented on a macroscale in the clinic and to further optimally assess calcified plaques in the context of biomechanical modelling.
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Affiliation(s)
- Hilary E Barrett
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Kim Van der Heiden
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ali C Akyildiz
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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23
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Gómez A, Tacheau A, Finet G, Lagache M, Martiel JL, Floc'h SL, Yazdani SK, Elias-Zuñiga A, Pettigrew RI, Cloutier G, Ohayon J. Intraluminal Ultrasonic Palpation Imaging Technique Revisited for Anisotropic Characterization of Healthy and Atherosclerotic Coronary Arteries: A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:35-49. [PMID: 30348475 DOI: 10.1016/j.ultrasmedbio.2018.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
Accurate mechanical characterization of coronary atherosclerotic lesions remains essential for the in vivo detection of vulnerable plaques. Using intravascular ultrasound strain measurements and based on the mechanical response of a circular and concentric vascular model, E. I. Céspedes, C. L. de Korte and A. F. van der Steen developed an elasticity-palpography technique in 2000 to estimate the apparent stress-strain modulus palpogram of the thick subendoluminal arterial wall layer. More recently, this approach was improved by our group to consider the real anatomic shape of the vulnerable plaque. Even though these two studies highlighted original and promising approaches for improving the detection of vulnerable plaques, they did not overcome a main limitation related to the anisotropic mechanical behavior of the vascular tissue. The present study was therefore designed to extend these previous approaches by considering the orthotropic mechanical properties of the arterial wall and lesion constituents. Based on the continuum mechanics theory prescribing the strain field, an elastic anisotropy index was defined. This new anisotropic elasticity-palpography technique was successfully applied to characterize ten coronary plaque and one healthy vessel geometries of patients imaged in vivo with intravascular ultrasound. The results revealed that the anisotropy index-palpograms were estimated with a good accuracy (with a mean relative error of 26.8 ± 48.8%) compared with ground true solutions.
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Affiliation(s)
- Armida Gómez
- Laboratory TIMC-IMAG/DyCTiM, UGA, CNRS UMR 5525, Grenoble, France
| | - Antoine Tacheau
- Laboratory TIMC-IMAG/DyCTiM, UGA, CNRS UMR 5525, Grenoble, France
| | - Gérard Finet
- Department of Hemodynamics and Interventional Cardiology, Hospices Civils de Lyon and Claude Bernard University Lyon1, INSERM Unit 886, Lyon, France
| | - Manuel Lagache
- Laboratory SYMME, SYMME, University Savoie Mont-Blanc, France; Polytech Annecy-Chambéry, University Savoie Mont-Blanc, Le Bourget du Lac, France
| | | | - Simon Le Floc'h
- Laboratory LMGC, CNRS UMR 5508, University of Montpellier II, Montpellier, France
| | - Saami K Yazdani
- Department of Mechanical Engineering, University of South Alabama, Mobile, Alabama, USA
| | - Alex Elias-Zuñiga
- Department of Mechanical Engineering Instituto Tecnológico y de Estudios Superiores de Monterrey, Campus Monterrey, Monterrey, Mexico
| | | | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Jacques Ohayon
- Laboratory TIMC-IMAG/DyCTiM, UGA, CNRS UMR 5525, Grenoble, France; Polytech Annecy-Chambéry, University Savoie Mont-Blanc, Le Bourget du Lac, France.
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24
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Li H, Porée J, Roy Cardinal MH, Cloutier G. Two-dimensional affine model-based estimators for principal strain vascular ultrasound elastography with compound plane wave and transverse oscillation beamforming. ULTRASONICS 2019; 91:77-91. [PMID: 30081331 DOI: 10.1016/j.ultras.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/26/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
Polar strain (radial and circumferential) estimations can suffer from artifacts because the center of a nonsymmetrical carotid atherosclerotic artery, defining the coordinate system in cross-sectional view, can be misregistered. Principal strains are able to remove coordinate dependency to visualize vascular strain components (i.e., axial and lateral strains and shears). This paper presents two affine model-based estimators, the affine phase-based estimator (APBE) developed in the framework of transverse oscillation (TO) beamforming, and the Lagrangian speckle model estimator (LSME). These estimators solve simultaneously the translation (axial and lateral displacements) and deformation (axial and lateral strains and shears) components that were then used to compute principal strains. To improve performance, the implemented APBE was also tested by introducing a time-ensemble estimation approach. Both APBE and LSME were tested with and without the plane strain incompressibility assumption. These algorithms were evaluated on coherent plane wave compounded (CPWC) images considering TO. LSME without TO but implemented with the time-ensemble and incompressibility constraint (Porée et al., 2015) served as benchmark comparisons. The APBE provided better principal strain estimations with the time-ensemble and incompressibility constraint, for both simulations and in vitro experiments. With a few exceptions, TO did not improve principal strain estimates for the LSME. With simulations, the smallest errors compared with ground true measures were obtained with the LSME considering time-ensemble and the incompressibility constraint. This latter estimator also provided the highest elastogram signal-to-noise ratios (SNRs) for in vitro experiments on a homogeneous vascular phantom without any inclusion, for applied strains varying from 0.07% to 4.5%. It also allowed the highest contrast-to-noise ratios (CNRs) for a heterogeneous vascular phantom with a soft inclusion, at applied strains from 0.07% to 3.6%. In summary, the LSME outperformed the implemented APBE, and the incompressibility constraint improved performances of both estimators.
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Affiliation(s)
- Hongliang Li
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada
| | - Jonathan Porée
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada
| | - Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, QC, Canada.
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25
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Correlative Detection of Isolated Single and Multi-Cellular Calcifications in the Internal Elastic Lamina of Human Coronary Artery Samples. Sci Rep 2018; 8:10978. [PMID: 30030502 PMCID: PMC6054664 DOI: 10.1038/s41598-018-29379-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/26/2018] [Indexed: 01/05/2023] Open
Abstract
Histopathology protocols often require sectioning and processing of numerous microscopy slides to survey a sample. Trade-offs between workload and sampling density means that small features can be missed. Aiming to reduce the workload of routine histology protocols and the concern over missed pathology in skipped sections, we developed a prototype x-ray tomographic scanner dedicated to rapid scouting and identification of regions of interest in pathology specimens, thereby allowing targeted histopathology analysis to replace blanket searches. In coronary artery samples of a deceased HIV patient, the scanner, called Tomopath, obtained depth-resolved cross-sectional images at 15 µm resolution in a 15-minute scan, which guided the subsequent histological sectioning and microscopy. When compared to a commercial tabletop micro-CT scanner, the prototype provided several-fold contrast-to-noise ratio in 1/11th the scan time. Correlated tomographic and histological images revealed two types of micro calcifications: scattered loose calcifications typically found in atherosclerotic lesions; isolated focal calcifications in one or several cells in the internal elastic lamina and occasionally in the tunica media, which we speculate were the initiation of medial calcification linked to kidney disease, but rarely detected at this early stage due to their similarity to particle contaminants introduced during histological processing, if not for the evidence from the tomography scan prior to sectioning. Thus, in addition to its utility as a scouting tool, in this study it provided complementary information to histological microscopy. Overall, the prototype scanner represents a step toward a dedicated scouting and complementary imaging tool for routine use in pathology labs.
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26
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Guo X, Giddens DP, Molony D, Yang C, Samady H, Zheng J, Mintz GS, Maehara A, Wang L, Pei X, Li ZY, Tang D. Combining IVUS and Optical Coherence Tomography for More Accurate Coronary Cap Thickness Quantification and Stress/Strain Calculations: A Patient-Specific Three-Dimensional Fluid-Structure Interaction Modeling Approach. J Biomech Eng 2018; 140:2659953. [PMID: 29059332 PMCID: PMC5816254 DOI: 10.1115/1.4038263] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/04/2017] [Indexed: 12/26/2022]
Abstract
Accurate cap thickness and stress/strain quantifications are of fundamental importance for vulnerable plaque research. Virtual histology intravascular ultrasound (VH-IVUS) sets cap thickness to zero when cap is under resolution limit and IVUS does not see it. An innovative modeling approach combining IVUS and optical coherence tomography (OCT) is introduced for cap thickness quantification and more accurate cap stress/strain calculations. In vivo IVUS and OCT coronary plaque data were acquired with informed consent obtained. IVUS and OCT images were merged to form the IVUS + OCT data set, with biplane angiography providing three-dimensional (3D) vessel curvature. For components where VH-IVUS set zero cap thickness (i.e., no cap), a cap was added with minimum cap thickness set as 50 and 180 μm to generate IVUS50 and IVUS180 data sets for model construction, respectively. 3D fluid-structure interaction (FSI) models based on IVUS + OCT, IVUS50, and IVUS180 data sets were constructed to investigate cap thickness impact on stress/strain calculations. Compared to IVUS + OCT, IVUS50 underestimated mean cap thickness (27 slices) by 34.5%, overestimated mean cap stress by 45.8%, (96.4 versus 66.1 kPa). IVUS50 maximum cap stress was 59.2% higher than that from IVUS + OCT model (564.2 versus 354.5 kPa). Differences between IVUS and IVUS + OCT models for cap strain and flow shear stress (FSS) were modest (cap strain <12%; FSS <6%). IVUS + OCT data and models could provide more accurate cap thickness and stress/strain calculations which will serve as basis for further plaque investigations.
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Affiliation(s)
- Xiaoya Guo
- Department of Mathematics, Southeast University, Nanjing 210096, China
| | - Don P Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - David Molony
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307
| | - Chun Yang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10022
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10022
| | - Liang Wang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609
| | - Xuan Pei
- School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China
| | - Zhi-Yong Li
- School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China
| | - Dalin Tang
- Department of Mathematics, Southeast University, Nanjing 210096, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609
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27
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Kowara M, Cudnoch-Jedrzejewska A, Opolski G, Wlodarski P. MicroRNA regulation of extracellular matrix components in the process of atherosclerotic plaque destabilization. Clin Exp Pharmacol Physiol 2018; 44:711-718. [PMID: 28440887 DOI: 10.1111/1440-1681.12772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/23/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022]
Abstract
The process of atherosclerotic plaque destabilization, leading to myocardial infarction, is still not fully understood. The pathway - composed of structural and regulatory proteins of the extracellular matrix (ECM) such as collagen, elastin, small leucine-rich proteoglycans, metalloproteinases, cathepsins and serine proteases - is one potential way of atherosclerotic plaque destabilization. The expression of these proteins is controlled by different microRNA molecules. The goal of this paper is to summarize the current investigations and knowledge about ECM in the process of atherosclerotic plaque destabilization, giving special attention to epigenetic expression regulation by microRNA.
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Affiliation(s)
- Michal Kowara
- Department of Experimental and Clinical Physiology, Laboratory of Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Cudnoch-Jedrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Pawel Wlodarski
- Department of Histology and Embryology, Center for Biostructure Research, Laboratory of Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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28
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Wu X, von Birgelen C, Li Z, Zhang S, Huang J, Liang F, Li Y, Wijns W, Tu S. Assessment of superficial coronary vessel wall deformation and stress: validation of in silico models and human coronary arteries in vivo. Int J Cardiovasc Imaging 2018; 34:849-861. [PMID: 29397475 DOI: 10.1007/s10554-018-1311-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
Cyclic biomechanical stress at the lumen-intima interface plays a crucial role in the rupture of coronary plaque. We performed a comprehensive assessment of a novel angiography-based method for four-dimensional (4D) dynamic assessment of superficial wall stress (SWS) and deformation with a total of 32 analyses in virtual stenosis models with equal lumen dimensions and 16 analyses in human coronary arteries in vivo. The in silico model analyses demonstrated that the SWS, derived by the proposed global displacement method without knowledge of plaque components or blood pressure, was comparable with the result calculated by traditional finite element method. Cardiac contraction-induced vessel deformation increased SWS. Softer plaque and positive arterial remodeling, associated with a greater plaque burden, showed more variation in mean lumen diameter within the cardiac cycle and resulted in higher SWS. In vivo patient analyses confirmed the accuracy of computed superficial wall deformation. The centerlines predicted by our method at random selected time instant matched well with the actual one in angiograms by Procrustes analysis (scaling: 0.995 ± 0.018; dissimilarity: 0.007 ± 0.014). Over 50% of the maximum SWS occurred at proximal plaque shoulders. This novel 4D approach could be successfully to predict superficial wall deformation of coronary artery in vivo. The dynamic SWS might be more realistic to evaluate the risk of plaque rupture.
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Affiliation(s)
- Xinlei Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiayue Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yingguang Li
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland.,Saolta University Healthcare Group, Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China. .,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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29
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Cardoso L, Weinbaum S. Microcalcifications, Their Genesis, Growth, and Biomechanical Stability in Fibrous Cap Rupture. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1097:129-155. [PMID: 30315543 DOI: 10.1007/978-3-319-96445-4_7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
For many decades, cardiovascular calcification has been considered as a passive process, accompanying atheroma progression, correlated with plaque burden, and apparently without a major role on plaque vulnerability. Clinical and pathological analyses have previously focused on the total amount of calcification (calcified area in a whole atheroma cross section) and whether more calcification means higher risk of plaque rupture or not. However, this paradigm has been changing in the last decade or so. Recent research has focused on the presence of microcalcifications (μCalcs) in the atheroma and more importantly on whether clusters of μCalcs are located in the cap of the atheroma. While the vast majority of μCalcs are found in the lipid pool or necrotic core, they are inconsequential to vulnerable plaque. Nevertheless, it has been shown that μCalcs located within the fibrous cap could be numerous and that they behave as an intensifier of the background circumferential stress in the cap. It is now known that such intensifying effect depends on the size and shape of the μCalc as well as the proximity between two or more μCalcs. If μCalcs are located in caps with very low background stress, the increase in stress concentration may not be sufficient to reach the rupture threshold. However, the presence of μCalc(s) in the cap with a background stress of about one fifth to one half the rupture threshold (a stable plaque) will produce a significant increase in local stress, which may exceed the cap rupture threshold and thus transform a non-vulnerable plaque into a vulnerable one. Also, the classic view that treats cardiovascular calcification as a passive process has been challenged, and emerging data suggest that cardiovascular calcification may encompass both passive and active processes. The passive calcification process comprises biochemical factors, specifically circulating nucleating complexes, which would lead to calcification of the atheroma. The active mechanism of atherosclerotic calcification is a cell-mediated process via cell death of macrophages and smooth muscle cells (SMCs) and/or the release of matrix vesicles by SMCs.
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Affiliation(s)
- Luis Cardoso
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA.
| | - Sheldon Weinbaum
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
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30
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Samady H, Molony DS. The Ongoing Quest to Predict Plaque Rupture. JACC Cardiovasc Imaging 2017; 10:1484-1486. [DOI: 10.1016/j.jcmg.2017.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 11/26/2022]
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31
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Liu X, Wu G, Xu C, He Y, Shu L, Liu Y, Zhang N, Lin C. Prediction of coronary plaque progression using biomechanical factors and vascular characteristics based on computed tomography angiography. Comput Assist Surg (Abingdon) 2017; 22:286-294. [PMID: 29032716 DOI: 10.1080/24699322.2017.1389407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Coronary atherosclerotic plaques progress in a highly individual manner. Accurately predicting plaque progression will promote clinical management of atherosclerosis. The purpose of this study was to investigate the role of local biomechanics factors and vascular characteristics in coronary plaque progression and arterial remodeling. METHODS Computed tomography angiography-based three-dimensional reconstruction of the native right coronary artery was performed in vivo in twelve patients with acute coronary syndrome at baseline and 12-month follow-up. The reconstructed arteries were divided into sequential 3-mm-long segments. Wall shear stress (WSS) and von Mises stress (VMS) were computed in all segments at baseline by applying fluid-structure interaction simulations. RESULTS In total, 365 segments 3-mm long were analyzed. The decrease in minimal lumen area was independently predicted by low baseline VMS (-0.73 ± 0.13 mm2), increase in plaque burden was independently predicted by small minimal lumen area and low baseline WSS (6.28 ± 0.96%), and decrease in plaque volume was independently predicted by low baseline VMS (-0.99 ± 0.49 mm3). Negative remodeling was more likely to occur in low- (55%) and moderate-VMS (40%) segments, but expansive remodeling was more likely to occur in high-VMS (44%) segments. CONCLUSIONS Local von Mises stress, wall shear stress, minimal lumen area, and plaque burden provide independent and additive prediction in identifying coronary plaque progression and arterial remodeling.
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Affiliation(s)
- Xiujian Liu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Guanghui Wu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Chuangye Xu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Yuna He
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Lixia Shu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Yuyang Liu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Nan Zhang
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Changyan Lin
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
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32
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Yang G, Zhao H, Wang P, Han X, Zao X, Liu Z, Qiu S, Liu Z. Measurement of deformation rate in nasal septum deviation by three-dimensional computer tomography reconstruction and its application in nasal septoplasty endoscopic surgery. Exp Ther Med 2017; 14:1519-1525. [PMID: 28781628 PMCID: PMC5526204 DOI: 10.3892/etm.2017.4644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/03/2017] [Indexed: 11/23/2022] Open
Abstract
Nasal septum deviation (NSD) typically occurs following otorhinolaryngologic surgery. However, there is a lack of biomechanical parameters able to accurately evaluate the severity of NSD. The present study aimed to determine whether the deformation rate (DR) is associated with visual analogue scale (VAS) and nasal airway resistance (NAR), and to evaluate the application of DR measurements in nasal septoplasty endoscopic surgery. In the present clinical trial, a total of 30 patients with NSD were enrolled, and DRs were calculated prior to surgery by three dimensional computer tomography (3D-CT) reconstruction techniques combined with mechanical analysis. The distribution of stress lines at the nasal septum deviation site was evaluated prior to operation. Following nasal septoplasty endoscopic surgery, pre and postoperation scores for VAS and NAR were compared. The results demonstrated that DR was significantly correlated with preoperational NAR (r=0.534) and VAS scores (r=0.397). According to preoperative CT measurements of NSD, DR and biomechanical properties, selective excision was performed to remove core areas of stress. It was observed that postoperative DR, NAR and VAS scores were significantly lower (all P<0.01) than those measured preoperation. Furthermore, over a follow-up period of 3 months, 23 cases (73.1%) were cured and 7 cases (23.3%) exhibited improvements. These results indicate that preoperative measurement of septum DR by 3D-CT reconstruction techniques may be important in determining the specific surgical approach of nasal septoplasty required.
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Affiliation(s)
- Gui Yang
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Hailiang Zhao
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Peng Wang
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Xiaodong Han
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Xinyu Zao
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Zhixian Liu
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Shuqi Qiu
- Rhinology Department, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China.,Immunology Research Laboratory, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China.,Immunology and Allergy Laboratory, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Zhiqiang Liu
- Immunology Research Laboratory, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China.,Immunology and Allergy Laboratory, Longgang ENT Hospital, Shenzhen, Guangdong 518172, P.R. China
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33
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Yabusaki K, Hutcheson JD, Vyas P, Bertazzo S, Body SC, Aikawa M, Aikawa E. Quantification of Calcified Particles in Human Valve Tissue Reveals Asymmetry of Calcific Aortic Valve Disease Development. Front Cardiovasc Med 2016; 3:44. [PMID: 27867942 PMCID: PMC5095138 DOI: 10.3389/fcvm.2016.00044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/14/2016] [Indexed: 12/17/2022] Open
Abstract
Recent studies indicated that small calcified particles observable by scanning electron microscopy (SEM) may initiate calcification in cardiovascular tissues. We hypothesized that if the calcified particles precede gross calcification observed in calcific aortic valve disease (CAVD), they would exhibit a regional asymmetric distribution associated with CAVD development, which always initiates at the base of aortic valve leaflets adjacent to the aortic outflow in a region known as the fibrosa. Testing this hypothesis required counting the calcified particles in histological sections of aortic valve leaflets. SEM images, however, do not provide high contrast between components within images, making the identification and quantification of particles buried within tissue extracellular matrix difficult. We designed a new unique pattern-matching based technique to allow for flexibility in recognizing particles by creating a gap zone in the detection criteria that decreased the influence of non-particle image clutter in determining whether a particle was identified. We developed this flexible pattern particle-labeling (FpPL) technique using synthetic test images and human carotid artery tissue sections. A conventional image particle counting method (preinstalled in ImageJ) did not properly recognize small calcified particles located in noisy images that include complex extracellular matrix structures and other commonly used pattern-matching methods failed to detect the wide variation in size, shape, and brightness exhibited by the particles. Comparative experiments with the ImageJ particle counting method demonstrated that our method detected significantly more (p < 2 × 10-7) particles than the conventional method with significantly fewer (p < 0.0003) false positives and false negatives (p < 0.0003). We then applied the FpPL technique to CAVD leaflets and showed a significant increase in detected particles in the fibrosa at the base of the leaflets (p < 0.0001), supporting our hypothesis. The outcomes of this study are twofold: (1) development of a new image analysis technique that can be adapted to a wide range of applications and (2) acquisition of new insight on potential early mediators of calcification in CAVD.
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Affiliation(s)
- Katsumi Yabusaki
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences (CICS), Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Joshua D Hutcheson
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences (CICS), Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Payal Vyas
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences (CICS), Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Sergio Bertazzo
- Department of Medical Physics and Biomedical Engineering, University College London , London , UK
| | - Simon C Body
- Center for Perioperative Genomics, Brigham and Women's Hospital, Boston, MA, USA; Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Masanori Aikawa
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences (CICS), Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences (CICS), Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
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Guo X, Zhu J, Maehara A, Monoly D, Samady H, Wang L, Billiar KL, Zheng J, Yang C, Mintz GS, Giddens DP, Tang D. Quantify patient-specific coronary material property and its impact on stress/strain calculations using in vivo IVUS data and 3D FSI models: a pilot study. Biomech Model Mechanobiol 2016; 16:333-344. [PMID: 27561649 DOI: 10.1007/s10237-016-0820-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/17/2016] [Indexed: 01/09/2023]
Abstract
Computational models have been used to calculate plaque stress and strain for plaque progression and rupture investigations. An intravascular ultrasound (IVUS)-based modeling approach is proposed to quantify in vivo vessel material properties for more accurate stress/strain calculations. In vivo Cine IVUS and VH-IVUS coronary plaque data were acquired from one patient with informed consent obtained. Cine IVUS data and 3D thin-slice models with axial stretch were used to determine patient-specific vessel material properties. Twenty full 3D fluid-structure interaction models with ex vivo and in vivo material properties and various axial and circumferential shrink combinations were constructed to investigate the material stiffness impact on stress/strain calculations. The approximate circumferential Young's modulus over stretch ratio interval [1.0, 1.1] for an ex vivo human plaque sample and two slices (S6 and S18) from our IVUS data were 1631, 641, and 346 kPa, respectively. Average lumen stress/strain values from models using ex vivo, S6 and S18 materials with 5 % axial shrink and proper circumferential shrink were 72.76, 81.37, 101.84 kPa and 0.0668, 0.1046, and 0.1489, respectively. The average cap strain values from S18 material models were 150-180 % higher than those from the ex vivo material models. The corresponding percentages for the average cap stress values were 50-75 %. Dropping axial and circumferential shrink consideration led to stress and strain over-estimations. In vivo vessel material properties may be considerably softer than those from ex vivo data. Material stiffness variations may cause 50-75 % stress and 150-180 % strain variations.
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Affiliation(s)
- Xiaoya Guo
- Department of Mathematics, Southeast University, Nanjing, 210096, China
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, 10022, USA
| | - David Monoly
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30307, USA
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30307, USA
| | - Liang Wang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, 01609, USA
| | - Kristen L Billiar
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, 63110, USA
| | - Chun Yang
- Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, China
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, 10022, USA
| | - Don P Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30307, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Dalin Tang
- Department of Mathematics, Southeast University, Nanjing, 210096, China. .,Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, 01609, USA.
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Chen H, Kassab GS. Microstructure-based biomechanics of coronary arteries in health and disease. J Biomech 2016; 49:2548-59. [PMID: 27086118 PMCID: PMC5028318 DOI: 10.1016/j.jbiomech.2016.03.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 12/27/2022]
Abstract
Coronary atherosclerosis is the major cause of mortality and disability in developed nations. A deeper understanding of mechanical properties of coronary arteries and hence their mechanical response to stress is significant for clinical prevention and treatment. Microstructure-based models of blood vessels can provide predictions of arterial mechanical response at the macro- and micro-mechanical level for each constituent structure. Such models must be based on quantitative data of structural parameters (constituent content, orientation angle and dimension) and mechanical properties of individual adventitia and media layers of normal arteries as well as change of structural and mechanical properties of atherosclerotic arteries. The microstructural constitutive models of healthy coronary arteries consist of three major mechanical components: collagen, elastin, and smooth muscle cells, while the models of atherosclerotic arteries should account for additional constituents including intima, fibrous plaque, lipid, calcification, etc. This review surveys the literature on morphology, mechanical properties, and microstructural constitutive models of normal and atherosclerotic coronary arteries. It also provides an overview of current gaps in knowledge that must be filed in order to advance this important area of research for understanding initiation, progression and clinical treatment of vascular disease. Patient-specific structural models are highlighted to provide diagnosis, virtual planning of therapy and prognosis when realistic patient-specific geometries and material properties of diseased vessels can be acquired by advanced imaging techniques.
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Affiliation(s)
- Huan Chen
- California Medical Innovations Institute, Inc., San Diego, CA 92121, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, Inc., San Diego, CA 92121, United States.
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Ong DS, Lee JS, Soeda T, Higuma T, Minami Y, Wang Z, Lee H, Yokoyama H, Yokota T, Okumura K, Jang IK. Coronary Calcification and Plaque Vulnerability: An Optical Coherence Tomographic Study. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.003929. [PMID: 26743463 DOI: 10.1161/circimaging.115.003929] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spotty superficial calcium deposits have been implicated in plaque vulnerability based on previous intravascular imaging studies. Biomechanical models suggest that microcalcifications between 5 and 65 µm in diameter can intensify fibrous cap stress, promoting plaque rupture. However, the 100- to 200-µm resolution of intravascular ultrasound limits its ability to discriminate single calcium deposits from clusters of smaller deposits, and a previous optical coherence tomographic investigation evaluated calcifications within a long segment of artery, which may not truly reflect the mechanics involved in potentiating focal plaque rupture. METHODS AND RESULTS Detailed optical coherence tomographic assessment of coronary calcification at the culprit plaque (10-mm length) was performed in 53 patients with acute ST-segment-elevation myocardial infarction mediated by plaque rupture and 55 patients with stable angina pectoris. The number and longitudinal length of individual calcium deposits were recorded. Cross-sectional images were analyzed every 1 mm for calcium arc and depth, and these quantitative parameters were used to define individual deposits as spotty, large, and superficial. There was no significant difference between ST-segment-elevation myocardial infarction mediated by plaque rupture and stable angina pectoris groups in the number of total (P=0.58), spotty (P=0.87), or large calcium deposits (P=0.27). Minimum calcium depth was similar between groups (P=0.27), as was the number of superficial deposits (P=0.35 using a 65-µm depth threshold and P=0.84 using a 100-µm depth threshold). CONCLUSIONS The number and pattern of culprit plaque calcifications did not differ between patients presenting with ST-segment-elevation myocardial infarction mediated by plaque rupture versus stable angina pectoris. The optical coherence tomographic assessment of coronary calcification may not be a useful marker of local plaque vulnerability as previously suspected. REGISTRATION INFORMATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.
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Affiliation(s)
- Daniel S Ong
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Jay S Lee
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Tsunenari Soeda
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Takumi Higuma
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Yoshiyasu Minami
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Zhao Wang
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Hang Lee
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Hiroaki Yokoyama
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Takashi Yokota
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Ken Okumura
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.)
| | - Ik-Kyung Jang
- From the Division of Cardiology (D.S.O., J.S.L., T.S., Y.M., Z.W., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (T.H., H.Y., T.Y, K.O.); and Division of Cardiology, Kyung Hee University, Seoul, South Korea (I.-K.J.).
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Wang L, Zheng J, Maehara A, Yang C, Billiar KL, Wu Z, Bach R, Muccigrosso D, Mintz GS, Tang D. Morphological and Stress Vulnerability Indices for Human Coronary Plaques and Their Correlations with Cap Thickness and Lipid Percent: An IVUS-Based Fluid-Structure Interaction Multi-patient Study. PLoS Comput Biol 2015; 11:e1004652. [PMID: 26650721 PMCID: PMC4674138 DOI: 10.1371/journal.pcbi.1004652] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/11/2015] [Indexed: 02/07/2023] Open
Abstract
Plaque vulnerability, defined as the likelihood that a plaque would rupture, is difficult to quantify due to lack of in vivo plaque rupture data. Morphological and stress-based plaque vulnerability indices were introduced as alternatives to obtain quantitative vulnerability assessment. Correlations between these indices and key plaque features were investigated. In vivo intravascular ultrasound (IVUS) data were acquired from 14 patients and IVUS-based 3D fluid-structure interaction (FSI) coronary plaque models with cyclic bending were constructed to obtain plaque wall stress/strain and flow shear stress for analysis. For the 617 slices from the 14 patients, lipid percentage, min cap thickness, critical plaque wall stress (CPWS), strain (CPWSn) and flow shear stress (CFSS) were recorded, and cap index, lipid index and morphological index were assigned to each slice using methods consistent with American Heart Association (AHA) plaque classification schemes. A stress index was introduced based on CPWS. Linear Mixed-Effects (LME) models were used to analyze the correlations between the mechanical and morphological indices and key morphological factors associated with plaque rupture. Our results indicated that for all 617 slices, CPWS correlated with min cap thickness, cap index, morphological index with r = -0.6414, 0.7852, and 0.7411 respectively (p<0.0001). The correlation between CPWS and lipid percentage, lipid index were weaker (r = 0.2445, r = 0.2338, p<0.0001). Stress index correlated with cap index, lipid index, morphological index positively with r = 0.8185, 0.3067, and 0.7715, respectively, all with p<0.0001. For all 617 slices, the stress index has 66.77% agreement with morphological index. Morphological and stress indices may serve as quantitative plaque vulnerability assessment supported by their strong correlations with morphological features associated with plaque rupture. Differences between the two indices may lead to better plaque assessment schemes when both indices were jointly used with further validations from clinical studies. Cardiovascular diseases are closely related to atherosclerotic plaque progression and rupture. Early detection of vulnerable plaques and prediction of potential plaque rupture and related clinical events are of vital importance. Plaque vulnerability, defined as the likelihood that a plaque would rupture, is difficult to measure due to lack of in vivo plaque rupture data. Morphological and stress-based plaque vulnerability indices were introduced in this paper as alternatives to obtain quantitative vulnerability assessment with potential improvement of patient screening tools. In vivo intravascular ultrasound data were acquired from patients and computational coronary plaque models were constructed to obtain data for analysis and index assignments. For the 617 slices from the 14 patients, morphological and stress indices were assigned to each slice using methods consistent with American Heart Association plaque classification schemes. Correlation analyses were performed for all the morphological and mechanical factors considered. The stress index has 66.77% agreement with morphological index. Morphological and stress indices may serve as quantitative plaque vulnerability assessment supported by their strong correlations with morphological features associated with plaque rupture. Differences between the two indices may lead to better plaque assessment schemes when the complementary indices were jointly used with further validations from clinical studies.
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Affiliation(s)
- Liang Wang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Massachusetts, United States of America
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States of America
| | - Akiko Maehara
- The Cardiovascular Research Foundation, New York, New York, United States of America
| | - Chun Yang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Massachusetts, United States of America
- Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, China
| | - Kristen L. Billiar
- Biomedical Engineering Department, Worcester Polytechnic Institute, Worcester, Massachusetts, United States of America
| | - Zheyang Wu
- Mathematical Sciences Department, Worcester Polytechnic Institute, Massachusetts, United States of America
| | - Richard Bach
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - David Muccigrosso
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States of America
| | - Gary S. Mintz
- The Cardiovascular Research Foundation, New York, New York, United States of America
| | - Dalin Tang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Massachusetts, United States of America
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- * E-mail:
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Hutcheson JD, Goettsch C, Rogers MA, Aikawa E. Revisiting cardiovascular calcification: A multifaceted disease requiring a multidisciplinary approach. Semin Cell Dev Biol 2015; 46:68-77. [PMID: 26358815 DOI: 10.1016/j.semcdb.2015.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/24/2022]
Abstract
The presence of cardiovascular calcification significantly predicts patients' morbidity and mortality. Calcific mineral deposition within the soft cardiovascular tissues disrupts the normal biomechanical function of these tissues, leading to complications such as heart failure, myocardial infarction, and stroke. The realization that calcification results from active cellular processes offers hope that therapeutic intervention may prevent or reverse the disease. To this point, however, no clinically viable therapies have emerged. This may be due to the lack of certainty that remains in the mechanisms by which mineral is deposited in cardiovascular tissues. Gaining new insight into this process requires a multidisciplinary approach. The pathological changes in cell phenotype that lead to the physicochemical deposition of mineral and the resultant effects on tissue biomechanics must all be considered when designing strategies to treat cardiovascular calcification. In this review, we overview the current cardiovascular calcification paradigm and discuss emerging techniques that are providing new insight into the mechanisms of ectopic calcification.
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Affiliation(s)
- Joshua D Hutcheson
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Claudia Goettsch
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Maximillian A Rogers
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
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Feng J, Rajeswaran T, He S, Wilkinson FL, Serracino-Inglott F, Azzawi M, Parikh V, Miraftab M, Alexander MY. Investigation of the composition of arterial plaques based on arterial waveforms and material properties. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:993-996. [PMID: 26736431 DOI: 10.1109/embc.2015.7318531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stroke is mainly caused by a narrowing of the carotid artery from a build-up of plaque. The risk of plaque rupture and subsequent stroke is dependent on plaque composition. Advances in imaging modalities offer a non-invasive means to assess the health of blood vessels and detect damage. However, the current diagnosis fails to identify patients with soft lipid plaque that are more susceptible to fissure, resulting in stroke. The aim of this study was to use waveform analysis to identify plaque composition and the risk of rupture. We have investigated pressure and flow by combining an artificial blood flow circuit with tubing containing different materials, to simulate plaques in a blood vessel. We used fat and bone to model lipid and calcification respectively to determine if the composition of plaques can be identified by arterial waveforms. We demonstrate that the arterial plaque models with different percentages of calcification and fat, results in significantly different arterial waveforms. These findings imply that arterial waveform analysis has the potential for further development to identify the vulnerable plaques prone to rupture. These findings could have implications for improved patient prognosis by speed of detection and a more appropriate treatment strategy.
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Gijsen FJH, Nieuwstadt HA, Wentzel JJ, Verhagen HJM, van der Lugt A, van der Steen AFW. Carotid Plaque Morphological Classification Compared With Biomechanical Cap Stress: Implications for a Magnetic Resonance Imaging-Based Assessment. Stroke 2015; 46:2124-8. [PMID: 26081843 DOI: 10.1161/strokeaha.115.009707] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/21/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Two approaches to target plaque vulnerability-a histopathologic classification scheme and a biomechanical analysis-were compared and the implications for noninvasive risk stratification of carotid plaques using magnetic resonance imaging were assessed. METHODS Seventy-five histological plaque cross sections were obtained from carotid endarterectomy specimens from 34 patients (>70% stenosis) and subjected to both a Virmani histopathologic classification (thin fibrous cap atheroma with <0.2-mm cap thickness, presumed vulnerable) and a peak cap stress computation (<140 kPa: presumed stable; >300 kPa: presumed vulnerable). To demonstrate the implications for noninvasive plaque assessment, numeric simulations of a typical carotid magnetic resonance imaging protocol were performed (0.62×0.62 mm(2) in-plane acquired voxel size) and used to obtain the magnetic resonance imaging-based peak cap stress. RESULTS Peak cap stress was generally associated with histological classification. However, only 16 of 25 plaque cross sections could be labeled as high-risk (peak cap stress>300 kPa and classified as a thin fibrous cap atheroma). Twenty-eight of 50 plaque cross sections could be labeled as low-risk (a peak cap stress<140 kPa and not a thin fibrous cap atheroma), leading to a κ=0.39. 31 plaques (41%) had a disagreement between both classifications. Because of the limited magnetic resonance imaging voxel size with regard to cap thickness, a noninvasive identification of only a group of low-risk, thick-cap plaques was reliable. CONCLUSIONS Instead of trying to target only vulnerable plaques, a more reliable noninvasive identification of a select group of stable plaques with a thick cap and low stress might be a more fruitful approach to start reducing surgical interventions on carotid plaques.
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Affiliation(s)
- Frank J H Gijsen
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.).
| | - Harm A Nieuwstadt
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Jolanda J Wentzel
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Hence J M Verhagen
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Aad van der Lugt
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Antonius F W van der Steen
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
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Vavruch C, Länne T, Fredrikson M, Lindström T, Östgren CJ, Nystrom FH. Serum leptin levels are independently related to the incidence of ischemic heart disease in a prospective study of patients with type 2 diabetes. Cardiovasc Diabetol 2015; 14:62. [PMID: 25994184 PMCID: PMC4460770 DOI: 10.1186/s12933-015-0208-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/01/2015] [Indexed: 12/19/2022] Open
Abstract
Background New and clinically useful markers of cardiovascular risk are of essence in type 2 diabetes since ischemic heart disease is a major cause of death in these patients. Methods We analyzed baseline data from 476 men and 244 women who participated in “Cardiovascular Risk factors in Patients with Diabetes -a Prospective study in Primary care” study. All participants had type 2 diabetes and were 55-66 years old at recruitment during year 2005 to 2008. Except for established traditional risk markers for vascular disease, we also estimated vascular complications non-invasively by performance of carotid-femoral pulse-wave velocity (PWV, with applanation-tonometry) and intima-media thickness of carotid arteries (IMT, with B-mode ultrasound). Patients were followed for incidence of ischemic heart disease mortality and morbidity until end of the year 2012, using the national Swedish Cause of Death and Hospitalization Registries. Results During the follow-up period of a median of 6 years 47 men and 10 women died or were hospitalized for ischemic heart disease including myocardial infarction. Leptin levels were positively related to the hazard ratio (HR) in men (HR for each log 10 unit 4.9, CI 1.99 to 11.8) and women (HR 11.5, CI 1.47 to 89.7). Leptin predicted ischemic heart disease independently of age, HbA1c, BMI, systolic blood pressure and LDL-cholesterol/HDL-cholesterol ratio (men: HR 12.9 CI 3.2-53, women: HR 19.9, CI 1.2-327) This finding of increased risk related to high leptin levels was also statistically significant when carotid-femoral PWV and IMT were both added to the equations in men (hazard ratio 9.2 CI 2.1-41). Conclusions Our data support the use of serum leptin in type 2 diabetes to add independent prognostic information in terms of ischemic heart disease when compared with traditional cardiovascular risk factors. In the men of the cohort this prognostic information was in addition also to data on IMT and PWV, two non-invasive measurements of the extent of vascular disease. The power to detect a similar relationship in women was less strong due to lower incidence of cardiovascular disease. Trial registration ClinicalTrials.gov: NCT01049737.
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Affiliation(s)
- Camilla Vavruch
- Department of Medical and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden.
| | - Toste Länne
- Department of Medical and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden.
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Torbjörn Lindström
- Department of Medical and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden.
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden.
| | - Fredrik H Nystrom
- Department of Medical and Health Sciences, Linköping University, SE 581 85, Linköping, Sweden.
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42
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Maldonado N, Kelly-Arnold A, Laudier D, Weinbaum S, Cardoso L. Imaging and analysis of microcalcifications and lipid/necrotic core calcification in fibrous cap atheroma. Int J Cardiovasc Imaging 2015; 31:1079-87. [PMID: 25837377 DOI: 10.1007/s10554-015-0650-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
The presence of microcalcifications (µCalcs) >5 µm within the cap of human fibroatheroma has been shown to produce a 200-700% increase in peak circumferential stress, which can transform a stable plaque into a vulnerable one, whereas µCalcs < 5 µm do not appear to increase risk. We quantitatively examine the possibility to distinguish caps with µCalcs > 5 µm based on the gross morphological features of fibroatheromas, and the correlation between the size and distribution of µCalcs in the cap and the calcification in the lipid/necrotic core beneath it. Atherosclerotic lesions (N = 72) were imaged using HR-μCT at 2.1-μm resolution for detailed analysis of atheroma morphology and composition, and validated using non-decalcified histology. At 2.1-μm resolution one observes four different patterns of calcification within the lipid/necrotic core, and is able to elucidate the 3D spatial progression of the calcification process using these four patterns. Of the gross morphological features identified, only minimum cap thickness positively correlated with the existence of µCalcs > 5 µm in the cap. We also show that µCalcs in the cap accumulate in the vicinity of the lipid/necrotic core boundary with few on the lumen side of the cap. HR-μCT enables three-dimensional assessment of soft tissue composition, lipid content, calcification patterns within lipid/necrotic cores and analysis of the axial progression of calcification within individual atheroma. The distribution of µCalcs within the cap is highly non-uniform and decreases sharply as one proceeds from the lipid pool/necrotic core boundary to the lumen.
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Affiliation(s)
- Natalia Maldonado
- Department of Biomedical Engineering, The City College New York, The City University of New York, Steinman Hall T-401, 140th Street and Convent Ave, New York, NY, 10031, USA
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Dabagh M, Vasava P, Jalali P. Effects of severity and location of stenosis on the hemodynamics in human aorta and its branches. Med Biol Eng Comput 2015; 53:463-76. [PMID: 25725629 DOI: 10.1007/s11517-015-1253-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/18/2015] [Indexed: 12/15/2022]
Abstract
Pulsatile blood flow is studied in a three-dimensional model of human thoracic aorta at different stages of atherosclerotic lesion growth, taking into account the effect of atherosclerotic plaque location and peripheral symmetry. The model is reconstructed from the computed tomography images. The wall shear stress (WSS), time-averaged WSS, and the oscillatory shear index are applied to determine susceptible sites for the onset of early atherosclerosis. Then, two different degrees of stenosis severity, 50 and 80 %, are introduced to vulnerable areas of the healthy aorta geometry. The overriding issue addressed is that the WSS distribution and magnitude are strongly affected by the atherosclerotic plaque size, its symmetric features, and the location, i.e., the branch it is formed. The present study, for the first time, is capable of providing information on the high shear environment that may exist upon the rupture of plaque surface and any thrombosis due to platelet deposition. The magnitude of WSS and its distribution at the throat of 50 % stenosed aortic arch are in agreement with the previous numerical study (Huang et al. in Exp Fluids 48(3):497-508, 2010). Results show that WSS values exceed 50 Pa at the throat of 80 % stenosed left common carotid and brachiocephalic arteries.
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Affiliation(s)
- Mahsa Dabagh
- Faculty of Technology, Lappeenranta University of Technology, Lappeenranta, Finland,
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44
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Czernuszewicz TJ, Homeister JW, Caughey MC, Farber MA, Fulton JJ, Ford PF, Marston WA, Vallabhaneni R, Nichols TC, Gallippi CM. Non-invasive in vivo characterization of human carotid plaques with acoustic radiation force impulse ultrasound: comparison with histology after endarterectomy. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:685-97. [PMID: 25619778 PMCID: PMC4331250 DOI: 10.1016/j.ultrasmedbio.2014.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 08/30/2014] [Accepted: 09/10/2014] [Indexed: 05/03/2023]
Abstract
Ischemic stroke from thromboembolic sources is linked to carotid artery atherosclerotic disease with a trend toward medical management in asymptomatic patients. Extent of disease is currently diagnosed by non-invasive imaging techniques that measure luminal stenosis, but it has been suggested that a better biomarker for determining risk of future thromboembolic events is plaque morphology and composition. Specifically, plaques that are composed of mechanically soft lipid/necrotic regions covered by thin fibrous caps are the most vulnerable to rupture. An ultrasound technique that non-invasively interrogates the mechanical properties of soft tissue, called acoustic radiation force impulse (ARFI) imaging, has been developed as a new modality for atherosclerotic plaque characterization using phantoms and atherosclerotic pigs, but the technique has yet to be validated in vivo in humans. In this preliminary study, in vivo ARFI imaging is presented in a case study format for four patients undergoing clinically indicated carotid endarterectomy and compared with histology. In two type Va plaques, characterized by lipid/necrotic cores covered by fibrous caps, mean ARFI displacements in focal regions were high relative to the surrounding plaque material, suggesting soft features were covered by stiffer layers within the plaques. In two type Vb plaques, characterized by heavy calcification, mean ARFI peak displacements were low relative to the surrounding plaque and arterial wall, suggesting stiff tissue. This pilot study illustrates the feasibility and challenges of transcutaneous ARFI for characterizing the material and structural composition of carotid atherosclerotic plaques via mechanical properties, in humans, in vivo.
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Affiliation(s)
- Tomasz J Czernuszewicz
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Jonathon W Homeister
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA; McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melissa C Caughey
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mark A Farber
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joseph J Fulton
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Peter F Ford
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William A Marston
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Timothy C Nichols
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caterina M Gallippi
- McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, USA; Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina, USA; Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina, USA.
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Abstract
Background Tortuous arteries are often seen in patients with hypertension and atherosclerosis. While the mechanical stress in atherosclerotic plaque under lumen pressure has been studied extensively, the mechanical stability of atherosclerotic arteries and subsequent effect on the plaque stress remain unknown. To this end, we investigated the buckling and post-buckling behavior of model stenotic coronary arteries with symmetric and asymmetric plaque. Methods Buckling analysis for a model coronary artery with symmetric and asymmetric plaque was conducted using finite element analysis based on the dimensions and nonlinear anisotropic materials properties reported in the literature. Results Artery with asymmetric plaque had lower critical buckling pressure compared to the artery with symmetric plaque and control artery. Buckling increased the peak stress in the plaque and led to the development of a high stress concentration in artery with asymmetric plaque. Stiffer calcified tissue and severe stenosis increased the critical buckling pressure of the artery with asymmetric plaque. Conclusions Arteries with atherosclerotic plaques are prone to mechanical buckling which leads to a high stress concentration in the plaques that can possibly make the plaques prone to rupture.
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46
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IVUS-based FSI models for human coronary plaque progression study: components, correlation and predictive analysis. Ann Biomed Eng 2014; 43:107-21. [PMID: 25245219 DOI: 10.1007/s10439-014-1118-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022]
Abstract
Atherosclerotic plaque progression is believed to be associated with mechanical stress conditions. Patient follow-up in vivo intravascular ultrasound coronary plaque data were acquired to construct fluid-structure interaction (FSI) models with cyclic bending to obtain flow wall shear stress (WSS), plaque wall stress (PWS) and strain (PWSn) data and investigate correlations between plaque progression measured by wall thickness increase (WTI), cap thickness increase (CTI), lipid depth increase (LDI) and risk factors including wall thickness (WT), WSS, PWS, and PWSn. Quarter average values (n = 178-1016) of morphological and mechanical factors from all slices were obtained for analysis. A predictive method was introduced to assess prediction accuracy of risk factors and identify the optimal predictor(s) for plaque progression. A combination of WT and PWS was identified as the best predictor for plaque progression measured by WTI. Plaque WT had best overall correlation with WTI (r = -0.7363, p < 1E-10), cap thickness (r = 0.4541, p < 1E-10), CTI (r = -0.4217, p < 1E-8), LD (r = 0.4160, p < 1E-10), and LDI (r = -0.4491, p < 1E-10), followed by PWS (with WTI: (r = -0.3208, p < 1E-10); cap thickness: (r = 0.4541, p < 1E-10); CTI: (r = -0.1719, p = 0.0190); LD: (r = -0.2206, p < 1E-10); LDI: r = 0.1775, p < 0.0001). WSS had mixed correlation results.
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Modelling of Atherosclerotic Plaque for Use in a Computational Test-Bed for Stent Angioplasty. Ann Biomed Eng 2014; 42:2425-39. [DOI: 10.1007/s10439-014-1107-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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48
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Human coronary plaque wall thickness correlated positively with flow shear stress and negatively with plaque wall stress: an IVUS-based fluid-structure interaction multi-patient study. Biomed Eng Online 2014; 13:32. [PMID: 24669780 PMCID: PMC3977946 DOI: 10.1186/1475-925x-13-32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atherosclerotic plaque progression and rupture are believed to be associated with mechanical stress conditions. In this paper, patient-specific in vivo intravascular ultrasound (IVUS) coronary plaque image data were used to construct computational models with fluid-structure interaction (FSI) and cyclic bending to investigate correlations between plaque wall thickness and both flow shear stress and plaque wall stress conditions. METHODS IVUS data were acquired from 10 patients after voluntary informed consent. The X-ray angiogram was obtained prior to the pullback of the IVUS catheter to determine the location of the coronary artery stenosis, vessel curvature and cardiac motion. Cyclic bending was specified in the model representing the effect by heart contraction. 3D anisotropic FSI models were constructed and solved to obtain flow shear stress (FSS) and plaque wall stress (PWS) values. FSS and PWS values were obtained for statistical analysis. Correlations with p < 0.05 were deemed significant. RESULTS Nine out of the 10 patients showed positive correlation between wall thickness and flow shear stress. The mean Pearson correlation r-value was 0.278 ± 0.181. Similarly, 9 out of the 10 patients showed negative correlation between wall thickness and plaque wall stress. The mean Pearson correlation r-value was -0.530 ± 0.210. CONCLUSION Our results showed that plaque vessel wall thickness correlated positively with FSS and negatively with PWS. The patient-specific IVUS-based modeling approach has the potential to be used to investigate and identify possible mechanisms governing plaque progression and rupture and assist in diagnosis and intervention procedures. This represents a new direction of research. Further investigations using more patient follow-up data are warranted.
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Tang D, Kamm RD, Yang C, Zheng J, Canton G, Bach R, Huang X, Hatsukami TS, Zhu J, Ma G, Maehara A, Mintz GS, Yuan C. Image-based modeling for better understanding and assessment of atherosclerotic plaque progression and vulnerability: data, modeling, validation, uncertainty and predictions. J Biomech 2014; 47:834-46. [PMID: 24480706 DOI: 10.1016/j.jbiomech.2014.01.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 01/30/2023]
Abstract
Medical imaging and image-based modeling have made considerable progress in recent years in identifying atherosclerotic plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. However, a clear understanding is needed about what we have achieved and what is really needed to translate research to actual clinical practices and bring benefits to public health. Lack of in vivo data and clinical events to serve as gold standard to validate model predictions is a severe limitation. While this perspective paper provides a review of the key steps and findings of our group in image-based models for human carotid and coronary plaques and a limited review of related work by other groups, we also focus on grand challenges and uncertainties facing the researchers in the field to develop more accurate and predictive patient screening tools.
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Affiliation(s)
- Dalin Tang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China; Worcester Polytechnic Institute, Worcester, MA 01609, USA.
| | - Roger D Kamm
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chun Yang
- Worcester Polytechnic Institute, Worcester, MA 01609, USA; China Information Tech. Designing & Consulting Institute Co., Ltd., Beijing 100048, China
| | - Jie Zheng
- Mallinkcrodt Inst. of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Richard Bach
- Cardiovascular Division, Washington University, St. Louis, MO 63110, USA
| | - Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Thomas S Hatsukami
- Division of Vascular Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | | | - Gary S Mintz
- The Cardiovascular Research Foundation, NY, NY, USA
| | - Chun Yuan
- Deparment of Radiology, University of Washington, Seattle, WA 98195, USA
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50
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Cardoso L, Kelly-Arnold A, Maldonado N, Laudier D, Weinbaum S. Effect of tissue properties, shape and orientation of microcalcifications on vulnerable cap stability using different hyperelastic constitutive models. J Biomech 2014; 47:870-7. [PMID: 24503048 DOI: 10.1016/j.jbiomech.2014.01.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 01/26/2023]
Abstract
Approximately half of all cardiovascular deaths associated with acute coronary syndrome occur when the thin fibrous cap tissue overlying the necrotic core in a coronary vessel is torn, ripped or fissured under the action of high blood pressure. From a biomechanics point of view, the rupture of an atheroma is due to increased mechanical stresses in the lesion, in which the ultimate stress (i.e. peak circumferential stress (PCS) at failure) of the tissue is exceeded. Several factors including the cap thickness, morphology, residual stresses and tissue composition of the atheroma have been shown to affect the PCS. Also important, we recently demonstrated that microcalcifications (μCalcs>5 µm are a common feature in human atheroma caps, which behave as local stress concentrators, increasing the local tissue stress by at least a factor of two surpassing the ultimate stress threshold for cap tissue rupture. In the present study, we used both idealized µCalcs with spherical shape and actual µCalcs from human coronary atherosclerotic caps, to determine their effect on increasing the circumferential stress in the fibroatheroma cap using different hyperelastic constitutive models. We have found that the stress concentration factor (SCF) produced by μCalcs in the fibroatheroma cap is affected by the material tissue properties, μCalcs spacing, aspect ratio and their alignment relative to the tensile axis of the cap.
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Affiliation(s)
- Luis Cardoso
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA; The Graduate Center of The City University of New York, New York, NY, USA
| | - Adreanne Kelly-Arnold
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
| | - Natalia Maldonado
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
| | - Damien Laudier
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
| | - Sheldon Weinbaum
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA; The Graduate Center of The City University of New York, New York, NY, USA.
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