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Gitsioudis G, Chatzizisis YS, Wolf P, Missiou A, Antoniadis AP, Mitsouras D, Bartling S, Arica Z, Stuber M, Rybicki FJ, Nunninger M, Erbel C, Libby P, Giannoglou GD, Katus HA, Korosoglou G. Combined non-invasive assessment of endothelial shear stress and molecular imaging of inflammation for the prediction of inflamed plaque in hyperlipidaemic rabbit aortas. Eur Heart J Cardiovasc Imaging 2016; 18:19-30. [PMID: 27013245 DOI: 10.1093/ehjci/jew048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/21/2016] [Indexed: 12/11/2022] Open
Abstract
AIMS To evaluate the incremental value of low endothelial shear stress (ESS) combined with high-resolution magnetic resonance imaging (MRI)- and computed tomography angiography (CTA)-based imaging for the prediction of inflamed plaque. METHODS AND RESULTS Twelve hereditary hyperlipidaemic rabbits underwent quantitative analysis of plaque in the thoracic aorta with 256-slice CTA and USPIO-enhanced (ultra-small superparamagnetic nanoparticles, P904) 1.5-T MRI at baseline and at 6-month follow-up. Computational fluid dynamics using CTA-based 3D reconstruction of thoracic aortas identified the ESS patterns in the convex and concave curvature subsegments of interest. Subsegments with low baseline ESS exhibited significant increase in wall thickness and plaque inflammation by MRI, in non-calcified plaque burden by CTA, and developed increased plaque size, lipid and inflammatory cell accumulation (high-risk plaque features) at follow-up by histopathology. Multiple regression analysis identified baseline ESS and inflammation by MRI to be independent predictors of plaque progression, while receiver operating curve analysis revealed baseline ESS alone or in combination with inflammation by MRI as the strongest predictor for augmented plaque burden and inflammation (low ESS at baseline: AUC = 0.84, P < 0.001; low ESS and inflammation by molecular MRI at baseline: AUC = 0.89, P < 0.001). CONCLUSION Low ESS predicts progression of plaque burden and inflammation as assessed by non-invasive USPIO-enhanced MRI. Combined non-invasive assessment of ESS and imaging of inflammation may serve to predict plaque with high-risk features.
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Affiliation(s)
| | - Yiannis S Chatzizisis
- Cardiovascular Division, University of Nebraska Medical Center, Omaha, Nebraska, USA .,First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Wolf
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Anna Missiou
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Antonios P Antoniadis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dimitrios Mitsouras
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sönke Bartling
- Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Zeynep Arica
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Stuber
- Russell H. Morgan Department of Radiology and Radiological Sciences, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Biomedical Imaging, University Hospital Lausanne, Lausanne, Switzerland
| | - Frank J Rybicki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Max Nunninger
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Christian Erbel
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Peter Libby
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George D Giannoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
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