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Zeng L, Luo JY, Liu F, Zhang ZR, Qiu YJ, Luo F, Tian XX, Li XM, Yang YN. Interplay between Risk Factors and Coronary Artery Calcium in Middle-Aged and Elderly Symptomatic Patients. Rev Cardiovasc Med 2023; 24:158. [PMID: 39077535 PMCID: PMC11264111 DOI: 10.31083/j.rcm2406158] [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: 09/23/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 07/31/2024] Open
Abstract
Background The prognostic value of coronary artery calcium (CAC) combined with risk factor burdens in middle-aged and elderly patients with symptoms is unclear. Methods A cohort study comprising 7432 middle-aged and elderly symptomatic patients (aged above 55 years) was conducted between December 2013 and September 2020. All patients had undergone coronary computed tomography angiography, and the Agatston score were used to measure CAC scores. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), which was defined as a composite outcome of nonfatal myocardial infarction, revascularization (percutaneous coronary intervention or coronary artery bypass graft), stroke, and cardiovascular death. Congestive heart failure, cardiogenic shock, malignant arrhythmia, and all-cause mortality were defined as the secondary outcomes. Results There are 970 (13%) patients with CAC 0-10, 2331 (31%) patients with CAC 11-100, and 4131 (56%) patients with CAC ≥ 101. The proportion of patients aged 55-65 years, 65-75 years and ≥ 75 years was 40.7%, 38.1% and 21.2%, respectively. The total number of MACCEs over the 3.4 years follow-up period was 478. The percentage of CAC ≥ 101 was higher among the 75-year-old group than the 55-65-year-old group, increasing from 46.5% to 68.2%. With the increase in the CAC score, the proportion of patients aged ≥ 75 years increased from 12.9% to 25.8%, compared to those aged 55-65 years. The number of risk factors gradually increased as the CAC scores increased in the symptomatic patients aged over 55 years and the similar tendencies were observed among the different age subgroups. The proportion of non-obstructive coronary artery disease (CAD) was comparable between the three age groups (53.5% vs 51.9% vs 49.1%), but obstruction CAD increased with age. The incidence of MACCE in the group with CAC ≥ 101 and ≥ 4 risk factors was 1.71 times higher (95% confidence interval (CI) 1.01-2.92; p = 0.044) than the rate in the group with CAC ≥ 101 and 1 risk factor. In the CAC 0-10 group, the incidence of MACCE in patients aged ≥ 75 years was 12.65 times higher (95% CI: 6.74-23.75; p < 0.0001) than that in patients aged 55-65 years. By taking into account the combination of CAC score, age, and risk factor burden, the predictive power of MACCE can be increased (area under the curve (AUC) = 0.614). Conclusions In symptomatic patients aged 55 or above, a rise in age, CAC scores, and risk factor burden was linked to a considerable risk of future MACCE. In addition, combining CAC scores, age and risk factors can more accurately predict outcomes for middle-aged and elderly patients with symptoms.
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Affiliation(s)
- Lu Zeng
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Jun-Yi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, Xinjiang, China
| | - Zhuo-Ran Zhang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Ya-Jing Qiu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Fan Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Xin-Xin Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Xiao-Mei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
| | - Yi-Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China
- Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, 830054 Urumqi, Xinjiang, China
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Sorokin AV, Patel N, Abdelrahman KM, Ling C, Reimund M, Graziano G, Sampson M, Playford M, Dey AK, Reddy A, Teague HL, Stagliano M, Amar M, Chen MY, Mehta N, Remaley AT. Complex association of apolipoprotein E-containing HDL with coronary artery disease burden in cardiovascular disease. JCI Insight 2022; 7:159577. [PMID: 35389891 PMCID: PMC9220837 DOI: 10.1172/jci.insight.159577] [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: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although traditional lipid parameters and coronary imaging techniques are valuable for cardiovascular disease (CVD) risk prediction, better diagnostic tests are still needed. Methods In a prospective, observational study, 795 individuals had extensive cardiometabolic profiling, including emerging biomarkers, such as apolipoprotein E–containing HDL-cholesterol (ApoE-HDL-C). Coronary artery calcium (CAC) score was assessed in the entire cohort, and quantitative coronary computed tomography angiography (CCTA) characterization of total burden, noncalcified burden (NCB), and fibrous plaque burden (FB) was performed in a subcohort (n = 300) of patients stratified by concentration of ApoE-HDL-C. Total and HDL-containing apolipoprotein C-III (ApoC-III) were also measured. Results Most patients had a clinical diagnosis of coronary artery disease (CAD) (n = 80.4% of 795), with mean age of 59 years, a majority being male (57%), and about half on statin treatment. The low ApoE-HDL-C group had more severe stenosis (11% vs. 2%, overall P < 0.001), with higher CAC as compared with high ApoE-HDL-C. On quantitative CCTA, the high ApoE-HDL-C group had lower NCB (β = –0.24, P = 0.0001), which tended to be significant in a fully adjusted model (β = –0.32, P = 0.001) and altered by ApoC-III in HDL levels. Low ApoE-HDL-C was significantly associated with LDL particle number (β = 0.31; P = 0.0001). Finally, when stratified by FB, ApoC-III in HDL showed a more robust predictive value of CAD over ApoE-HDL-C (AUC: 0.705, P = 0.0001) in a fully adjusted model. Conclusion ApoE-containing HDL-C showed a significant association with early coronary plaque characteristics and is affected by the presence of ApoC-III, indicating that low ApoE-HDL-C and high ApoC-III may be important markers of CVD severity. Trial Registration ClinicalTrials.gov: NCT01621594. Funding This work was supported by the NHLBI at the NIH Intramural Research Program.
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Affiliation(s)
- Alexander V Sorokin
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Nidhi Patel
- Section of Inflammation and Cardiometabolic Diseases, NIH, NHLBI, Bethesda, United States of America
| | - Khaled M Abdelrahman
- Section of Inflammation and Cardiometabolic Diseases, NIH, NHLBI, Bethesda, United States of America
| | - Clarence Ling
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Mart Reimund
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Giorgio Graziano
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Maureen Sampson
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Martin Playford
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, NIH, NHLBI, Bethesda, United States of America
| | - Aarthi Reddy
- Section of Inflammation and Cardiometabolic Diseases, NIH, NHLBI, Bethesda, United States of America
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, NIH, NHLBI, Bethesda, United States of America
| | - Michael Stagliano
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Marcelo Amar
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Marcus Y Chen
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
| | - Nehal Mehta
- Section of Inflammation and Cardiometabolic Diseases, NIH, NHLBI, Bethesda, United States of America
| | - Alan T Remaley
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch, NIH, NHLBI, Bethesda, United States of America
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Recent Trends in Artificial Intelligence-Assisted Coronary Atherosclerotic Plaque Characterization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910003. [PMID: 34639303 PMCID: PMC8508413 DOI: 10.3390/ijerph181910003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 01/21/2023]
Abstract
Coronary artery disease is a major cause of morbidity and mortality worldwide. Its underlying histopathology is the atherosclerotic plaque, which comprises lipid, fibrous and—when chronic—calcium components. Intravascular ultrasound (IVUS) and intravascular optical coherence tomography (IVOCT) performed during invasive coronary angiography are reference standards for characterizing the atherosclerotic plaque. Fine image spatial resolution attainable with contemporary coronary computed tomographic angiography (CCTA) has enabled noninvasive plaque assessment, including identifying features associated with vulnerable plaques known to presage acute coronary events. Manual interpretation of IVUS, IVOCT and CCTA images demands scarce physician expertise and high time cost. This has motivated recent research into and development of artificial intelligence (AI)-assisted methods for image processing, feature extraction, plaque identification and characterization. We performed parallel searches of the medical and technical literature from 1995 to 2021 focusing respectively on human plaque characterization using various imaging modalities and the use of AI-assisted computer aided diagnosis (CAD) to detect and classify atherosclerotic plaques, including their composition and the presence of high-risk features denoting vulnerable plaques. A total of 122 publications were selected for evaluation and the analysis was summarized in terms of data sources, methods—machine versus deep learning—and performance metrics. Trends in AI-assisted plaque characterization are detailed and prospective research challenges discussed. Future directions for the development of accurate and efficient CAD systems to characterize plaque noninvasively using CCTA are proposed.
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Artificial Intelligence to Assist in Exclusion of Coronary Atherosclerosis During CCTA Evaluation of Chest Pain in the Emergency Department: Preparing an Application for Real-world Use. J Digit Imaging 2021; 34:554-571. [PMID: 33791909 DOI: 10.1007/s10278-021-00441-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/09/2020] [Accepted: 03/01/2021] [Indexed: 12/22/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) evaluation of chest pain patients in an emergency department (ED) is considered appropriate. While a "negative" CCTA interpretation supports direct patient discharge from an ED, labor-intensive analyses are required, with accuracy in jeopardy from distractions. We describe the development of an artificial intelligence (AI) algorithm and workflow for assisting qualified interpreting physicians in CCTA screening for total absence of coronary atherosclerosis. The two-phase approach consisted of (1) phase 1-development and preliminary testing of an algorithm for vessel-centerline extraction classification in a balanced study population (n = 500 with 50% disease prevalence) derived by retrospective random case selection, and (2) phase 2-simulated clinical Trialing of developed algorithm on a per-case (entire coronary artery tree) basis in a more "real-world" study population (n = 100 with 28% disease prevalence) from an ED chest pain series. This allowed pre-deployment evaluation of the AI-based CCTA screening application which provides vessel-by-vessel graphic display of algorithm inference results integrated into a clinically capable viewer. Algorithm performance evaluation used area under the receiver operating characteristic curve (AUC-ROC); confusion matrices reflected ground truth vs AI determinations. The vessel-based algorithm demonstrated strong performance with AUC-ROC = 0.96. In both phase 1 and phase 2, independent of disease prevalence differences, negative predictive values at the case level were very high at 95%. The rate of completion of the algorithm workflow process (96% with inference results in 55-80 s) in phase 2 depended on adequate image quality. There is potential for this AI application to assist in CCTA interpretation to help extricate atherosclerosis from chest pain presentations.
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Automatic quantification of myocardium and pericardial fat from coronary computed tomography angiography: a multicenter study. Eur Radiol 2020; 31:3826-3836. [PMID: 33206226 DOI: 10.1007/s00330-020-07482-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/03/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To develop a deep learning-based method for simultaneous myocardium and pericardial fat quantification from coronary computed tomography angiography (CCTA) for the diagnosis and treatment of cardiovascular disease (CVD). METHODS We retrospectively identified CCTA data obtained between May 2008 and July 2018 in a multicenter (six centers) CVD study. The proposed method was evaluated on 422 patients' data by two studies. The first overall study involves training model on CVD patients and testing on non-CVD patients, as well as training on non-CVD patients and testing on CVD patients. The second study was performed using the leave-center-out approach. The method performance was evaluated using Dice similarity coefficient (DSC), Jaccard index (JAC), 95% Hausdorff distance (HD95), mean surface distance (MSD), residual mean square distance (RMSD), and the center of mass distance (CMD). The robustness of the proposed method was tested using the nonparametric Kruskal-Wallis test and post hoc test to assess the equality of distribution of DSC values among different tests. RESULTS The automatic segmentation achieved a strong correlation with contour (ICC and R > 0.97, p value < 0.001 throughout all tests). The accuracy of the proposed method remained high through all the tests, with the median DSC higher than 0.88 for pericardial fat and 0.96 for myocardium. The proposed method also resulted in mean MSD, RMSD, HD95, and CMD of less than 1.36 mm for pericardial fat and 1.00 mm for myocardium. CONCLUSIONS The proposed deep learning-based segmentation method enables accurate simultaneous quantification of myocardium and pericardial fat in a multicenter study. KEY POINTS • Deep learning-based myocardium and pericardial fat segmentation method tested on 422 patients' coronary computed tomography angiography in a multicenter study. • The proposed method provides segmentations with high volumetric accuracy (ICC and R > 0.97, p value < 0.001) and similar shape as manual annotation by experienced radiologists (median Dice similarity coefficient ≥ 0.88 for pericardial fat and 0.96 for myocardium).
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Kwan AC, Pourmorteza A, Stutman D, Bluemke DA, Lima JAC. Next-Generation Hardware Advances in CT: Cardiac Applications. Radiology 2020; 298:3-17. [PMID: 33201793 DOI: 10.1148/radiol.2020192791] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Impending major hardware advances in cardiac CT include three areas: ultra-high-resolution (UHR) CT, photon-counting CT, and phase-contrast CT. Cardiac CT is a particularly demanding CT application that requires a high degree of temporal resolution, spatial resolution, and soft-tissue contrast in a moving structure. In this review, cardiac CT is used to highlight the strengths of these technical advances. UHR CT improves visualization of calcified and stented vessels but may result in increased noise and radiation exposure. Photon-counting CT uses multiple photon energies to reduce artifacts, improve contrast resolution, and perform material decomposition. Finally, phase-contrast CT uses x-ray refraction properties to improve spatial and soft-tissue contrast. This review describes these hardware advances in CT and their relevance to cardiovascular imaging.
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Affiliation(s)
- Alan C Kwan
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - Amir Pourmorteza
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - Dan Stutman
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - David A Bluemke
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
| | - João A C Lima
- From the Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP, Suite A3600, Los Angeles, CA 90048-0750 (A.C.K.); Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.P.); Winship Cancer Institute, Emory University, Atlanta, Ga (A.P.); Department of Biomedical Engineering, Georgia Institute of Technology-Emory University, Atlanta, Ga (A.P.); Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Md (D.S.); Extreme Light Infrastructure-Nuclear Physics, Bucharest-Magurele, Romania (D.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); and Department of Cardiology, The Johns Hopkins Hospital, Baltimore, Md (J.A.C.L.)
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From CT to artificial intelligence for complex assessment of plaque-associated risk. Int J Cardiovasc Imaging 2020; 36:2403-2427. [PMID: 32617720 DOI: 10.1007/s10554-020-01926-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
The recent technological developments in the field of cardiac imaging have established coronary computed tomography angiography (CCTA) as a first-line diagnostic tool in patients with suspected coronary artery disease (CAD). CCTA offers robust information on the overall coronary circulation and luminal stenosis, also providing the ability to assess the composition, morphology, and vulnerability of atherosclerotic plaques. In addition, the perivascular adipose tissue (PVAT) has recently emerged as a marker of increased cardiovascular risk. The addition of PVAT quantification to standard CCTA imaging may provide the ability to extract information on local inflammation, for an individualized approach in coronary risk stratification. The development of image post-processing tools over the past several years allowed CCTA to provide a significant amount of data that can be incorporated into machine learning (ML) applications. ML algorithms that use radiomic features extracted from CCTA are still at an early stage. However, the recent development of artificial intelligence will probably bring major changes in the way we integrate clinical, biological, and imaging information, for a complex risk stratification and individualized therapeutic decision making in patients with CAD. This review aims to present the current evidence on the complex role of CCTA in the detection and quantification of vulnerable plaques and the associated coronary inflammation, also describing the most recent developments in the radiomics-based machine learning approach for complex assessment of plaque-associated risk.
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Joshi AA, Lerman JB, Dey AK, Sajja AP, Belur AD, Elnabawi YA, Rodante JA, Aberra TM, Chung J, Salahuddin T, Natarajan B, Dave J, Goyal A, Groenendyk JW, Rivers JP, Baumer Y, Teague HL, Playford MP, Bluemke DA, Ahlman MA, Chen MY, Gelfand JM, Mehta NN. Association Between Aortic Vascular Inflammation and Coronary Artery Plaque Characteristics in Psoriasis. JAMA Cardiol 2019; 3:949-956. [PMID: 30208407 DOI: 10.1001/jamacardio.2018.2769] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Inflammation is critical to atherosclerosis. Psoriasis, a chronic inflammatory disease associated with early cardiovascular events and increased aortic vascular inflammation (VI), provides a model to study the process of early atherogenesis. Fludeoxyglucose F 18 positron emission tomography/computed tomography (18F-FDG PET/CT) helps quantify aortic VI, and coronary computed tomography angiography provides coronary artery disease (CAD) assessment through evaluation of total plaque burden (TB) and noncalcified coronary plaque burden (NCB), luminal stenosis, and high-risk plaques (HRP). To our knowledge, association between aortic VI and broad CAD indices has not yet been assessed in a chronic inflammatory disease state. Such a study may provide information regarding the utility of aortic VI in capturing early CAD. Objective To assess the association between aortic VI and CAD indices, including TB, NCB, luminal stenosis, and HRP prevalence, in psoriasis. Design, Setting, and Participants In a cross-sectional cohort study at the National Institutes of Health, 215 consecutive patients with psoriasis were recruited from surrounding outpatient dermatology practices. All patients underwent 18F-FDG PET/CT for aortic VI assessment, and 190 of 215 patients underwent coronary computed tomography angiography to characterize CAD. The study was conducted between January 1, 2013, and May 31, 2017. Data were analyzed in March 2018. Exposures Aortic VI assessed by 18F-FDG PET/CT. Main Outcomes and Measures Primary outcome: TB and NCB. Secondary outcomes: luminal stenosis and HRP. Results Among 215 patients with psoriasis (mean [SD] age, 50.4 [12.6] years; 126 men [59%]), patients with increased aortic VI had increased TB (standardized β = 0.48; P < .001), and higher prevalence of luminal stenosis (OR, 3.63; 95% CI, 1.71-7.70; P = .001) and HRP (OR, 3.05; 95% CI, 1.42-6.47; P = .004). The aortic VI and TB association was primarily driven by NCB (β = 0.49; P < .001), whereas the aortic VI and HRP association was driven by low-attenuation plaque (OR, 5.63; 95% CI, 1.96-16.19; P = .001). All associations of aortic VI remained significant after adjustment for cardiovascular risk factors: aortic VI and TB (β = 0.23; P < .001), NCB (β = 0.24; P < .001), luminal stenosis (OR, 3.40; 95% CI, 1.40-8.24; P = .007), and HRP (OR, 2.72; 95% CI, 1.08-6.83; P = .03). No association was found between aortic VI and dense-calcified coronary plaque burden. Conclusions and Relevance Aortic VI is associated with broad CAD indices, suggesting that aortic VI may be a surrogate for early CAD. Larger prospective studies need to assess these associations longitudinally and examine treatment effects on these outcomes.
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Affiliation(s)
- Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph B Lerman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aparna P Sajja
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Agastya D Belur
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tsion M Aberra
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan Chung
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Taufiq Salahuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Balaji Natarajan
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jenny Dave
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya Goyal
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacob W Groenendyk
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joshua P Rivers
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Baumer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Mark A Ahlman
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Research Center, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia.,The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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9
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Sorokin AV, Kotani K, Elnabawi YA, Dey AK, Sajja AP, Yamada S, Ueda M, Harrington CL, Baumer Y, Rodante JA, Gelfand JM, Chen MY, Joshi AA, Playford MP, Remaley AT, Mehta NN. Association Between Oxidation-Modified Lipoproteins and Coronary Plaque in Psoriasis. Circ Res 2019; 123:1244-1254. [PMID: 30571459 DOI: 10.1161/circresaha.118.313608] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
RATIONALE Psoriasis is a systemic inflammatory skin disease associated with cardiovascular disease and lipid dysfunction. However, traditional lipid parameters have limited prognostic value, whereas assessing oxidation-modified lipids in this inflammatory driven condition may capture additional risk. Recently, a study showed that psoriasis was associated with increased lipid-rich coronary plaques; therefore, investigating potential relationships with oxidation-modified lipids may speed understanding of increased cardiovascular disease in psoriasis. OBJECTIVE To understand whether oxidation-modified lipids associate with traditional lipid phenotypes, cardiometabolic disease biomarkers, and total coronary plaque, with focus on noncalcified burden (NCB) by coronary computed tomographic angiography in psoriasis. METHODS AND RESULTS Psoriasis subjects and controls (n=252) had profiling for oxidation-modified LDL (low-density lipoprotein), HDL (high-density lipoprotein), Lp(a) (lipoprotein[a]), cholesterol efflux capacity, lipoprotein particle size and number by NMR spectroscopy, and PON-1 (paraoxonase-1) activity. Blinded coronary computed tomographic angiography coronary artery disease characterization included total burden, NCB, and dense-calcified burden. Compared with healthy volunteers, psoriasis subjects were older (mean age, 50.1), had increased body mass index, and homeostatic model assessment of insulin resistance. Psoriasis subjects had increase in oxidized Lp(a), Lp(a), and oxidized HDL (oxHDL; P <0.05 for all) with significant association of oxidized LDL (β=0.10; P=0.020) and oxHDL (β=-0.11; P=0.007) with NCB. Moreover, psoriasis subjects expressed significantly higher PON-1 (kU/µL) activity compared with healthy volunteers (8.55±3.21 versus 6.24±3.82; P=0.01). Finally, psoriasis treatment was associated with a reduction in oxHDL (U/mL; 203.79±88.40 versus 116.36±85.03; P<0.001) and with a concomitant decrease in NCB at 1 year (1.04±0.44 versus 0.95±0.32; P=0.03). CONCLUSIONS Traditional lipids did not capture risk of lipid-rich plaque as assessed by NCB, whereas assaying oxidation-modification of lipids revealed significant association with oxidized LDL and oxHDL. The PON-1 activity was increased in psoriasis suggesting possible compensatory antioxidative effect. Psoriasis treatment was associated with a reduction in oxHDL. These findings support performance of larger studies to understand oxidation-modified lipids in inflammatory states.
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Affiliation(s)
- Alexander V Sorokin
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan (K.K.)
| | - Youssef A Elnabawi
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Amit K Dey
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Aparna P Sajja
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Masashi Ueda
- Hokenkagaku-West, Co, Ltd, Kyoto-City, Japan (M.U.)
| | - Charlotte L Harrington
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yvonne Baumer
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Justin A Rodante
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine (J.M.G.).,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.)
| | - Marcus Y Chen
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Aditya A Joshi
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Martin P Playford
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Alan T Remaley
- Section of Lipoprotein Metabolism, Translational Vascular Medicine Branch (A.T.R.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Nehal N Mehta
- From the Section of Inflammation and Cardiometabolic Diseases, Cardiovascular Branch, (A.V.S., Y.A.E., A.K.D., A.P.S., C.L.H., Y.B., J.A.R., M.Y.C., A.A.J., M.P.P., N.N.M.), National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
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Li Y, Liu J, Huang JW, Song JC, Ma ZL, Shi HB. In vivo MRI detection of atherosclerosis in ApoE-deficient mice by using tenascin-C-targeted USPIO. Acta Radiol 2018; 59:1431-1437. [PMID: 29566551 DOI: 10.1177/0284185118762613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Atherosclerosis is the main cause of cardiovascular and cerebrovascular diseases. Non-invasive molecular imaging to detect and characterize the plaques is essential for reducing life-threatening cardiovascular events. PURPOSE To investigate the possibility of the anti-tenascin-C-USPIO specific probe as a molecular marker of atherosclerotic plaques detected by 7.0-T magnetic resonance imaging (MRI). MATERIAL AND METHODS Twenty ApoE-/- mice fed with a high fat diet were used for detecting the aorta arch atherosclerotic plaques by 7.0-T MRI at 16 and 24 weeks. Ten mice in the targeted group were injected with anti-tenascin-C-USPIO and another ten in the control group were injected with pure USPIO (n = 5 each time point in each group). Histopathologic examination was used to evaluate the plaques and immunohistochemistry analysis was used to compare tenascin-C expression. RESULTS The relative signal intensity (rSI) changes of the targeted group decreased more than those of the control group (16 weeks: -15.65 ± 0.78% vs. -3.43 ± 2.57%; 24 weeks: -26.38 ± 1.54% vs. -11.12 ± 1.60%, respectively; P < 0.05). Histopathological analyses demonstrated visible atherosclerotic plaques formation and development over time from 16 weeks to 24 weeks. Tenascin-C expression of the plaques at 24 weeks was higher than that at 16 weeks (0.22 ± 0.04 vs. 0.13 ± 0.02, P < 0.05). The MR images correlated well with the progression of atherosclerotic plaques. CONCLUSION Tenascin-C expression increased with the progression of atherosclerosis. Anti-tenascin-C-USPIO could provide a useful molecular imaging tool for detecting and monitoring atherosclerotic plaques by MRI.
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Affiliation(s)
- Yan Li
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jun Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jun-wen Huang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jia-cheng Song
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Zhan-long Ma
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai-bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Song FX, Zhou J, Zhou JJ, Shi YX, Zeng MS, Zhang ZY, Lv P, Sheng RF. The diagnosis of coronary plaque stability by multi-slice computed tomography coronary angiography. J Thorac Dis 2018; 10:2365-2376. [PMID: 29850142 DOI: 10.21037/jtd.2018.04.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Coronary computed tomographic angiography is a robust non-invasive method to assess coronary artery disease (CAD) and analyze coronary plaque stability, especially for the non-calcified plaques. The aim of this study was to investigate the differential characteristics between the unstable coronary plaques and the stable coronary plaques using multi-slice computed tomography (MSCT). Methods Sixty patients with coronary heart disease (37 unstable plaques and 31 stable plaques) were included. The napkin ring thickness, napkin-ring sign, plaque CT attenuation and degree of lumen stenosis were retrospectively analyzed. The diagnostic performances of MSCT were determined to predict the unstable plaques. The difference was statistically significant if P<0.05. Results The napkin ring thickness of the unstable plaques was thinner than that of the stable plaques (P<0.05). The napkin-ring sign was more frequently observed in the unstable group (89.2%) than the stable group (22.6%, P<0.05). The average CT value of the unstable plaques (26.8±17.8 HU) was lower than that of the stable plaques (68.5±25.5 HU, P<0.05). The unstable plaques had more severe lumen stenosis or occlusion (70.3%) than the stable plaques (41.9%, P<0.05). The measurable napkin ring thickness of the plaques with a cutoff value of 0.8 mm and an accuracy of 89.5% was one independent factor to predict unstable plaques. The optimal combined threshold of the napkin-ring sign and/or the plaque CT value of 53 HU with an accuracy of 80.9% was to predict unstable plaques. Conclusions The optimal combined threshold of the napkin-ring sign and/or the plaque CT value ≤53 HU may be a good indicator to predict the unstable plaques in patients with CAD. The subgroup of measurable napkin ring thickness of the non-calcified plaques may also be an independent factor to predict the unstable plaques in patients with CAD.
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Affiliation(s)
- Feng-Xiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Jun Zhou
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Jun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu-Xin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhi-Yong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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12
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De Filippo M, Capasso R. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) imaging in the assessment of patients presenting with chest pain suspected for acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:255. [PMID: 27500156 PMCID: PMC4958724 DOI: 10.21037/atm.2016.06.30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/18/2016] [Indexed: 01/19/2023]
Abstract
Acute chest pain is an important clinical challenge and a major reason for presentation to the emergency department. Although multiple imaging techniques are available to assess patients with suspected acute coronary syndrome (ACS), considerable interest has been focused on the use of non-invasive imaging options as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR). According to several recent evidences, CCTA has been shown to represent a useful tool to rapidly and accurately diagnose coronary artery disease (CAD) in patients with low to intermediate cardiovascular risk. CCTA examination has the unique ability to non-invasively depict the coronary anatomy, not only allowing visualization of the lumen of the arteries in order to detect severe stenosis or occlusion responsible of myocardial ischemia, but also allows the assessment of coronary artery wall by demonstrating the presence or absence of CAD. However, routine CCTA is not able to differentiate ischemic from non-ischemic chest pain in patients with known CAD and it does not provide any functional assessment of the heart. Conversely, CMR is considered the gold standard in the evaluation of morphology, function, viability and tissue characterization of the heart. CMR offers a wide range of tools for diagnosing myocardial infarction (MI) at least at the same time of the elevation of cardiac troponin values, differentiating infarct tissue and ischemic myocardium from normal myocardium or mimicking conditions, and distinguishing between new and old ischemic events. In high-risk patients, with acute and chronic manifestations of CAD, CMR may be preferable to CCTA, since it would allow detection, differential diagnosis, prognostic evaluation and management of MI.
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Affiliation(s)
- Massimo De Filippo
- Department of Radiology, University of Parma, Parma Hospital, Parma, Italy
| | - Raffaella Capasso
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
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Abstract
The aims of this study were to identify arteriographic manifestations of acute renal hemorrhage and to evaluate the efficacy of emergency embolization. Emergency renal artery angiography was performed on 83 patients with acute renal hemorrhage. As soon as bleeding arteries were identified, emergency embolization was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The arteriographic presentation and the effect of the treatment for acute renal hemorrhage were analyzed retrospectively. Contrast extravasation was observed in 41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture complicated by a renal artery-calyceal fistula. Another 16 patients had tumor vasculature seen on arteriography. Before the procedure, 35 patients underwent renal artery computed tomography angiography (CTA). Following emergency embolization, complete hemostasis was achieved in 80 patients, although persistent hematuria was present in 3 renal trauma patients and 1 patient who had undergone percutaneous nephrolithotomy (justifying surgical removal of the ipsilateral kidney in this patient). Two-year follow-up revealed an overall effective rate of 95.18 % (79/83) for emergency embolization. There were no serious complications. Emergency embolization is a safe, effective, minimally invasive treatment for renal hemorrhage. Because of the diversified arteriographic presentation of acute renal hemorrhage, proper selection of the embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an important role in diagnosing and localizing the bleeding artery.
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Affiliation(s)
- Hong Liang Wang
- From the Department of Interventional Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Andrew M, John H. The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. Int J Cardiovasc Imaging 2015; 31 Suppl 2:145-57. [DOI: 10.1007/s10554-015-0773-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/15/2015] [Indexed: 11/25/2022]
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Rodriguez K, Kwan AC, Lai S, Lima JAC, Vigneault D, Sandfort V, Pattanayak P, Ahlman MA, Mallek M, Sibley CT, Bluemke DA. Coronary Plaque Burden at Coronary CT Angiography in Asymptomatic Men and Women. Radiology 2015; 277:73-80. [PMID: 26035436 DOI: 10.1148/radiol.2015142551] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose To assess the relationship between total, calcified, and noncalcified coronary plaque burdens throughout the entire coronary vasculature at coronary computed tomographic (CT) angiography in relationship to cardiovascular risk factors in asymptomatic individuals with low-to-moderate risk. Materials and Methods This HIPAA-compliant study had institutional review board approval, and written informed consent was obtained. Two hundred two subjects were recruited to an ongoing prospective study designed to evaluate the effect of HMG-CoA reductase inhibitors on atherosclerosis. Eligible subjects were asymptomatic individuals older than 55 years who were eligible for statin therapy. Coronary CT angiography was performed by using a 320-detector row scanner. Coronary wall thickness and plaque were evaluated in all epicardial coronary arteries greater than 2 mm in diameter. Images were analyzed by using dedicated software involving an adaptive lumen attenuation algorithm. Total plaque index (calcified plus noncalcified plaque) was defined as plaque volume divided by vessel length. Multivariable regression analysis was performed to determine the relationship between risk factors and plaque indexes. Results The mean age of the subjects was 65.5 years ± 6.9 (standard deviation) (36% women), and the median coronary artery calcium (CAC) score was 73 (interquartile range, 1-434). The total coronary plaque index was higher in men than in women (42.06 mm(2) ± 9.22 vs 34.33 mm(2) ± 8.35; P < .001). In multivariable analysis controlling for all risk factors, total plaque index remained higher in men than in women (by 5.01 mm(2); P = .03) and in those with higher simvastatin doses (by 0.44 mm(2)/10 mg simvastatin dose equivalent; P = .02). Noncalcified plaque index was positively correlated with systolic blood pressure (β = 0.80 mm(2)/10 mm Hg; P = .03), diabetes (β = 4.47 mm(2); P = .03), and low-density lipoprotein (LDL) cholesterol level (β = 0.04 mm(2)/mg/dL; P = .02); the association with LDL cholesterol level remained significant (P = .02) after additional adjustment for the CAC score. Conclusion LDL cholesterol level, systolic blood pressure, and diabetes were associated with noncalcified plaque burden at coronary CT angiography in asymptomatic individuals with low-to-moderate risk. (©) RSNA, 2015 Online supplemental material is available for this article.
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Affiliation(s)
- Karen Rodriguez
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Alan C Kwan
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Shenghan Lai
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - João A C Lima
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Davis Vigneault
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Veit Sandfort
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Puskar Pattanayak
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Mark A Ahlman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Marissa Mallek
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - Christopher T Sibley
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
| | - David A Bluemke
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (K.R., A.C.K., D.V., V.S., P.P., M.A.A., M.M., C.T.S., D.A.B.); and Department of Radiology (S.L.) and Cardiology Division, Department of Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md
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Coronary CT angiography in the quantitative assessment of coronary plaques. BIOMED RESEARCH INTERNATIONAL 2014; 2014:346380. [PMID: 25162010 PMCID: PMC4138793 DOI: 10.1155/2014/346380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/17/2014] [Indexed: 01/31/2023]
Abstract
Coronary computed tomography angiography (CCTA) has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.
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Marrugat J. ¿Podemos modernizar la prevención cardiovascular? Rev Clin Esp 2014; 214:253-5. [DOI: 10.1016/j.rce.2014.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
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Li JF, Chen S, Feng JD, Zhang MY, Liu XX. RETRACTED: Probucol via inhibition of NHE1 attenuates LPS-accelerated atherosclerosis and promotes plaque stability in vivo. Exp Mol Pathol 2014; 96:250-6. [PMID: 24594116 DOI: 10.1016/j.yexmp.2014.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 02/23/2014] [Indexed: 01/29/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the authors. Concern had previously been raised about the veracity of some of the data in Figure 6 which appears to contain similar experimental data to many other publications, described here: https://pubpeer.com/publications/72ACDBE9751C8FD443A223FEB806E8#. The corresponding author contacted the journal and acknowledged that some of the experiments were not conducted by the authors themselves and they no longer have confidence in the reliability of the results. The authors would like to apologize for any inconvenience caused. The Editor-in-Chief agreed to retract the article.
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Affiliation(s)
- Jian-Fei Li
- Department of Cardiology, The 4th Hospital of Harbin Medical University, Harbin 150001, China
| | - Song Chen
- Department of Cardiology, The 4th Hospital of Harbin Medical University, Harbin 150001, China
| | - Jun-Duo Feng
- Health examination center, Hospital of Heilongjiang Armed Police Corps, 558 Xinyanglu Road, Harbin 150076, China
| | - Ming-Yu Zhang
- Department of Cardiology, The 4th Hospital of Harbin Medical University, Harbin 150001, China
| | - Xiao-Xia Liu
- Department of Cardiology, The 4th Hospital of Harbin Medical University, Harbin 150001, China
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Carreras F, Leta R, Pons-Lladó G. Impact of multidetector computed tomography noninvasive coronary angiography on epidemiology: toward direct evidence of cardiovascular risk. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:926-928. [PMID: 24774104 DOI: 10.1016/j.rec.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/11/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Francesc Carreras
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau y Clínica Creu Blanca, Barcelona, Spain.
| | - Ruben Leta
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau y Clínica Creu Blanca, Barcelona, Spain
| | - Guillem Pons-Lladó
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau y Clínica Creu Blanca, Barcelona, Spain
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Carreras F, Leta R, Pons-Lladó G. Impacto de la coronariografía no invasiva por tomografía computarizada con multidetectores en epidemiología: hacia una evidencia directa del riesgo cardiovascular. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Wu X, Balu N, Li W, Chen Y, Shi X, Kummitha CM, Yu X, Yuan C, Lu ZR. Molecular MRI of atherosclerotic plaque progression in an ApoE(-/-) mouse model with a CLT1 peptide targeted macrocyclic Gd(III) chelate. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2013; 3:446-455. [PMID: 24116353 PMCID: PMC3784808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/02/2013] [Indexed: 06/02/2023]
Abstract
Molecular imaging of atherosclerotic biomarkers is critical for non-invasive detection and diagnosis of atherosclerotic plaques and therapeutic management. Fibrin and fibronectin accumulate at elevated levels in atherosclerotic plaques and are associated with atherogenesis and disease progression. Molecular imaging of these biomarkers has the potential to non-invasively characterize plaque burden. In this work, we investigated the effectiveness of a peptide-targeted macrocyclic Gd(III) chelate, CLT1-dL-(DOTA-Gd)4, specific to fibrin-fibronectin complexes for molecular MRI of atherosclerosis. Atherosclerotic plaques were induced in Apolipoprotein E-knockout (ApoE(-/-)) mice by feeding with high fat and cholesterol-enriched diet (HFD) for up to 30 weeks. MRI of the vessel wall in the arch aorta was performed at 10, 20 and 30 weeks after the onset of HFD. High spatial-resolution MRI was performed prior and up to 35 minutes after i.v. injection of CLT1-dL-(DOTA-Gd)4 or a nonspecific control agent at a dose of 0.1 mmol-Gd/kg. CLT1-dL-(DOTA-Gd)4 produced stronger enhancement in the atherosclerotic lesions of the aortic wall than the control at all time points in the mice. Cross sectional MR images of the aortic arch revealed progressive thickening of the atherosclerotic vessel wall in the mice on HFD for up to 30 weeks. This progression correlated well to histological staining, as well as fibrin and fibronectin immunochemical stained images. Molecular MRI with CLT1-dL-(DOTA-Gd)4 has a potential for detecting atherosclerosis and non-invasive monitoring of the progression of the plaques.
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Affiliation(s)
- Xueming Wu
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
| | - Niranjan Balu
- Department of Radiology, University of WashingtonSeattle, Washington 98019, USA
| | - Wen Li
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
| | - Yong Chen
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
| | - Xiaoyue Shi
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
| | - China M Kummitha
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
| | - Xin Yu
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
| | - Chun Yuan
- Department of Radiology, University of WashingtonSeattle, Washington 98019, USA
| | - Zheng-Rong Lu
- Department of Biomedical Engineering, Case Western Reserve UniversityCleveland, OH 44106, USA
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Guo T, Wang J, Yang J, Chen W, An G, Fan L, Peng Q. Lentivirus-mediated RNA interference of chymase increases the plaque stability in atherosclerosis in vivo. Exp Mol Pathol 2013; 95:51-6. [PMID: 23712028 DOI: 10.1016/j.yexmp.2013.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 11/19/2022]
Abstract
Chymase activity was proved to be closely related with plaque vulnerability in a hamster model of atherosclerosis with chymase inhibitors. Considering that chymase inhibitors are nonspecific, here we further investigated the role of chymase in atherosclerosis in vivo through injection of lentivirus containing chymase shRNA or chymase cDNA. Our results revealed that silencing of the chymase gene by shRNA remarkably enhanced atherosclerosis plaque stability without alterations in body weight or serum lipid levels. Lentiviral expression of a gain-of-function chymase gene promoted the formation of vulnerable plaque in hamsters. Mechanistically, chymase functions as an activator of MMP9 in atherosclerotic lesions that induces plaque instability.
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Affiliation(s)
- Tao Guo
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University, Qilu Hospital, Jinan City, Shandong 250012, China
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