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Manubolu VS, Ichikawa K, Budoff MJ. Innovations in cardiac computed tomography: Imaging in coronary artery disease. Prog Cardiovasc Dis 2024; 84:51-59. [PMID: 38754532 DOI: 10.1016/j.pcad.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool in the non-invasive evaluation of coronary artery disease (CAD). Recent advancements in imaging techniques, quantitative plaque assessment methods, assessment of coronary physiology, and perivascular coronary inflammation have propelled CCTA to the forefront of CAD management, enabling precise risk stratification, disease monitoring, and evaluation of treatment response. However, challenges persist, including the need for cardiovascular outcomes data for therapy modifications based on CCTA findings and the lack of standardized quantitative plaque assessment techniques to establish universal guidelines for treatment strategies. This review explores the current utilization of CCTA in clinical practice, highlighting its clinical impact and discussing challenges and opportunities for future development. By addressing these nuances, CCTA holds promise for revolutionizing coronary imaging and improving CAD management in the years to come. Ultimately, the goal is to provide precise risk stratification, optimize medical therapy, and improve cardiovascular outcomes while ensuring cost-effectiveness for healthcare systems.
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Roukoz H, Tholakanahalli V. Epicardial ablation of ventricular tachycardia in ischemic cardiomyopathy: A review and local experience. Indian Pacing Electrophysiol J 2024; 24:84-93. [PMID: 38340957 PMCID: PMC11010455 DOI: 10.1016/j.ipej.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/29/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
Myocardial scar in ischemic cardiomyopathy is predominantly endocardial, however, between 5% and 15% of these patients have an arrhythmogenic epicardial substrate. Percutaneous epicardial ablation should be considered in patients with ICM and VT especially if they failed an endocardial ablation. Simultaneous epicardial and endocardial ablation of VT in ICM may reduce short- and medium-term VT recurrence compared with an endocardial only approach. Cardiac imaging could be used to help guide patient selection for a combined epi-endo approach. Complications related to epicardial access can happen in up to 7% of patients. Epicardial ablation in these patients should be referred to experienced tertiary centers. We review the literature and share interesting cases.
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Nadel J, Wang X, Saha P, Bongers A, Tumanov S, Giannotti N, Chen W, Vigder N, Chowdhury MM, da Cruz GL, Velasco C, Prieto C, Jabbour A, Botnar RM, Stocker R, Phinikaridou A. Molecular magnetic resonance imaging of myeloperoxidase activity identifies culprit lesions and predicts future atherothrombosis. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae004. [PMID: 38370393 PMCID: PMC10870993 DOI: 10.1093/ehjimp/qyae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
Aims Unstable atherosclerotic plaques have increased activity of myeloperoxidase (MPO). We examined whether molecular magnetic resonance imaging (MRI) of intraplaque MPO activity predicts future atherothrombosis in rabbits and correlates with ruptured human atheroma. Methods and results Plaque MPO activity was assessed in vivo in rabbits (n = 12) using the MPO-gadolinium (Gd) probe at 8 and 12 weeks after induction of atherosclerosis and before pharmacological triggering of atherothrombosis. Excised plaques were used to confirm MPO activity by liquid chromatography-tandem mass spectrometry (LC-MSMS) and to determine MPO distribution by histology. MPO activity was higher in plaques that caused post-trigger atherothrombosis than plaques that did not. Among the in vivo MRI metrics, the plaques' R1 relaxation rate after administration of MPO-Gd was the best predictor of atherothrombosis. MPO activity measured in human carotid endarterectomy specimens (n = 30) by MPO-Gd-enhanced MRI was correlated with in vivo patient MRI and histological plaque phenotyping, as well as LC-MSMS. MPO-Gd retention measured as the change in R1 relaxation from baseline was significantly greater in histologic and MRI-graded American Heart Association (AHA) type VI than type III-V plaques. This association was confirmed by comparing AHA grade to MPO activity determined by LC-MSMS. Conclusion We show that elevated intraplaque MPO activity detected by molecular MRI employing MPO-Gd predicts future atherothrombosis in a rabbit model and detects ruptured human atheroma, strengthening the translational potential of this approach to prospectively detect high-risk atherosclerosis.
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Affiliation(s)
- James Nadel
- Heart Research Institute, Arterial Inflammation and Redox Biology Group, 7 Eliza St, Newtown, Sydney, NSW 2042, Australia
- Department of Cardiology, St Vincent’s Hospital, Sydney, NSW, Australia
- Department of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Xiaoying Wang
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Prakash Saha
- Academic Department of Surgery, Cardiovascular Division, King’s College London, London, UK
| | - André Bongers
- Biological Resources Imaging Laboratory, University of New South Wales, Sydney, NSW, Australia
| | - Sergey Tumanov
- Heart Research Institute, Arterial Inflammation and Redox Biology Group, 7 Eliza St, Newtown, Sydney, NSW 2042, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicola Giannotti
- Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Weiyu Chen
- Heart Research Institute, Arterial Inflammation and Redox Biology Group, 7 Eliza St, Newtown, Sydney, NSW 2042, Australia
| | - Niv Vigder
- Heart Research Institute, Arterial Inflammation and Redox Biology Group, 7 Eliza St, Newtown, Sydney, NSW 2042, Australia
| | | | | | - Carlos Velasco
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Claudia Prieto
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Pontificia Universidad Católica de Chile, Institute for Biological and Medical Engineering, Santiago, Chile
| | - Andrew Jabbour
- Department of Cardiology, St Vincent’s Hospital, Sydney, NSW, Australia
- Department of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - René M Botnar
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Pontificia Universidad Católica de Chile, Institute for Biological and Medical Engineering, Santiago, Chile
- King’s BHF Centre of Research Excellence, London, UK
| | - Roland Stocker
- Heart Research Institute, Arterial Inflammation and Redox Biology Group, 7 Eliza St, Newtown, Sydney, NSW 2042, Australia
| | - Alkystis Phinikaridou
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- King’s BHF Centre of Research Excellence, London, UK
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Gaudino M, Di Franco A, Spadaccio C, Rahouma M, Robinson NB, Demetres M, Fremes S, Doenst T. Difference in spontaneous myocardial infarction and mortality in percutaneous versus surgical revascularization trials: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2023; 165:662-669.e14. [PMID: 34045061 PMCID: PMC8802340 DOI: 10.1016/j.jtcvs.2021.04.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/16/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES It has been hypothesized that the survival benefit of coronary artery bypass (CABG) compared with percutaneous interventions (PCI) may be associated with the reduction in spontaneous myocardial infarction (SMI) achieved by surgery. This, however, has not been formally investigated. The present meta-analysis aims to evaluate the association between the difference in SMI and in survival in PCI versus CABG randomized controlled trials (RCTs). METHODS A systematic search was performed to identify all RCTs comparing PCI with CABG for the treatment of coronary artery disease and reporting SMI outcomes. Generic inverse variance method was used to pool outcomes as natural logarithms of the incident rate ratios across studies. Subgroup analysis and interaction test were used to compare the difference of the primary outcome among trials that did and did not report a significant reduction in SMI- in the patients treated by CABG. Primary outcome was all-cause mortality; secondary outcome was SMI. RESULTS Twenty RCTs were included in the meta-analysis. A statistically significant difference in SMI in favor of CABG was found in 7 of the included trials (35%). Overall, PCI was associated with significantly greater all-cause mortality (incident rate ratio, 1.13; 95% confidence interval, 1.01-1.28). At subgroup analysis, a significant difference in survival in favor of CABG was seen only in trials that reported a significant reduction in SMI in the surgical arm (P for interaction 0.02). CONCLUSIONS In the published PCI versus CABG trials, the reduction in all-cause mortality in the surgical arm is associated with the protective effect of CABG against SMI.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, USA
| | - Stephen Fremes
- Schulich Heart Centre, Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany
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Stone PH, Libby P, Boden WE. Fundamental Pathobiology of Coronary Atherosclerosis and Clinical Implications for Chronic Ischemic Heart Disease Management-The Plaque Hypothesis: A Narrative Review. JAMA Cardiol 2023; 8:192-201. [PMID: 36515941 PMCID: PMC11016334 DOI: 10.1001/jamacardio.2022.3926] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Recent clinical and imaging studies underscore that major adverse cardiac events (MACE) outcomes are associated not solely with severe coronary obstructions (ischemia hypothesis or stenosis hypothesis), but with the plaque burden along the entire coronary tree. New research clarifies the pathobiologic mechanisms responsible for plaque development/progression/destabilization leading to MACE (plaque hypothesis), but the translation of these insights to clinical management strategies has lagged. This narrative review elaborates the plaque hypothesis and explicates the current understanding of underlying pathobiologic mechanisms, the provocative destabilizing influences, the diagnostic and therapeutic implications, and their actionable clinical management approaches to optimize the management of patients with chronic coronary disease. Observations Clinical trials of management strategies for patients with chronic coronary artery disease demonstrate that while MACE rate increases progressively with the anatomic extent of coronary disease, revascularization of the ischemia-producing obstruction does not forestall MACE. Most severely obstructive coronary lesions often remain quiescent and seldom destabilize to cause a MACE. Coronary lesions that later provoke acute myocardial infarction often do not narrow the lumen critically. Invasive and noninvasive imaging can identify the plaque anatomic characteristics (plaque burden, plaque topography, lipid content) and local hemodynamic/biomechanical characteristics (endothelial shear stress, plaque structural stress, axial plaque stress) that can indicate the propensity of individual plaques to provoke a MACE. Conclusions and Relevance The pathobiologic construct concerning the culprit region of a plaque most likely to cause a MACE (plaque hypothesis), which incorporates multiple convergent plaque features, informs the evolution of a new management strategy capable of identifying the high-risk portion of plaque wherever it is located along the course of the coronary artery. Ongoing investigations of high-risk plaque features, coupled with technical advances to enable prognostic characterization in real time and at the point of care, will soon enable evaluation of the entire length of the atheromatous coronary artery and broaden the target(s) of our therapeutic intervention to include all regions of the plaque (both flow limiting and nonflow limiting).
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Affiliation(s)
- Peter H Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - William E Boden
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, and Boston University School of Medicine, Boston, Massachusetts
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6
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Ansheles AA. [The Revival of the "Ischemic" Approach in the Assessment of Ischemic Heart Disease: Analysis of Major World Research]. KARDIOLOGIIA 2023; 63:60-67. [PMID: 36749203 DOI: 10.18087/cardio.2023.1.n1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 02/08/2023]
Abstract
This analytical review focuses on large international studies on diagnostics of ischemic heart disease and addresses the role of radionuclide methods in evaluating myocardial perfusion and transient ischemia. Based on the reviewed data, the authors proposed a comprehensive instrumental approach to selecting a tactics for the management of patients with suspected or documented ischemic heart disease and for evaluating their prognosis.
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Affiliation(s)
- A A Ansheles
- Chazov National Medical Research Center of Cardiology, Moscow
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7
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Assessment of indices of conjunctival microvascular function in patients with and without obstructive coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:26-33. [PMID: 36707373 DOI: 10.1016/j.carrev.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atherosclerotic heart disease often remains asymptomatic until presentation with a major adverse cardiovascular event. Primary preventive therapies improve outcomes, but conventional screening often misattributes risk. Vascular imaging can be utilised to detect atherosclerosis, but often involves ionising radiation. The conjunctiva is a readily accessible vascular network allowing non-invasive hemodynamic evaluation. AIM To compare conjunctival microcirculatory function in patients with and without obstructive coronary artery disease. METHODS We compared the conjunctival microcirculation of myocardial infarction patients (MI-cohort) to controls with no obstructive coronary artery disease (NO-CAD cohort). Conjunctival imaging was performed using a smartphone and slit-lamp biomicroscope combination. Microvascular indices of axial (Va) and cross-sectional (Vcs) velocity; blood flow rate (Q); and wall shear rate (WSR) were compared in all conjunctival vessels between 5 and 45 μm in diameter. RESULTS A total of 127 patients were recruited (66 MI vs 61 NO-CAD) and 3602 conjunctival vessels analysed (2414 MI vs 1188 NO-CAD). Mean Va, Vcs and Q were significantly lower in the MI vs NO-CAD cohort (Va 0.50 ± 0.17 mm/s vs 0.55 ± 0.15 mm/s, p < 0.001; Vcs 0.35 ± 0.12 mm/s vs 0.38 ± 0.10 mm/s, p < 0.001; Q 154 ± 116 pl/s vs 198 ± 130 pl/s, p < 0.001). To correct for differences in mean vessel diameter, WSR was compared in 10-36 μm vessels (3268/3602 vessels) and was lower in the MI-cohort (134 ± 64 s-1 vs 140 ± 63 s-1, p = 0.002). CONCLUSIONS Conjunctival microcirculatory alterations can be observed in patients with obstructive coronary artery disease. The conjunctival microvasculature merits further evaluation in cardiovascular risk screening.
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Justo FA, de Deus Herrera B, Soares PR, Scudeler TL. Plato's allegory of the cave and the paradigm of complete revascularization in STEMI. Clin Cardiol 2022; 46:232-233. [PMID: 36541034 PMCID: PMC9933109 DOI: 10.1002/clc.23946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/16/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fernanda A. Justo
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Bruna de Deus Herrera
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Paulo R. Soares
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Thiago L. Scudeler
- Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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9
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Limpijankit T, Jongjirasiri S, Meemook K, Unwanatham N, Thakkinstian A, Laothamatas J. Predictive values of coronary artery calcium and arterial stiffness for long-term cardiovascular events in patients with stable coronary artery disease. Clin Cardiol 2022; 46:171-183. [PMID: 36448219 PMCID: PMC9933115 DOI: 10.1002/clc.23955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subclinical atherosclerosis detected by increased coronary artery calcium (CAC) or arterial stiffness as reflected by cardio-ankle vascular index (CAVI) has been associated with major adverse cardiovascular events (MACEs). However, comparative data from these two assessments in the same population are still limited. METHODS From 2005 to 2013, patients with stable coronary artery disease (CAD), both asymptomatic and symptomatic who underwent both coronary computed tomography and CAVI were enrolled and followed for occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke) until December 2019. A cause-specific hazard model was applied to assess the associations of CAC score, and CAVI with long-term MACEs. RESULTS A total of 8687 patients participated. Of them, CAC scores were 0, 1-99, 100-399, and ≥400 in 49.7%, 31.9%, 12.3%, and 6.1%, respectively. Arterial stiffness (CAVI ≥ 9.0) was associated with the magnitude of CAC in 23.8%, 36.3%, 44.5%, and 56.2%, respectively. During an average of 9.9 ± 2.4 years follow-up, MACEs occurred in 8.0% (95% CI: 7.4%, 8.6%) of subjects. After adjusting for covariables, CAC scores of 100-399 and ≥400, and CAVIs of ≥9.0 were found to independently predict the occurrence of MACEs with the hazard ratios (95% CI) of 1.70 (1.13, 1.98), 1.87 (1.33, 2.63), and 1.27 (1.06, 1.52), respectively. Other risk predictors were hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), aspirin, and statin therapy. CONCLUSIONS A CAC score ≥100 or a CAVI ≥ 9.0 predicts the long-term occurrence of MACEs in both asymptomatic and symptomatic patients with stable CAD. These two noninvasive tests can be used as screening tools to guide treatment for the prevention of future CV events.
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Affiliation(s)
- Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Sutipong Jongjirasiri
- Department of Radiology, Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Krissada Meemook
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Nattawut Unwanatham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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De Vita A, Pizzi C, Tritto I, Morrone D, Villano A, Bergamaschi L, Lanza GA. Clinical outcomes of patients with coronary microvascular dysfunction in absence of obstructive coronary atherosclerosis. J Cardiovasc Med (Hagerstown) 2022; 23:421-426. [PMID: 35763761 DOI: 10.2459/jcm.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Up to 50% of patients presenting with stable, mainly exercise-induced, chest pain and 10-20% of those admitted to hospital with chest pain suggesting an acute coronary syndrome show normal or near-normal coronary arteries at angiography. Coronary microvascular dysfunction (CMD) is a major cause of symptoms in these patients. However, controversial data exist about their prognosis. In this article, we critically review characteristics and results of the main studies that assessed clinical outcome of patients with angina chest pain and nonobstructive coronary artery disease presenting with either a stable angina pattern or an acute coronary syndrome. Published data indicate that the patients included in most studies are heterogeneous and a major determinant of clinical outcome is the presence of atherosclerotic, albeit not obstructive, coronary artery disease. Long-term prognosis seems instead excellent in patients with totally normal coronary arteries and a syndrome of CMD-related stable angina (microvascular angina). On the other hand, the prognostic impact of CMD in patients presenting with an acute coronary syndrome needs to be better assessed in future studies.
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Affiliation(s)
- Antonio De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome
| | - Carmine Pizzi
- Università di Bologna, Alma Mater Studiorum, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna
| | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia
| | - Doralisa Morrone
- Università di Pisa, Dipartimento di patologia chirurgica, medica, molecolare e dell'area critica, Pisa, Italy
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome
| | - Luca Bergamaschi
- Università di Bologna, Alma Mater Studiorum, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna
| | - Gaetano A Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome
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11
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Cryptogenic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Dzaye O, Razavi AC, Blaha MJ, Mortensen MB. Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management. Curr Opin Cardiol 2021; 36:769-775. [PMID: 34620792 PMCID: PMC8547346 DOI: 10.1097/hco.0000000000000911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a summary of recent literature on the relative impact of luminal stenosis versus atherosclerotic plaque burden in atherosclerotic cardiovascular disease (ASCVD) risk stratification and management. RECENT FINDINGS Recent results from both randomized controlled clinical trials as well as observational cohort studies have demonstrated that ASCVD risk is mediated mainly by the extent of atherosclerotic disease burden rather than by the presence of coronary stenosis or inducible ischemia. Although patients with obstructive CAD are generally at higher risk for ASCVD events than patients with nonobstructive CAD, this is driven by a higher plaque burden in those with obstructive CAD. Accordingly, the ASCVD risk for a given plaque burden is similar in patients with and without obstructive CAD. Accompanying these observations are randomized controlled trial data, which show that optimization of medical therapy instead of early revascularization is most important for improving prognosis in patients with stable obstructive CAD. SUMMARY Emerging evidence shows that atherosclerotic plaque burden, and not stenosis per se, is the main driver of ASCVD risk in patients with CAD. This information challenges the current paradigm of selecting patients for intensive secondary prevention measures based primarily on the presence of obstructive CAD.
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Affiliation(s)
- Omar Dzaye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alexander C. Razavi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Martin Bødtker Mortensen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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13
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De Filippo O, Di Franco A, Boretto P, Bruno F, Cusenza V, Desalvo P, Demetres M, Saglietto A, Franchin L, Piroli F, Marengo G, Elia E, Falk V, Conrotto F, Doenst T, Rinaldi M, De Ferrari GM, D'Ascenzo F, Gaudino M. Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01238-1. [PMID: 34538641 DOI: 10.1016/j.jtcvs.2021.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Comparative data after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs distal) are scant. The aim of this meta-analysis was to investigate outcomes after PCI or CABG for ULMCA disease according to lesion site. METHODS Randomized controlled trials (RCTs) and adjusted observational studies that compared PCI versus CABG in patients with ULMCA disease and reported outcomes according to lesion site were systematically identified. Major adverse cardiovascular events (MACE; a composite of all-cause death, myocardial infarction, stroke, and repeat revascularization) and all-cause death were the co-primary end points. Individual components of MACE were secondary end points. Sensitivity analysis including RCTs only were performed for each outcome. RESULTS Nine studies (3 RCTs, 6 adjusted observational), encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or distal ULMCA, respectively) were included. At the 5-year follow-up, there were no significant differences between CABG and PCI for MACE, death, or any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10 [95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95% CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The benefit of CABG for MACE and revascularization was confirmed in the analysis limited to RCTs, whereas the benefit for mortality was not. CONCLUSIONS Among patients with distal ULMCA disease, CABG is associated with lower incidence of MACE and revascularization compared with PCI, whereas no differences in outcomes were observed for ostial/shaft ULMCA disease.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Paolo Boretto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Vincenzo Cusenza
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Paolo Desalvo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences, Translational Cardiovascular Technologies, ETH Zurich, Zurich, Switzerland
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Huang R, DeMarco JK, Ota H, Macedo TA, Abdelmoneim SS, Huston J, Pellikka PA, Mulvagh SL. Prognostic Value of Intraplaque Neovascularization Detected by Carotid Contrast-Enhanced Ultrasound in Patients Undergoing Stress Echocardiography. J Am Soc Echocardiogr 2021; 34:614-624. [DOI: 10.1016/j.echo.2020.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
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Urbak L, Ripa RS, Sandholt BV, Kjaer A, Sillesen H, Graebe M. Carotid plaque inflammatory activity assessed by 2-[18F]FDG-PET imaging decrease after a neurological thromboembolic event. EJNMMI Res 2021; 11:30. [PMID: 33755791 PMCID: PMC7988031 DOI: 10.1186/s13550-021-00773-y] [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: 10/29/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Atherosclerotic plaque vulnerability is comprised by plaque composition driven by inflammatory activity and these features can be depicted with 3D ultrasound and 2-[18F]FDG-PET, respectively. The study investigated timely changes in carotid artery plaque inflammation and morphology after a thromboembolic event with PET/CT and novel ultrasound volumetric grayscale median (GSM) readings. Patients with a single hemisphere-specific neurological symptom and the presence of an ipsilateral carotid artery atherosclerotic plaque were prospectively included to both 2-[18F]FDG PET/CT and 3D ultrasound scans of the plaque immediately after their event and again three months later. On PET/CT images the maximum standardized uptake value (SUVmax) was measured and the volumetric ultrasound acquisitions were analyzed using a semiautomated software measuring GSM values. Results Baseline scans were performed by a mean of 7 days (range 2–14) after the symptom and again after 98 days (range 91–176). For the entire group (n = 14), we found a decrease in average SUVmax from baseline to follow-up of − 0.18 (95% confidence interval: − 0.34 to − 0.02, P = 0.034). GSM did not increase significantly over time (mean change: + 2.21, 95% confidence interval: − 17.02 to 21.44, P = 0.808). Conclusion A decrease in culprit lesion 2-[18F]FDG-uptake 3 months after an event indicates a decrease in inflammatory activity, suggesting that carotid plaque stabilization over time. 3D ultrasound morphological quantitative differences in GSM were not detectable after 3 months.
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Affiliation(s)
- Laerke Urbak
- Department of Vascular Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Rasmus S Ripa
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Benjamin V Sandholt
- Department of Vascular Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Martin Graebe
- Department of Vascular Surgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Anatomic and Flow Characteristics of Left Anterior Descending Coronary Artery Angiographic Stenoses Predisposing to Myocardial Infarction. Am J Cardiol 2021; 141:7-15. [PMID: 33220322 DOI: 10.1016/j.amjcard.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
The impact of the anatomic characteristics of coronary stenoses on the development of future coronary thrombosis has been controversial. This study aimed at identifying the anatomic and flow characteristics of left anterior descending (LAD) coronary artery stenoses that predispose to myocardial infarction, by examining angiograms obtained before the index event. We identified 90 patients with anterior ST-elevation myocardial infarction (STEMI) for whom coronary angiograms and their reconstruction in the three-dimensional space were available at 6 to 12 months before the STEMI, and at the revascularization procedure. The majority of culprit lesions responsible for STEMI occurred between 20 and 40 mm from the LAD ostium, whereas the majority of stable lesions not associated with STEMI were found in distances >60 mm (p < 0.001). Culprit lesions were significantly more stenosed (diameter stenosis 68.6 ± 14.2% vs 44.0 ± 10.4%, p < 0.001), and significantly longer than stable ones (15.3 ± 5.4 mm vs 9.2 ± 2.5 mm, p < 0.001). Bifurcations at culprit lesions were significantly more frequent (88.8%) compared with stable lesions (34.4%, p < 0.001). Computational fluid dynamics simulations demonstrated that hemodynamic conditions in the vicinity of culprit lesions promote coronary thrombosis due to flow recirculation. A multiple logistic regression model with diameter stenosis, lesion length, distance from the LAD ostium, distance from bifurcation, and lesion symmetry, showed excellent accuracy in predicting the development of a culprit lesion (AUC: 0.993 [95% CI: 0.969 to 1.000], p < 0.0001). In conclusion, specific anatomic and hemodynamic characteristics of LAD stenoses identified on coronary angiograms may assist risk stratification of patients by predicting sites of future myocardial infarction.
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Hanke H, Lenz C, Finking G. The Discovery of the Pathophysiological Aspects of Atherosclerosis — A Review. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098609] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H. Hanke
- From the College of Medicine, Department of Internal Medicine, Division of Cardiology, University of Ulm, Germany
| | - Chr. Lenz
- From the College of Medicine, Department of Internal Medicine, Division of Cardiology, University of Ulm, Germany
| | - G. Finking
- From the College of Medicine, Department of Internal Medicine, Division of Cardiology, University of Ulm, Germany
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18
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, McNulty I, Uemura S, Kakuta T, Jang IK. Predictors of Rapid Plaque Progression: An Optical Coherence Tomography Study. JACC Cardiovasc Imaging 2020; 14:1628-1638. [PMID: 33011121 DOI: 10.1016/j.jcmg.2020.08.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to identify morphological predictors of rapid plaque progression. BACKGROUND Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former pattern will cause stable angina when the narrowing reaches a critical threshold, whereas the latter pattern may lead to acute coronary syndromes or sudden cardiac death. METHODS Patients who underwent optical coherence tomography (OCT) imaging during the index procedure and follow-up angiography with a minimum interval of 6 months were selected. Nonculprit lesions with a diameter stenosis of ≥30% on index angiography were assessed. Lesion progression was defined as a decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with rapid progression, morphological changes from baseline to follow-up were assessed. RESULTS Among 517 lesions in 248 patients, 50 lesions showed rapid progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%, respectively), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%, respectively), layered plaque (60.0% vs. 34.0%, respectively), macrophage accumulation (62.0% vs. 42.4%, respectively), microvessel (46.0% vs. 29.1%, respectively), plaque rupture (12.0% vs. 4.7%, respectively), and thrombus (6.0% vs. 1.1%, respectively) at baseline compared with those without rapid progression. Multivariate analysis identified lipid-rich plaque (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.02 to 4.62; p = 0.045]), TCFA (OR: 5.85; 95% CI: 2.01 to 17.03; p = 0.001), and layered plaque (OR: 2.19; 95% CI: 1.03 to 4.17; p = 0.040) as predictors of subsequent rapid lesion progression. In a subgroup analysis for plaques with rapid progression, a new layer was detected in 25 of 41 plaques (61.0%) at follow-up. CONCLUSIONS Lipid-rich plaques, TCFA, and layered plaques were predictors of subsequent rapid plaque progression. A new layer, a signature of previous plaque disruption and healing, was detected in more than half of the lesions with rapid progression at follow-up. (Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
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Affiliation(s)
- Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea.
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Choi H, Uceda DE, Dey AK, Abdelrahman KM, Aksentijevich M, Rodante JA, Elnabawi YA, Reddy A, Keel A, Erb-Alvarez J, Teague H, Playford MP, Zhou W, Chen MY, Gelfand JM, Bluemke DA, Buckler A, Mehta NN. Treatment of Psoriasis With Biologic Therapy Is Associated With Improvement of Coronary Artery Plaque Lipid-Rich Necrotic Core: Results From a Prospective, Observational Study. Circ Cardiovasc Imaging 2020; 13:e011199. [PMID: 32927971 DOI: 10.1161/circimaging.120.011199] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lipid-rich necrotic core (LRNC), a high-risk coronary plaque feature assessed by coronary computed tomography angiography, is associated with increased risk of future cardiovascular events in patients with subclinical, nonobstructive coronary artery disease. Psoriasis is a chronic inflammatory condition that is associated with increased prevalence of high-risk coronary plaque and risk of cardiovascular events. This study characterized LRNC in psoriasis and how LRNC modulates in response to biologic therapy. METHODS Consecutive biologic naïve psoriasis patients (n=209) underwent coronary computed tomography angiography at baseline and 1-year to assess changes in LRNC using a novel histopathologically validated software (vascuCAP Elucid Bioimaging, Boston, MA) before and after biologic therapy over 1 year. RESULTS Study participants were middle-aged, predominantly male with similar cardiometabolic and psoriasis status between treatment groups. In all participants at baseline, LRNC was associated with Framingham risk score (β [standardized β]=0.12 [95% CI, 0.00-0.15]; P=0.045), and psoriasis severity (β=0.13 [95% CI, 0.01-0.26]; P=0.029). At 1-year, participants receiving biologic therapy had a reduction in LRNC (mm2; 3.12 [1.99-4.66] versus 2.97 [1.84-4.35]; P=0.028), while those who did not receive biologic therapy over 1 year demonstrated no significant change with nominally higher LRNC (3.12 [1.82-4.60] versus 3.34 [2.04-4.74]; P=0.06). The change in LRNC was significant compared with that of the nonbiologic treated group (ΔLRNC, -0.22 mm2 versus 0.14 mm2, P=0.004) and remained significant after adjusting for cardiovascular risk factors and psoriasis severity (β=-0.09 [95% CI, -0.01 to -0.18]; P=0.033). CONCLUSIONS LRNC was associated with psoriasis severity and cardiovascular risk factors in psoriasis. Additionally, there was favorable modification of LRNC in those on biologic therapy. This study provides evidence of potential reduction in LRNC with treatment of systemic inflammation. Larger, longer follow-up prospective studies should be conducted to understand how changes in LRNC may translate into a reduction in future cardiovascular events in psoriasis.
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Affiliation(s)
- Harry Choi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Domingo E Uceda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Khaled M Abdelrahman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Milena Aksentijevich
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Aarthi Reddy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Julie Erb-Alvarez
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Heather Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Wunan Zhou
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
| | | | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.)
| | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (H.C., D.E.U., A.K.D., K.M.A., M.A., J.A.R., Y.A.E., A.R., A.K., J.E.-A., H.T., M.P.P., W.Z., M.Y.C., N.N.M.)
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Lanza GA, Crea F, Kaski JC. Clinical outcomes in patients with primary stable microvascular angina: is the jury still out? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 5:283-291. [PMID: 31168622 DOI: 10.1093/ehjqcco/qcz029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 01/14/2023]
Abstract
Several studies have demonstrated that angina chest pain in presence of normal or near normal coronary arteries (NCAs) is mainly related to coronary microvascular dysfunction (CMD). However, controversial findings exist about clinical outcome of these patients. In this article, we critically review characteristics and results of the main clinical studies reporting clinical outcome of stable patients with angina chest pain and non-obstructive coronary artery disease (NO-CAD). Published data indicate that clinical outcomes of these patients are heterogeneous, but those with strict criteria for primary stable microvascular angina (MVA, i.e. typical angina with NCAs mainly related to efforts) do not appear to have an increased mortality or risk of major coronary events. A major determinant of outcome in patients with MVA and NO-CAD seems instead related to non-critical atherosclerotic disease, the presence of which should suggest a more aggressive management of cardiovascular risk factors and preventive management. Future studies should assess whether CMD may have a relevant prognostic role in the latter clinical context and/or in other clinical settings of NO-CAD different from primary stable MVA.
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Affiliation(s)
- Gaetano Antonio Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Cardiologia, Largo A. Gemelli, 8, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Cardiologia, Largo A. Gemelli, 8, Rome, Italy
| | - Juan Carlos Kaski
- Cardiovascular and Cell Sciences Research Institute, St. George's University of London, London, UK
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Araki M, Soeda T, Kim HO, Thondapu V, Russo M, Kurihara O, Shinohara H, Minami Y, Higuma T, Lee H, Yonetsu T, Kakuta T, Jang IK. Spatial Distribution of Vulnerable Plaques: Comprehensive In Vivo Coronary Plaque Mapping. JACC Cardiovasc Imaging 2020; 13:1989-1999. [PMID: 32912472 DOI: 10.1016/j.jcmg.2020.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The authors performed a comprehensive analysis on the distribution of coronary plaques with different phenotypes from our 3-vessel optical coherence tomography (OCT) database. BACKGROUND Previous pathology studies demonstrated that thin-cap fibroatheroma (TCFA) is localized in specific segments of the epicardial coronary arteries. A detailed description of in vivo coronary plaques of various phenotypes has not been reported. METHODS OCT images of all 3 coronary arteries in 131 patients were analyzed every 1 mm to assess plaque phenotype and features of vulnerability. In addition, plaques were divided into tertiles according to percent area stenosis (%AS). RESULTS Among 534 plaques identified in 393 coronary arteries, 27.0% were fibrous plaques, 13.3% were fibrocalcific plaques, 40.8% were thick-cap fibroatheromas, and 18.9% were TCFAs. TCFAs showed clustering in the proximal segment, particularly in the left anterior descending artery. On the other hand, fibrous plaques were relatively evenly distributed throughout the entire length of the coronary arteries. In patients with acute coronary syndromes (ACS), TCFAs showed stronger proximal clustering in the left anterior descending, 2 clustering peaks in the right coronary artery, and 1 clustering peak in the circumflex artery. The pattern of TCFA distribution was less obvious in patients without ACS. The prevalence of TCFA was higher in the highest %AS tertile, compared with the lowest %AS tertile (30% vs. 9%; p < 0.001). CONCLUSIONS The present 3-vessel OCT study showed that TCFAs cluster at specific locations in the epicardial coronary arteries, especially in patients with ACS. TCFA was more prevalent in segments with tight stenosis. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
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Affiliation(s)
- Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan.
| | - Hyung Oh Kim
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vikas Thondapu
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michele Russo
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroki Shinohara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea.
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22
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R. Figulla H, Lauten A, S. Maier L, Sechtem U, Silber S, Thiele H. Percutaneous Coronary Intervention in Stable Coronary Heart Disease -Is Less More? DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:137-144. [PMID: 32234189 PMCID: PMC7132080 DOI: 10.3238/arztebl.2020.0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/07/2019] [Accepted: 12/30/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND This review concerns the putative benefit of percutaneous coronary intervention (PCI) over optimal medical therapy (OMT) for symptomatic patients with stable angina pectoris, or for asymptomatic persons in whom screening tests have revealed coronary heart disease (CHD; this entity has been newly designated chronic coronary syndrome, or CCS). Moreover, it addresses the question whether the indications for which PCI is now performed in Germany on patients with CCS are consistent with current scientific knowledge. METHODS The pathophysiological concept of CHD and ischemia induction is discussed in the light of the scientific literature. This concept implies that PCI might be beneficial in the treatment of CCS. The benefit of PCI over OMT has now been evaluated in seven randomized trials (the so-called milestone trials). The current situation in Germany is presented here as well, on the basis of the available data. RESULTS The pathophysiological concept of CHD implies that the particular coronary artery stenoses that are likely to give rise to a myocardial infarction (the so-called vulnerable plaques) cannot be identified prospectively with current methods. Moreover, a coronary artery stenosis will not necessarily cause myocardial ischemia. All of the randomized trials carried out to date that have compared OMT to PCI-plus-OMT in patients with CCS have led to the conclusion that PCI, because it focuses on individual coronary artery stenoses, cannot prolong survival or lower the incidence of myocardial infarction over the long term. This remains the case even if a single coronary artery stenosis is known to be causing moderate or severe myocardial ischemia (a conclusion of the ISCHEMIA trial). A PCI performed only because the coronary stenosis or stenoses meet certain morphological criteria, without any demonstration of a resulting functional disturbance, is generally detrimental to the health of the patient, with rare exceptions, and is inconsistent with the recommendations of current guidelines. The number of PCIs being performed in Germany at present is high compared to other countries; this arouses concern that the indications for it may be dubious in many cases. CONCLUSION Current data imply that PCI for CCS does not improve outcomes in a large percentage of cases. A symptomatic benefit exists only in patients with frequent angina pectoris. The selection of CCS patients for PCI needs to be more strictly bound to the recommendations of current guidelines, particularly in Germany.
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Affiliation(s)
| | - Alexander Lauten
- Department of Cardiology (CBF), Charité – Universitätsmedizin Berlin
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg
| | | | - Sigmund Silber
- Cardiology practice, Munich and Stent Therapy at the Isar Heart Center, Munich
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Leipzig Heart Center
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23
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Chhai P, Rhee K. Computational study on phase lag of arterial-wall motion for assessment of plaque vulnerability. Proc Inst Mech Eng H 2020; 234:517-526. [PMID: 32036750 DOI: 10.1177/0954411920905697] [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] [Indexed: 11/15/2022]
Abstract
The wall motion of atherosclerotic plaque was analyzed using a computational method, and the effects of tissue viscoelasticity, fibrosis thickness, and lipid-core stiffness on wall displacement waveforms were examined. The viscoelasticity of plaque tissues was modeled using a time Prony series with four Maxwell elements. Computational simulation of tissue indentation tests showed the validity of the proposed viscoelastic constitutive models. Decreasing the relative moduli of the viscoelastic model reduced their viscous characteristics while enhancing the stiffness of the wall, which corresponded with the effects of decreased smooth muscle cells content. A finite-element analysis was conducted for atherosclerotic wall models and wall displacement waveforms were computed. The phase difference between the first harmonics of pressure and displacement waves was selected to represent the time delay of the wall motion. As the relative modulus decreased, the wall displacement and phase lag decreased. A thinner wall and softer lipid core corresponded to a greater wall displacement and smaller phase lag. Because the phase lag of the arterial-wall motion was smaller for the plaque with a thinner cap, lower smooth muscle cells content, and softer lipid core (all features of plaques with high rupture risk), first harmonics of pressure and displacement waves can be used as an index to assess plaque vulnerability.
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Affiliation(s)
- Pengsrorn Chhai
- Department of Mechanical Engineering, Myongji University, Yongin-si, South Korea
| | - Kyehan Rhee
- Department of Mechanical Engineering, Myongji University, Yongin-si, South Korea
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24
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Franchi F, Olthoff M, Krier J, Noble C, Al-Hijji M, Ramaswamy V, Witt T, Burke M, Benscoter M, Lerman A, Sandhu GS, Rodriguez-Porcel M. A Metabolic Intravascular Platform to Study FDG Uptake in Vascular Injury. Cardiovasc Eng Technol 2020; 11:328-336. [PMID: 32002814 DOI: 10.1007/s13239-020-00457-z] [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: 08/01/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Metabolic alterations underlie many pathophysiological conditions, and their understanding is critical for the development of novel therapies. Although the assessment of metabolic changes in vivo has been historically challenging, recent developments in molecular imaging have allowed us to study novel metabolic research concepts directly in the living subject, bringing us closer to patients. However, in many instances, there is need for sensors that are in close proximity to the organ under investigation, for example to study vascular metabolism. METHODS In this study, we developed and validated a metabolic detection platform directly in the living subject under an inflammatory condition. The signal collected by a scintillating fiber is amplified using a photomultiplier tube and decodified by an in-house tunable analysis platform. For in vivo testing, we based our experiments on the metabolic characteristics of macrophages, cells closely linked to inflammation and avid for glucose and its analog 18F-fluorodeoxyglucose (18F-FDG). The sensor was validated in New Zealand rabbits, in which inflammation was induced by either a) high cholesterol (HC) diet for 16 weeks or b) vascular balloon endothelial denudation followed by HC diet. RESULTS There was no difference in weight, hemodynamics, blood pressure, or heart rate between the groups. Vascular inflammation was detected by the metabolic sensor (Inflammation: 0.60 ± 0.03 AU vs. control: 0.48 ± 0.03 AU, p = 0.01), even though no significant inflammation/atherosclerosis was detected by intravascular ultrasound, underscoring the high sensitivity of the system. These findings were confirmed by the presence of macrophages on ex vivo aortic tissue staining. CONCLUSION In this study, we validated a tunable very sensitive metabolic sensor platform that can be used for the detection of vascular metabolism, such as inflammation. This sensor can be used not only for the detection of macrophage activity but, with alternative probes, it could allow the detection of other pathophysiological processes.
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Affiliation(s)
- F Franchi
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.
| | - M Olthoff
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - J Krier
- Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - C Noble
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - V Ramaswamy
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - T Witt
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Burke
- Division of Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - M Benscoter
- Division of Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - A Lerman
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - G S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Rodriguez-Porcel
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
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25
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PCI and CABG for Treating Stable Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:964-976. [PMID: 30819365 DOI: 10.1016/j.jacc.2018.11.053] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/09/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease. Thus, PCI and CABG mechanisms may differ. Viability and/or ischemia detection to guide revascularization have been unable to accurately predict treatment effects of CABG or PCI, questioning a revascularization mechanism for improving survival. By contrast, preventing myocardial infarction may save lives. However, the majority of infarcts are generated by non-flow-limiting stenoses, but PCI is solely focused on treating flow-limiting lesions. Thus, PCI cannot be expected to significantly limit new infarcts, but CABG may do so through providing flow distal to vessel occlusions. All comparisons of CABG to PCI or medical therapy that demonstrate survival effects with CABG also demonstrate infarct reduction. Thus, CABG may differ from PCI by providing "surgical collateralization," prolonging life by preventing myocardial infarctions. The evidence is reviewed here.
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26
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Marlevi D, Mulvagh SL, Huang R, DeMarco JK, Ota H, Huston J, Winter R, Macedo TA, Abdelmoneim SS, Larsson M, Pellikka PA, Urban MW. Combined spatiotemporal and frequency-dependent shear wave elastography enables detection of vulnerable carotid plaques as validated by MRI. Sci Rep 2020; 10:403. [PMID: 31942025 PMCID: PMC6962347 DOI: 10.1038/s41598-019-57317-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/25/2019] [Indexed: 12/29/2022] Open
Abstract
Fatal cerebrovascular events are often caused by rupture of atherosclerotic plaques. However, rupture-prone plaques are often distinguished by their internal composition rather than degree of luminal narrowing, and conventional imaging techniques might thus fail to detect such culprit lesions. In this feasibility study, we investigate the potential of ultrasound shear wave elastography (SWE) to detect vulnerable carotid plaques, evaluating group velocity and frequency-dependent phase velocities as novel biomarkers for plaque vulnerability. In total, 27 carotid plaques from 20 patients were scanned by ultrasound SWE and magnetic resonance imaging (MRI). SWE output was quantified as group velocity and frequency-dependent phase velocities, respectively, with results correlated to intraplaque constituents identified by MRI. Overall, vulnerable lesions graded as American Heart Association (AHA) type VI showed significantly higher group and phase velocity compared to any other AHA type. A selection of correlations with intraplaque components could also be identified with group and phase velocity (lipid-rich necrotic core content, fibrous cap structure, intraplaque hemorrhage), complementing the clinical lesion classification. In conclusion, we demonstrate the ability to detect vulnerable carotid plaques using combined SWE, with group velocity and frequency-dependent phase velocity providing potentially complementary information on plaque characteristics. With such, the method represents a promising non-invasive approach for refined atherosclerotic risk prediction.
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Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden. .,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Sharon L Mulvagh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America.,Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Runqing Huang
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, United States of America.,Department of Radiology, Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Reidar Winter
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Thanila A Macedo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Sahar S Abdelmoneim
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matthew W Urban
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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27
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Figini F, Chen SL, Sheiban I. ST-elevation Myocardial Infarction and Multivessel Coronary Artery Disease – A Critical Review of Current Practice, Evidence and Meta-analyses. Heart Int 2020; 14:80-85. [DOI: 10.17925/hi.2020.14.2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023] Open
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28
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Kim K, Lim C, Kim G, Chung JH, Cho YS, Cho JH, Seo JB, Chung WY, Oh SJ, Choi JS, Kim JS, Park JJ, Suh JW, Youn TJ, Chae IH, Choi DJ. Association of Plasma Marker of Oxidized Lipid with Histologic Plaque Instability in Patients with Peripheral Artery Disease. Ann Vasc Surg 2019; 66:554-565. [PMID: 31706994 DOI: 10.1016/j.avsg.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/05/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between oxidized low-density lipoprotein (OxLDL) and plaque instability in coronary and carotid artery disease is well established. However, the association between OxLDL and the histologic changes of plaque in peripheral artery disease has not been clearly elucidated. This study aims to investigate the association between plasma OxLDL and histologic plaque instability in patients with peripheral artery disease. METHODS Prospectively obtained plaques from 48 patients who underwent endovascular atherectomy (n = 20), surgical endarterectomy (n = 9), or bypass surgery (n = 19) for treatment of atherosclerotic femoropopliteal artery disease were evaluated for histologic fibrosis, sclerosis, calcification, necrosis, cholesterol cleft, and foamy macrophages using hematoxylin and eosin, oil red O, and immunohistochemical staining. Unstable plaques were defined as plaques that were positive for foamy macrophages and with lipid content of more than 10% of the total plaque area. Plasma OxLDL levels were measured using an enzyme-linked immunosorbent assay (Mercodia AB, Uppsala, Sweden). RESULTS Of the 48 patients, 26 (54%) had unstable plaques. The unstable plaque group was younger, had fewer angiographic total occlusions, less calcification, and more CD68-positive and LOX-1-positive cells than the stable plaque group. Plasma OxLDL levels were significantly higher in the unstable plaque group than in the stable plaque group (57.4 ± 13.9 vs. 47.2 ± 13.6 U/L, P = 0.014). Multivariate analysis revealed that plasma OxLDL level, smoking, angiographic nontotal occlusion, and statin nonuse were independent predictors of unstable plaque. CONCLUSIONS Among patients with peripheral artery disease, the histologic instability of femoropopliteal plaque was independently associated with high plasma OxLDL, smoking, nontotal occlusion, and statin nonuse. Further large-scale studies are necessary to evaluate the role of noninvasive OxLDL measurement for predicting plaque instability and future adverse vascular event.
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Affiliation(s)
- Kichun Kim
- The Armed Forces Medical Command, Seongnam, South Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Gilhyang Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Jun Hwan Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jae-Bin Seo
- Department of Internal Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Se-Jin Oh
- Department of Cardiothoracic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae-Sung Choi
- Department of Cardiothoracic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jun-Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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29
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Varela Barca L, Sáez de Ibarra S. JI. La cirugía coronaria no es solo un método de revascularización miocárdica sino un método de «protección miocárdica» en comparación con el intervencionismo percutáneo. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Choi SSS, Mandelis A. Review of the state of the art in cardiovascular endoscopy imaging of atherosclerosis using photoacoustic techniques with pulsed and continuous-wave optical excitations. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-15. [PMID: 31414585 PMCID: PMC6983488 DOI: 10.1117/1.jbo.24.8.080902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/22/2019] [Indexed: 05/15/2023]
Abstract
Intravascular photoacoustics (IV-PA) is an emerging atherosclerosis imaging modality that provides chemical-specific optical information of arterial walls with acoustic depth penetration and resolution. As lipid composition of atherosclerotic plaques is considered to be one of the primary indicators for plaque vulnerability, many IV-PA applications are calibrated so as to target plaque necrotic cores. Based on the mode of optical excitation and the corresponding signal processing technique, IV-PA is categorized into two different modalities. The pulse-based IV-PA has been the universal IV-PA imaging mode with its high peak power and straightforward time-domain signal processing technique. As an alternative, the low power continuous-wave (CW)-based IV-PA has been under intense development as a radar-like frequency-domain signal processing modality. The two state-of-the-art types of IV-PA are reviewed in terms of their physics and imaging capabilities, with major emphasis on frequency-swept CW-based IV-PA that has been recently introduced in the field.
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Affiliation(s)
- Sung Soo Sean Choi
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
| | - Andreas Mandelis
- University of Toronto, Center for Advanced Diffusion-Wave and Photoacoustic Technologies, Department of Mechanical and Industrial Engineering, Toronto, Ontario, Canada
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31
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Finck T, Hardenberg J, Will A, Hendrich E, Haller B, Martinoff S, Hausleiter J, Hadamitzky M. 10-Year Follow-Up After Coronary Computed Tomography Angiography in Patients With Suspected Coronary Artery Disease. JACC Cardiovasc Imaging 2019; 12:1330-1338. [DOI: 10.1016/j.jcmg.2018.07.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
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32
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Coronary Atherosclerotic Plaque Vulnerability Rather than Stenosis Predisposes to Non-ST Elevation Acute Coronary Syndromes. Cardiol Res Pract 2019; 2019:2642740. [PMID: 30984422 PMCID: PMC6432700 DOI: 10.1155/2019/2642740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/26/2018] [Accepted: 02/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background Non-ST elevation acute coronary syndromes (NSTE-ACS) may arise from moderately stenosed atherosclerotic lesions that suddenly undergo transformation to vulnerable plaques complicated by rupture and thrombosis. Objective Assessment and tissue characterization of the coronary atherosclerotic lesions among NSTE-ACS patients compared to those with stable angina. Methodology Evaluation of IVUS studies of 312 coronary lesions was done by 2 different experienced IVUS readers, 216 lesions in 66 patients with NSTE-ACS (group I) versus 96 lesions in 50 patients with stable angina (group II). Characterization of coronary plaques structure was done using colored-coded iMap technique. Results The Syntax score was significantly higher in group I compared to group II (18.7 ± 7.8 vs. 8.07 ± 2.5, p=0.001). Body mass index (BMI) was significantly higher in group II while triglycerides levels were higher in group I (P=0.01 & P=0.04, respectively). History of previous MI and PCI was significantly higher in group I (P=0.016 & P=0.001, respectively). The coronary lesions of NSTE-ACS patients had less vessel area (9.86 ± 3.8 vs 11.36 ± 2.9, p=0.001), stenosis percentage (54.7 ± 14.9% vs 68.6 ± 8.7%, p=0.001), and plaque burden (54.4 ± 14.7 vs 67.8 ± 9.8, p=0.001) with negative remodeling index (0.95 ± 20 vs 1.02 ± 0.14, p=0.008) compared to the stable angina group. On the other hand, they had more lipid content (21.8 ± 7.03% vs 7.26 ± 3.47%, p=0.001), necrotic core (18.08 ± 10.19% vs 15.83 ± 4.9%, p=0.02), and calcifications (10.4 ± 5.2% vs 4.19 ± 3.29%, p=0.001) while less fibrosis (51.67 ± 7.07% vs 70.37 ± 11.7%, p=0.001) compared to the stable angina patients. Syntax score and core composition especially calcification and lipid content were significant predictors to NSTE-ACS. Conclusions The vulnerability rather than the stenotic severity is the most important factor that predisposes to non-ST segment elevation acute coronary syndromes. The vulnerability is related to the lesion characteristics especially lipidic core and calcification while lesion fibrosis favours lesion stability.
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van Rosendael AR, Shaw LJ, Xie JX, Dimitriu-Leen AC, Smit JM, Scholte AJ, van Werkhoven JM, Callister TQ, DeLago A, Berman DS, Hadamitzky M, Hausleiter J, Al-Mallah MH, Budoff MJ, Kaufmann PA, Raff G, Chinnaiyan K, Cademartiri F, Maffei E, Villines TC, Kim YJ, Feuchtner G, Lin FY, Jones EC, Pontone G, Andreini D, Marques H, Rubinshtein R, Achenbach S, Dunning A, Gomez M, Hindoyan N, Gransar H, Leipsic J, Narula J, Min JK, Bax JJ. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score. JACC Cardiovasc Imaging 2019; 12:1987-1997. [PMID: 30660516 DOI: 10.1016/j.jcmg.2018.10.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/19/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS). BACKGROUND Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification. METHODS A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971). RESULTS The mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort. CONCLUSIONS The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).
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Affiliation(s)
- Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joe X Xie
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jeorg Hausleiter
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | | | | | | | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Todd C Villines
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Millie Gomez
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Niree Hindoyan
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
| | - Jonathon Leipsic
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jagat Narula
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Herscovici R, Sedlak T, Wei J, Pepine CJ, Handberg E, Bairey Merz CN. Ischemia and No Obstructive Coronary Artery Disease ( INOCA ): What Is the Risk? J Am Heart Assoc 2018; 7:e008868. [PMID: 30371178 PMCID: PMC6201435 DOI: 10.1161/jaha.118.008868] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Romana Herscovici
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCA
| | - Tara Sedlak
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Janet Wei
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCA
| | | | | | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCA
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Javadzadegan A, Moshfegh A, Afrouzi HH, Omidi M. Magnetohydrodynamic blood flow in patients with coronary artery disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 163:111-122. [PMID: 30119846 DOI: 10.1016/j.cmpb.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/26/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We aim to investigate the effect of a magnetic field with varying intensities on haemodynamic perturbations in a cohort of patients with coronary artery disease. METHODS Transient computational fluid dynamics (CFD) simulations were performed in three-dimensional (3D) models of coronary arteries reconstructed from 3D quantitative coronary angiography. The effect of magnetic field on wall shear stress (WSS) derived parameters including maximum wall shear stress (MWSS) and size of regions with low wall shear stress (ALWSS) as well as length of flow recirculation zones were determined. RESULTS The results showed a substantial reduction in MWSS, ALWSS and length of flow recirculation zones in the presence of magnetic field, in particular for coronaries with moderate to severe stenoses. When the whole cohort examined, time-averaged wall shear stress (TAWSS), ALWSS and the length of flow recirculation zones in the absence of magnetic field were approximately 1.71, 4.69 and 8.46 times greater than those in the presence of magnetic field, respectively. CONCLUSION Our findings imply that an externally applied magnetic field can improve haemodynamic perturbations in human coronary arteries.
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Affiliation(s)
- Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia; Concord Repatriation General Hospital, Sydney Local Health District, NSW 2139, Australia.
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia; Concord Repatriation General Hospital, Sydney Local Health District, NSW 2139, Australia
| | | | - Mohammad Omidi
- Faculty of Mechanical Engineering, Babol Noshirvani University of Technology, Babol, Iran
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Javadzadegan A, Moshfegh A, Behnia M. Effect of magnetic field on haemodynamic perturbations in atherosclerotic coronary arteries. J Med Eng Technol 2018; 42:148-156. [DOI: 10.1080/03091902.2018.1447034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ashkan Javadzadegan
- Macquarie University, Sydney, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Abouzar Moshfegh
- Macquarie University, Sydney, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Masud Behnia
- School of Management, Macquarie University, Sydney, Australia
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Silber S. [Do you know your risk of getting a heart attack?]. MMW Fortschr Med 2018; 160:38-44. [PMID: 29508323 DOI: 10.1007/s15006-018-0243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kilic S, Kocabas U, Can LH, Yavuzgil O, Zoghi M. The Severity of Coronary Arterial Stenosis in Patients With Acute ST-Elevated Myocardial Infarction: A Thrombolytic Therapy Study. Cardiol Res 2018; 9:11-16. [PMID: 29479380 PMCID: PMC5819623 DOI: 10.14740/cr639w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 11/12/2022] Open
Abstract
Background It is widely believed that ST-elevated myocardial infarction (STEMI) generally occurs at the site of mild to moderate coronary stenosis. The aim of this study was to determine the degree of stenosis of infarct-related artery (IRA) in STEMI patients who underwent coronary angiography (CAG) after successful reperfusion with thrombolytic therapy (TT). Methods A total of 463 consecutive patients between January 2008 and December 2013 with acute STEMI treated with TT were evaluated retrospectively. The patients in whom reperfusion failed (n = 120), death occurred before CAG (n = 12), IRA cannot be determined (n = 10), and CAG was not performed in index hospitalization (n = 54) were excluded from the study. To determine the severity of stenosis of IRA, two experienced cardiologists who were unaware of each other used quantitative CAG analysis. Significant stenosis was defined as a ≥ 50% stenosis in the coronary artery lumen. A total of 267 patients who were successfully reperfused with TT and in whom CAG was performed during hospitalization with median 8 (1 - 17) days after myocardial infarction were included in the study. Results The mean age of patients was 55.7 ± 10.8 years (85.5% male). Most of the patients had a significant stenosis in IRA ( ≥ 50%, n = 236, group 1) after successful TT; whereas only 11.6% had stenosis < 50% (n = 31, group 2). In addition, majority of the patients had ≥ 70.4% (n = 188, 70.4%) stenosis in IRA. Average of stenosis in IRA was 74±16%. Conclusions In contrast to the general opinion, we detected that majority of STEMI patients had a significant stenosis in IRA.
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Affiliation(s)
- Salih Kilic
- Department of Cardiology, Doctor Ersin Arslan Research and Training Hospital, Gaziantep, Turkey
| | - Umut Kocabas
- Department of Cardiology, Soma State Hospital, Manisa, Turkey
| | - Levent Hurkan Can
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Oguz Yavuzgil
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
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Costopoulos C, Huang Y, Brown AJ, Calvert PA, Hoole SP, West NEJ, Gillard JH, Teng Z, Bennett MR. Plaque Rupture in Coronary Atherosclerosis Is Associated With Increased Plaque Structural Stress. JACC Cardiovasc Imaging 2017; 10:1472-1483. [PMID: 28734911 PMCID: PMC5725311 DOI: 10.1016/j.jcmg.2017.04.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to identify the determinants of plaque structural stress (PSS) and the relationship between PSS and plaques with rupture. BACKGROUND Plaque rupture is the most common cause of myocardial infarction, occurring particularly in higher risk lesions such as fibroatheromas. However, prospective intravascular ultrasound-virtual histology studies indicate that <10% higher risk plaques cause clinical events over 3 years, indicating that other factors also determine plaque rupture. Plaque rupture occurs when PSS exceeds its mechanical strength; however, the determinants of PSS and its association with plaques with proven rupture are not known. METHODS We analyzed plaque structure and composition in 4,053 virtual histology intravascular ultrasound frames from 32 fibroatheromas with rupture from the intravascular ultrasound-virtual histology in Vulnerable Atherosclerosis study and 32 fibroatheromas without rupture on optical coherence tomography from a stable angina cohort. Mechanical loading in the periluminal region was estimated by calculating maximum principal PSS by finite element analysis. RESULTS PSS increased with increasing lumen area (r = 0.46; p = 0.001), lumen eccentricity (r = 0.32; p = 0.001), and necrotic core ≥10% (r = 0.12; p = 0.001), but reduced when dense calcium was ≥10% (r = -0.12; p = 0.001). Ruptured fibroatheromas showed higher PSS (133 kPa [quartiles 1 to 3: 90 to 191 kPa] vs. 104 kPa [quartiles 1 to 3: 75 to 142 kPa]; p = 0.002) and variation in PSS (55 kPa [quartiles 1 to 3: 37 to 75 kPa] vs. 43 kPa [quartiles 1 to 3: 34 to 59 kPa]; p = 0.002) than nonruptured fibroatheromas, with rupture primarily occurring either proximal or immediately adjacent to the minimal luminal area (87.5% vs. 12.5%; p = 0.001). PSS was higher in segments proximal to the rupture site (143 kPa [quartiles 1 to 3: 101 to 200 kPa] vs. 120 kPa [quartiles 1 to 3: 78 to 180 kPa]; p = 0.001) versus distal segments, associated with increased necrotic core (19.1% [quartiles 1 to 3: 11% to 29%] vs. 14.3% [quartiles 1 to 3: 8% to 23%]; p = 0.001) but reduced fibrous/fibrofatty tissue (63.6% [quartiles 1 to 3: 46% to 78%] vs. 72.7% [quartiles 1 to 3: 54% to 86%]; p = 0.001). PSS >135 kPa was a good predictor of rupture in higher risk regions. CONCLUSIONS PSS is determined by plaque composition, plaque architecture, and lumen geometry. PSS and PSS variability are increased in plaques with rupture, particularly at proximal segments. Incorporating PSS into plaque assessment may improve identification of rupture-prone plaques.
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Affiliation(s)
- Charis Costopoulos
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Patrick A Calvert
- Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom
| | - Stephen P Hoole
- Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom
| | - Nick E J West
- Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom
| | - Jonathan H Gillard
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom; Department of Engineering, University of Cambridge, Cambridge, United Kingdom.
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
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Analysis of Cardiovascular Tissue Components for the Diagnosis of Coronary Vulnerable Plaque from Intravascular Ultrasound Images. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9837280. [PMID: 29065676 PMCID: PMC5320383 DOI: 10.1155/2017/9837280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/03/2017] [Accepted: 01/15/2017] [Indexed: 12/05/2022]
Abstract
The purpose of this study was to characterize cardiovascular tissue components and analyze the different tissue properties for predicting coronary vulnerable plaque from intravascular ultrasound (IVUS) images. For this purpose, sequential IVUS image frames were obtained from human coronary arteries using 20 MHz catheters. The plaque regions between the intima and media-adventitial borders were manually segmented in all IVUS images. Tissue components of the plaque regions were classified into having fibrous tissue (FT), fibrofatty tissue (FFT), necrotic core (NC), or dense calcium (DC). The media area and lumen diameter were also estimated simultaneously. In addition, the external elastic membrane (EEM) was computed to predict the vulnerable plaque after the tissue characterization. The reliability of manual segmentation was validated in terms of inter- and intraobserver agreements. The quantitative results found that the FT and the media as well as the NC would be good indicators for predicting vulnerable plaques in IVUS images. In addition, the lumen was not suitable for early diagnosis of vulnerable plaque because of the low significance compared to the other vessel parameters. To predict vulnerable plaque rupture, future study should have additional experiments using various tissue components, such as the EEM, FT, NC, and media.
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Sen T, Astarcioglu MA, Beton O, Asarcikli LD, Kilit C. Which Coronary Lesions Are More Prone to Cause Acute Myocardial Infarction? Arq Bras Cardiol 2017; 108:149-153. [PMID: 28099589 PMCID: PMC5344660 DOI: 10.5935/abc.20170003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022] Open
Abstract
Background According to common belief, most myocardial infarctions (MIs) are due to the
rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data
from recent trials challenge this belief, suggesting that the risk of
coronary occlusion is, in fact, much higher after severe stenosis. The aim
of this study was to investigate whether or not acute ST-elevation MIs
result from high-grade stenoses by evaluating the presence of coronary
collateral circulation (CCC). Methods We retrospectively included 207 consecutive patients who had undergone
primary percutaneous coronary intervention for acute ST-elevation MI.
Collateral blood flow distal to the culprit lesion was assessed by two
investigators using the Rentrop scoring system. Results Out of the 207 patients included in the study, 153 (73.9%) had coronary
collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in
54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively.
Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and
neutrophil count were significantly lower in the group with good collateral
vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively). Conclusion More than 70% of the patients with acute MI had CCC with Rentrop scores of
1-3 during primary coronary angiography. This shows that most cases of acute
MI in our study originated from underlying high-grade stenoses, challenging
the common believe. Higher serum triglycerides levels, greater MPV, and
increased WBC and neutrophil counts were independently associated with
impaired development of collateral vessels.
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Affiliation(s)
- Taner Sen
- Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Kutahya - Turkey
| | - Mehmet Ali Astarcioglu
- Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Kutahya - Turkey
| | | | | | - Celal Kilit
- Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Kutahya - Turkey
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The Difference between the optical coherence tomography (OCT) findings of newly progressed coronary lesions in symptomatic and asymptomatic patients. Int J Cardiol 2016; 222:391-395. [PMID: 27500767 DOI: 10.1016/j.ijcard.2016.07.187] [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: 06/01/2016] [Accepted: 07/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Generally, newly progressed coronary lesions (NPCLs) are considered to be composed of lipid-rich plaques. In case of vulnerable plaque rupture, they may quickly become culprit lesions responsible for acute coronary syndromes. METHODS Between September 2011 and September 2015, 2034 patients underwent scheduled follow-up coronary angiography (CAG) after percutaneous coronary intervention (PCI) in Tsuchiya General Hospital. Patients with NPCLs found by CAG during the follow-up period were evaluated by optical coherence tomography (OCT). NPCLs were defined as the lesions with less than 50% diameter stenosis, which progressed to more than 75% diameter stenosis within 3years after the previous CAG. Patients with restenosis after PCI were excluded. We compared OCT findings of NPCLs between symptomatic and asymptomatic patients. RESULTS The follow-up CAG showed NPCLs in 64 patients (3.2%). OCT revealed fibrous plaque in 42 patients (65.6%) and thin-cap fibroatheroma in one patient. Thirteen patients had chest symptoms for one month before CAG and the remaining 51 patients were asymptomatic. The prevalence of fibrous plaque and intimal disruption or plaque rupture were not significantly different between symptomatic and asymptomatic patients (61.5% vs. 66.7%, p=0.752 and 30.8% vs. 11.8%, p=0.213, respectively). However, thrombi were more frequently observed in symptomatic patients (61.5% vs. 13.7%, p<0.001). CONCLUSIONS The majority of NPCLs found in asymptomatic patients at follow-up CAG were not vulnerable; however, those found in symptomatic patients might be vulnerable. In clinical practice, NPCLs found in asymptomatic patients should be evaluated for functional severity of stenosis in order to determine the need for coronary revascularization.
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Blanke P, Naoum C, Ahmadi A, Cheruvu C, Soon J, Arepalli C, Gransar H, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Rubinshtein R, Marquez H, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Chang HJ, Chow BW, Min J, Leipsic J. Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC Cardiovasc Imaging 2016; 9:1280-1288. [PMID: 27568114 DOI: 10.1016/j.jcmg.2015.12.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) among patients with diabetes mellitus (DM) compared with nondiabetic subjects. BACKGROUND The long-term prognostic value of coronary CTA in patients with DM is not well established. METHODS Patients enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry with 5-year follow-up data were identified. The extent and severity of coronary artery disease (CAD) were analyzed at baseline coronary CTA and in relation to outcomes between diabetic and nondiabetic patients. CAD according to coronary CTA was defined as none (0% stenosis), nonobstructive (1% to 49% stenosis), or obstructive (≥50% stenosis). Time to death (and in a subgroup, time to major adverse cardiovascular event) was estimated by using multivariable Cox proportional hazards models. RESULTS A total of 1,823 patients were identified as having DM with 5-year clinical follow-up and were propensity-matched to 1,823 patients without DM (mean age 61.8 ± 10.9 years; 54.4% male). Patients with DM did not exhibit a heightened risk of death compared with the propensity-matched nondiabetic subjects in the absence of CAD on coronary CTA (risk-adjusted hazard ratio [HR] of DM: 1.32; 95% confidence interval [CI]: 0.78 to 2.24; p = 0.296). Patients with DM were at increased risk of dying compared with nondiabetic subjects in the setting of nonobstructive CAD (in the propensity-matched cohort: HR, 2.10; 95% CI: 1.43 to 3.09; p < 0.001) with a mortality risk greater than nondiabetic subjects with obstructive disease (p < 0.001). In a risk-adjusted hazard analysis among patients with DM, both per-patient obstructive CAD and nonobstructive CAD conferred an increase in all-cause mortality risk compared with patients without atherosclerosis on coronary CTA (nonobstructive disease-HR: 2.07; 95% CI: 1.33 to 3.24; p = 0.001; obstructive disease-HR: 2.22; 95% CI: 1.47 to 3.36; p < 0.001). CONCLUSIONS Among patients with DM, nonobstructive and obstructive CAD according to coronary CTA were associated with higher rates of all-cause mortality and major adverse cardiovascular events at 5 years, and this risk was significantly higher than in nondiabetic subjects. Importantly, patients with DM without CAD according to coronary CTA were at a risk comparable to that of nondiabetic subjects.
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Affiliation(s)
- Philipp Blanke
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Naoum
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Ahmadi
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chaitu Cheruvu
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeanette Soon
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chesnal Arepalli
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, California
| | | | - Mouaz H Al-Mallah
- Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan
| | - Filippo Cademartiri
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hugo Marquez
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | - Todd C Villines
- Department of Medicine, Walter Reed Medical Center, Washington, D.C
| | - Martin Hadamitzky
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Erica Maffei
- Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Benjamin W Chow
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - James Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Shih CC, Lai TY, Huang CC. Evaluating the intensity of the acoustic radiation force impulse (ARFI) in intravascular ultrasound (IVUS) imaging: Preliminary in vitro results. ULTRASONICS 2016; 70:64-74. [PMID: 27135187 DOI: 10.1016/j.ultras.2016.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 05/13/2023]
Abstract
The ability to measure the elastic properties of plaques and vessels is significant in clinical diagnosis, particularly for detecting a vulnerable plaque. A novel concept of combining intravascular ultrasound (IVUS) imaging and acoustic radiation force impulse (ARFI) imaging has recently been proposed. This method has potential in elastography for distinguishing between the stiffness of plaques and arterial vessel walls. However, the intensity of the acoustic radiation force requires calibration as a standard for the further development of an ARFI-IVUS imaging device that could be used in clinical applications. In this study, a dual-frequency transducer with 11MHz and 48MHz was used to measure the association between the biological tissue displacement and the applied acoustic radiation force. The output intensity of the acoustic radiation force generated by the pushing element ranged from 1.8 to 57.9mW/cm(2), as measured using a calibrated hydrophone. The results reveal that all of the acoustic intensities produced by the transducer in the experiments were within the limits specified by FDA regulations and could still displace the biological tissues. Furthermore, blood clots with different hematocrits, which have elastic properties similar to the lipid pool of plaques, with stiffness ranging from 0.5 to 1.9kPa could be displaced from 1 to 4μm, whereas the porcine arteries with stiffness ranging from 120 to 291kPa were displaced from 0.4 to 1.3μm when an acoustic intensity of 57.9mW/cm(2) was used. The in vitro ARFI images of the artery with a blood clot and artificial arteriosclerosis showed a clear distinction of the stiffness distributions of the vessel wall. All the results reveal that ARFI-IVUS imaging has the potential to distinguish the elastic properties of plaques and vessels. Moreover, the acoustic intensity used in ARFI imaging has been experimentally quantified. Although the size of this two-element transducer is unsuitable for IVUS imaging, the experimental results reported herein can be applied in ARFI-IVUS imaging applications.
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Affiliation(s)
- Cho-Chiang Shih
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Yu Lai
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
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Javadzadegan A, Yong ASC, Chang M, Ng MKC, Behnia M, Kritharides L. Haemodynamic assessment of human coronary arteries is affected by degree of freedom of artery movement. Comput Methods Biomech Biomed Engin 2016; 20:260-272. [DOI: 10.1080/10255842.2016.1215439] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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47
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Huntzicker S, Shekhar H, Doyley MM. Contrast-Enhanced Quantitative Intravascular Elastography: The Impact of Microvasculature on Model-Based Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1167-81. [PMID: 26924697 PMCID: PMC4811726 DOI: 10.1016/j.ultrasmedbio.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 05/03/2023]
Abstract
Model-based intravascular ultrasound elastography visualizes the stress distribution within vascular tissue-information that clinicians could use to predict the propensity of atherosclerotic plaque rupture. However, there are concerns that clusters of microvessels may reduce the accuracy of the estimated stress distribution. Consequently, we have developed a contrast-enhanced intravascular ultrasound system to investigate how plaque microvasculature affects the performance of model-based elastography. In simulations, diameters of 200, 400 and 800 μm were used, where the latter diameter represented a cluster of microvessels. In phantoms, we used a microvessel with a diameter of 750 μm. Peak stress errors of 3% and 38% were incurred in the fibrous cap when stress recovery was performed with and without a priori information about microvessel geometry. The results indicate that incorporating geometric information about plaque microvasculature obtained with contrast-enhanced ultrasound imaging improves the accuracy of estimates of the stress distribution within the fibrous cap precisely.
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Affiliation(s)
- Steven Huntzicker
- Department of Electrical & Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA
| | - Himanshu Shekhar
- Department of Electrical & Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA
| | - Marvin M Doyley
- Department of Electrical & Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York, USA.
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48
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O'Donnell M, Kasner SE. Cryptogenic Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Lee NJ, Litt H. Cardiac CT angiography for evaluation of acute chest pain. Int J Cardiovasc Imaging 2015; 32:101-12. [PMID: 26342713 DOI: 10.1007/s10554-015-0763-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/31/2015] [Indexed: 01/23/2023]
Abstract
Chest pain is the second most common emergency department (ED) presentation in the United States. Cardiac computed tomography angiography (CCTA) now plays an important role in the evaluation of patients with suspected acute coronary syndrome in the ED setting. In this article, we review the available techniques focused on the use of CCTA to evaluate patients fosr coronary atherosclerosis for timely triage of acute chest pain.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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50
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Ahmadi A, Leipsic J, Blankstein R, Taylor C, Hecht H, Stone GW, Narula J. Do plaques rapidly progress prior to myocardial infarction? The interplay between plaque vulnerability and progression. Circ Res 2015; 117:99-104. [PMID: 26089367 DOI: 10.1161/circresaha.117.305637] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a common misperception in the cardiology community that most acute coronary events arise from ruptures of mildly stenotic plaques. This notion has emanated from multiple studies that had measured the degree of angiographic luminal narrowing in culprit plaques months to years before myocardial infarction. However, angiographic studies within 3 months before myocardial infarction, immediately after myocardial infarction with thrombus aspiration or fibrinolytic therapy, and postmortem pathological observations have all shown that culprit plaques in acute myocardial infarction are severely stenotic. Serial angiographic studies also have demonstrated a sudden rapid lesion progression before most cases of acute coronary syndromes. The possible mechanisms for such rapid plaque progression and consequent luminal obstruction include recurrent plaque rupture and healing and intraplaque neovascularization and hemorrhage with deposition of erythrocyte-derived free cholesterol. Moreover, recent intravascular and noninvasive imaging studies have demonstrated that plaques which result in coronary events have larger plaque volume and necrotic core size with greater positive vessel remodeling compared with plaques, which remain asymptomatic during several years follow-up, although these large atheromatous vulnerable plaques may angiographically seem mild. As such, it is these vulnerable plaques which are more prone to rapid plaque progression or are those in which plaque progression is more likely to become clinically evident. Therefore, in addition to characterizing plaque morphology, inflammatory activity, and severity, detection of the rate of plaque progression might identify vulnerable plaques with an increased potential for adverse outcomes.
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Affiliation(s)
- Amir Ahmadi
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.)
| | - Jonathon Leipsic
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.)
| | - Ron Blankstein
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.)
| | - Carolyn Taylor
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.)
| | - Harvey Hecht
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.)
| | - Gregg W Stone
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.)
| | - Jagat Narula
- From the Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Division of Cardiology (A.A., J.L., C.T.), and Division of Radiology (J.L.), University of British Columbia, Vancouver, BC, Canada; Division of Cardiovascular Medicine, Brigham and Women Hospital, Harvard Medical School, Boston, MA (R.B.); and Medical Center and the Cardiovascular Research Foundation, Columbia University, New York, NY (G.W.S.).
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