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Sottmann L, Schmeling A. Philemon and Baucis death: a literature review. Int J Legal Med 2024; 138:1011-1021. [PMID: 37981585 PMCID: PMC11003922 DOI: 10.1007/s00414-023-03126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
Double death, i.e., two bodies at a scene, is relatively rare. The double death from natural causes of two close persons is called Philemon and Baucis death in the medicolegal literature. Despite being mentioned for the first time more than 50 years ago, all detailed case reports on this case constellation are from the last 15 years. A comprehensive review of the literature on this phenomenon has not yet been published. In this article, we review the available literature on Philemon and Baucis death. Pathophysiologically, it can be assumed that this phenomenon is a sub-form of so-called psychogenic death. Therefore, we equally review the literature on sudden cardiac death due to acute psychological stress.
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Affiliation(s)
- Lukas Sottmann
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany.
| | - Andreas Schmeling
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
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2
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Wang Y, Zheng J, Li Q, Ma Y, Liu C, Deng J, Gao D. The relationship between complement C1q and coronary plaque vulnerability based on optical coherence tomography analysis. Sci Rep 2024; 14:9477. [PMID: 38658599 PMCID: PMC11043360 DOI: 10.1038/s41598-024-60128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
To determine the association between complement C1q and vulnerable plaque morphology among coronary artery disease (CAD) patients. We conducted a retrospective observational study of 221 CAD patients admitted to The Second Affiliated Hospital of Xi'an Jiaotong University. Intravascular optical coherence tomography was utilized to describe the culprit plaques' morphology. Using logistic regression analysis to explore the correlation between C1q and vulnerable plaques, and receiver operator characteristic (ROC) analysis assess the predictive accuracy. As reported, the complement C1q level was lower in ACS patients than CCS patients (18.25 ± 3.88 vs. 19.18 ± 4.25, P = 0.045). The low complement-C1q-level group was more prone to develop vulnerable plaques. In lipid-rich plaques, the complement C1q level was positively correlated with the thickness of fibrous cap (r = 0.480, P = 0.041). Univariate and multivariate logistic regression analyses suggested that complement C1q could be an independent contributor to plaques' vulnerability. For plaque rupture, erosion, thrombus, and cholesterol crystals, the areas under the ROC curve of complement C1q level were 0.873, 0.816, 0.785, and 0.837, respectively (P < 0.05 for all). In CAD patients, the complement C1q could be a valuable indicator of plaque vulnerability.
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Affiliation(s)
- Yuan Wang
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China
| | - Jiawei Zheng
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China
| | - Qing Li
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China
| | - Yao Ma
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China
| | - Chang Liu
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China
| | - Jie Deng
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China
| | - Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, 710000, Shaanxi, People's Republic of China.
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Kim YJ, Park KM. Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review. J Clin Med 2024; 13:2184. [PMID: 38673457 PMCID: PMC11050973 DOI: 10.3390/jcm13082184] [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: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Sudden cardiac death (SCD) is rare among athletes. However, hypertrophic cardiomyopathy is the leading cause of SCD among those <35 years of age. Meanwhile, coronary artery disease (CAD) is the primary SCD cause among those ≥35 years of age. CAD-induced plaque ruptures are believed to be a significant cause of cardiovascular diseases in middle-aged individuals who participate in extreme long-distance running activities such as marathons. A total of 1970 articles related to EIH were identified using search terms. Out of these, 1946 studies were excluded for reasons such as arterial hypertension, exercise-induced pulmonary hypertension, the absence of exercise stress testing (EST), and a lack of relevance to EIH. The study analyzed 24 studies related to both long-distance runners with exercise-induced hypertension (EIH) and the general public. Among these, 11 studies were quasi-experimentally designed studies used in randomized controlled trials (RCTs) on long-distance runners with EIH. Additionally, 12 studies utilized cohort designs, and one study with a quasi-experimental design was conducted among the general population. Recent studies suggest that an imbalance between oxygen demand and supply due to ventricular hypertrophy may be the actual cause of cardiovascular disease, regardless of CAD. Exercising excessively over an extended period can reduce endothelial function and increase arterial stiffness, which in turn increases afterload and leads to an excessive increase in blood pressure during exercise. Exercise-induced hypertension (EIH), which increases the morbidity rate of resting hypertension and is a risk factor for cardio-cerebro-vascular diseases, is more prevalent in middle-aged long-distance runners than in runners from other age groups, and it increases the prevalence of critical arrhythmias, such as atrial fibrillation or ventricular arrhythmias. EIH is associated with angiotensin II activity, and angiotensin II receptor blockers show promising effects in middle-aged runners. Further, guidelines for preventing excessive participation in races and restricting exercise intensity and frequency would be useful. This review identifies EIH as a potential risk factor for cardiovascular diseases and describes how EIH induces SCD.
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Affiliation(s)
- Young-Joo Kim
- Department of Exercise Rehabilitation Welfare, Sungshin Women’s University, 34 da-gil, Bomun-ro, Seongbuk-gu, Seoul 02844, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Bass RD, Phillips J, Sánchez JS, Shah P, Sum S, Waksman R, Garcia-Garcia HM. The Ability of Near-Infrared Spectroscopy to Identify Vulnerable Patients and Plaques: A Systematic Review and Meta-Analysis. Heart Fail Clin 2024; 20:101-112. [PMID: 37953017 DOI: 10.1016/j.hfc.2023.06.004] [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] [Indexed: 11/14/2023]
Abstract
Previous studies have analyzed the efficacy of near-infrared spectroscopy-derived lipid core burden index (LCBI) in quantifying and identifying high-risk plaques and patients at increased risk of future major adverse cardiac outcomes/major adverse cardiovascular and cerebrovascular events. A maxLCBI4mm of 400 or greater seems to be an effective threshold for classifying at-risk plaques. This meta-analysis provides a more precise odds ratio with a narrow standard deviation that can be used to guide future studies.
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Affiliation(s)
- Ronald D Bass
- School of Medicine, Georgetown University, 3800 Reservoir Road, NorthWest, Washington, DC 20007, USA
| | - Joseph Phillips
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive Iowa City, IA 52242, USA
| | - Jorge Sanz Sánchez
- Hospital Universitari I Politecnic La Fe, Avinguda de Fernando Abril Martorell, no 106, 46026 València, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Avenue, Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029 Madrid, Spain
| | - Priti Shah
- InfraRedx, A Nipro Company, 28 Crosby Drive, Suite 100, Bedford, MA 01730, USA
| | - Stephen Sum
- InfraRedx, A Nipro Company, 28 Crosby Drive, Suite 100, Bedford, MA 01730, USA
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street, Suite 4B-1, Washington, DC, 20010, USA
| | - Hector M Garcia-Garcia
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street, Suite 4B-1, Washington, DC, 20010, USA.
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Cotier P, Mayer C, Etting I, Lorin de la Grandmaison G, Alvarez JC. Evaluation of the cardiovascular risk induced by cannabis use from a series of 43 autopsy cases. Int J Legal Med 2023; 137:1725-1733. [PMID: 37650902 DOI: 10.1007/s00414-023-03079-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
The aim of this monocentric observational autopsy study was to confirm the existence of a link between cannabis use and cardiovascular risk. It was based on the analysis of autopsy findings, cardiovascular pathological findings, and toxicological data in 43 autopsy cases of people who died with tetrahydrocannabinol (THC) in their blood over a 2-year period. Hair analysis was performed when available (n = 40) to distinguish between occasional and chronic cannabis use and to take into account other possible exposures, including smoking, drug consumption, and the use of other drugs of abuse (mainly cocaine, heroin, and amphetamine). A statistically significant association (Fisher's exact test, p < 0.001) was found between cannabis use, an undetermined manner of death, and the presence of an arrhythmogenic cardiac condition. An association was also found between cannabis use and the presence of advanced coronary heart disease (p = 0.01), heart disease (including ischemic heart disease, p = 0.003), or cardiomyopathy (p = 0.01). Through its systemic vascular action, cannabis could be a factor in triggering sudden death in subjects with arrhythmogenic cardiac conditions. In view of this finding, the mode of death of subjects who died in the presence of THC in the blood would in most cases be an "accident." These results highlight the potential adverse cardiac effects associated with cannabis use.
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Affiliation(s)
- Paul Cotier
- Service de Médecine légale, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, hôpital Raymond Poincaré, 104 bvd R. Poincaré, 92380, Garches, France
| | - Charlotte Mayer
- Service de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, 92380, Garches, France
| | - Isabelle Etting
- Service de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, 92380, Garches, France
| | - Geoffroy Lorin de la Grandmaison
- Service de Médecine légale, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, hôpital Raymond Poincaré, 104 bvd R. Poincaré, 92380, Garches, France
| | - Jean-Claude Alvarez
- Service de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, 92380, Garches, France.
- Université Paris-Saclay/Versailles, Inserm U-1018, CESP, Équipe MOODS, Plateforme de spectrométrie de masse, 78180, Montigny-le-Bretonneux, France.
- Laboratoire de Pharmacologie - Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, 104, Boulevard R. Poincaré, 92380, Garches, France.
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Hommels TM, Hermanides RS, Fabris E, Kedhi E. Exploring new insights in coronary lesion assessment and treatment in patients with diabetes mellitus: the impact of optical coherence tomography. Cardiovasc Diabetol 2023; 22:123. [PMID: 37226183 DOI: 10.1186/s12933-023-01844-1] [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: 03/21/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
In this review, we summarise new insights into diagnostic approaches and treatment strategies for coronary artery disease (CAD) in patients with diabetes mellitus (DM). Despite the improvements in therapy, the clinical management of DM patients remains challenging as they develop more extensive CAD at a younger age and consistently have worse clinical outcomes than non-DM patients. Current diagnostic modalities as well as revascularisation treatments mainly focus on ischemic lesions. However, the impact of plaque morphology and composition are emerging as strong predictors of adverse cardiac events even in the absence of identified ischemia. In particular, the presence of vulnerable plaques such as thin-cap fibroatheroma (TCFA) lesions has been identified as a very strong predictor of future adverse events. This emphasises the need for an approach combining both functional and morphological methods in the assessment of lesions. In particular, optical coherence tomography (OCT) has proven to be a valuable asset by truly identifying TCFAs. New treatment strategies should consist of individualised and advanced medical regimens and may evolve towards plaque sealing through percutaneous treatment.
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Affiliation(s)
| | | | - Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Elvin Kedhi
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Poniatowskiego 15, 40-055, Katowice, Poland.
- Department of Cardiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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The Ability of Near-Infrared Spectroscopy to Identify Vulnerable Patients and Plaques: A Systematic Review and Meta-Analysis. Interv Cardiol Clin 2023; 12:245-256. [PMID: 36922065 DOI: 10.1016/j.iccl.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Previous studies have analyzed the efficacy of near-infrared spectroscopy-derived lipid core burden index (LCBI) in quantifying and identifying high-risk plaques and patients at increased risk of future major adverse cardiac outcomes/major adverse cardiovascular and cerebrovascular events. A maxLCBI4mm of 400 or greater seems to be an effective threshold for classifying at-risk plaques. This meta-analysis provides a more precise odds ratio with a narrow standard deviation that can be used to guide future studies.
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8
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Nakahara T, Strauss HW, Narula J, Jinzaki M. Vulnerable Plaque Imaging. Semin Nucl Med 2023; 53:230-240. [PMID: 36333157 DOI: 10.1053/j.semnuclmed.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Atherosclerotic plaques progress as a result of inflammation. Both invasive and noninvasive imaging techniques have been developed to identify and characterize plaque as vulnerable (more likely to rupture and cause a clinical event). Imaging techniques to identify vulnerable include identifying vessels with focal subendothelial collections of I) inflammatory cells; II) lipid/ fatty acid; III) local regions of hypoxia; IV) local expression of angiogenesis factors; V) local expression of protease; VI) intravascular foci of thrombus; hemorrhage (most often seen in the aftermath of a clinical event); VII) apoptosis and VIII) microcalcification. This review provides an overview of atherosclerotic plaque progression and tracers which can visualize specific molecules associated with vulnerability.
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Affiliation(s)
- Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - H William Strauss
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mahahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Sandhyavenu H, Patel HP, Patel RH, Desai R, Patel AA, Patel BA, Patel J, Zahid S, Khan SU, Deshmukh A, Nasir K, DeSimone CV, Dani SS, Thakkar S. Rising trend of acute myocardial infarction among young cannabis users: A 10-year nationwide gender and race stratified analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200167. [PMID: 36874042 PMCID: PMC9975233 DOI: 10.1016/j.ijcrp.2022.200167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
Background The use of cannabis has massively increased among younger patients due to increasing legalization and availability. Methods We performed a retrospective nationwide study using the Nationwide inpatient sample (NIS) database to analyze the trends of acute myocardial infarction (AMI) in young cannabis users and related outcomes among patients aged 18-49 years from 2007 to 2018, using ICD-9 and ICD-10 codes. Results Out of 819,175 hospitalizations, 230,497 (28%) admissions reported using cannabis. There was a significantly higher number of males (78.08% vs. 71.58%, p < 0.0001) and African Americans (32.22% vs. 14.06%, p < 0.0001) admitted with AMI and reported cannabis use. The incidence of AMI among cannabis users consistently increased from 2.36% in 2007 to 6.55% in 2018. Similarly, the risk of AMI in cannabis users among all races increased, with the biggest increase in African Americans from 5.69% to 12.25%. In addition, the rate of AMI in cannabis users among both sexes showed an upward trend, from 2.63% to 7.17% in males and 1.62%-5.12% in females. Conclusion The incidence of AMI in young cannabis users has increased in recent years. The risk is higher among males and African Americans.
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Affiliation(s)
| | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Riddhiben H Patel
- Department of Internal Medicine, HCA Medical City Arlington, Dallas, Tx, USA
| | - Rohan Desai
- Department of Internal Medicine, Texas Tech University Health Science Center El Paso, El Paso, Tx, USA
| | - Achint A Patel
- Department of Public Health, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Bhavin A Patel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jaimin Patel
- Department of Internal Medicine, GCS Medical College, Gujarat, India
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Safi U Khan
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Khurram Nasir
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA
| | | | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Samarthkumar Thakkar
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tx, USA
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Mahečić LM, Iljazović F, Mišigoj-Duraković M, Babić Z. Incidence of cardiovascular events when watching intense football matches - sex differences. Acta Cardiol 2022; 77:250-256. [PMID: 33827377 DOI: 10.1080/00015385.2021.1908703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION FIFA World Cup represent one of the world's greatest phenomena. The spectators watch the matches of national teams with great emotional involvement. It is well documented fact that emotional stress can be a trigger of unwanted cardiovascular (CV) event. AIM The aim of this retrospective study was to determine whether there had been an increase in the number of the emergency admissions for CVD in the Emergency Room and Clinic for Cardiovascular Diseases of the Sestre milosrdnice University Hospital Centre during and after the matches that the Croatian national team played in the FIFA World Cup 2018. METHODS The hospital's database was examined for the dates when Croatia played its matches, plus two more days after each match. An unexposed period that included the same dates in 2017 and 2019 was formed. RESULTS 1093 cases were assessed. The incidence of CV admissions during the exposed period was 1.15 (95% confidence interval [CI]; 1.02 to 1.31) times higher than during the unexposed period. There was a 1.30 (95% CI; 1.1 to 1.54) times higher incidence in women compared to the unexposed period. Arrhythmias and angina pectoris were the CVDs that occurred more frequently in the exposed period. CONCLUSION This study showed that watching Croatian national team's matches and cheering represented an additional risk for a CV incident, especially in women.
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Affiliation(s)
| | | | | | - Zdravko Babić
- Faculty for Kinesiology, University of Zagreb, Zadar, Croatia
- Department of Internal Medicine, University of Zagreb School of Medicine, Zadar, Croatia
- Intensive Cardiac Care Unit at the Department for Cardiovascular Diseases, Sestre milosrdnice University Hospital Centre, Zadar, Croatia
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Discrepancy between plaque vulnerability and functional severity of angiographically intermediate coronary artery lesions. Cardiovasc Interv Ther 2022; 37:691-698. [PMID: 35260967 DOI: 10.1007/s12928-022-00851-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
Abstract
This study sought to investigate the relationship between physiological severity and plaque vulnerability of intermediate coronary artery stenoses as assessed by fractional flow reserve (FFR) and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). We included vessels where both FFR and NIRS-IVUS were performed. A positive FFR was defined as FFR ≤ 0.80. Lipid core burden index of the entire target vessel (TV-LCBI), maximum LCBI in 4 mm (maxLCBI4mm), and maximum plaque burden (PB) were evaluated using NIRS-IVUS. A vulnerable plaque was defined as a lipid-rich plaque (maxLCBI4mm ≥ 400) with large PB (≥ 70%). A total of 59 vessels of 45 patients were included. Median FFR value was 0.75 [interquartile 0.72, 0.82]. An FFR value of ≤ 0.80 was observed in 42 vessels (71%). TV-LCBI (correlation coefficient [CC] = - 0.331, p = 0.011), lesion length (CC = - 0.350, p = 0.007), and PB (CC = - 0.230, p = 0.080) negatively correlated with FFR value, while maxLCBI4mm did not (CC = - 0.156, p = 0.24). The prevalence of vulnerable plaques (26.2% vs. 29.4%, p > 0.99) and mean TV-LCBI, maxLCBI4mm, and PB values were not significantly different between the vessels with FFR ≤ 0.80 and those with FFR > 0.80. In multivariable logistic models, diabetes mellitus (p = 0.003) and hemoglobin A1c (p = 0.012) were associated with the presence of a vulnerable plaque. In conclusion, the results of the present study suggested that FFR may reflect total lipid burden but not necessarily plaque vulnerability. In patients with coronary artery disease and a high likelihood of rapid atherosclerosis progression, such as diabetes mellitus patients, assessing plaque vulnerability in addition to the functional severity of coronary artery lesions may help stratify better the risk of future events.
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Smyth A, O’Donnell M, Hankey GJ, Rangarajan S, Lopez-Jaramillo P, Xavier D, Zhang H, Canavan M, Damasceno A, Langhorne P, Avezum A, Pogosova N, Oguz A, Yusuf S. Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study. Eur Heart J 2022; 43:202-209. [PMID: 34850877 PMCID: PMC10503880 DOI: 10.1093/eurheartj/ehab738] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 10/10/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS In INTERSTROKE, we explored the association of anger or emotional upset and heavy physical exertion with acute stroke, to determine the importance of triggers in a large, international population. METHODS AND RESULTS INTERSTROKE was a case-control study of first stroke in 32 countries. Using 13 462 cases of acute stroke we adopted a case-crossover approach to determine whether a trigger within 1 hour of symptom onset (case period), vs. the same time on the previous day (control period), was associated with acute stroke. A total of 9.2% (n = 1233) were angry or emotional upset and 5.3% (n = 708) engaged in heavy physical exertion during the case period. Anger or emotional upset in the case period was associated with increased odds of all stroke [odds ratio (OR) 1.37, 99% confidence interval (CI), 1.15-1.64], ischaemic stroke (OR 1.22, 99% CI, 1.00-1.49), and intracerebral haemorrhage (ICH) (OR 2.05, 99% CI 1.40-2.99). Heavy physical exertion in the case period was associated with increased odds of ICH (OR 1.62, 99% CI 1.03-2.55) but not with all stroke or ischaemic stroke. There was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time, or day of symptom onset. Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive. CONCLUSION Acute anger or emotional upset was associated with the onset of all stroke, ischaemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only.
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Affiliation(s)
- Andrew Smyth
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada
- HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, University Road, Galway, Ireland
- Department of Nephrology, Galway University Hospital, Saolta University Health Care Group, Newcastle Road, Galway, Ireland
| | - Martin O’Donnell
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada
- HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, University Road, Galway, Ireland
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada
| | - Patricio Lopez-Jaramillo
- Instituto de Investigaciones Masira, Escuela de Medicina, Universidad de Santander (UDES), Calle 70 N 55-210, Bucaramanga, Colombia
| | - Denis Xavier
- St John's Medical College and Research Institute, 100 Feet Rd, John Nagar, Koramangala, Bangalore, India
| | - Hongye Zhang
- Beijing Hypertension League Institute, Fuxingroad Road 36A, Beijing, China
| | - Michelle Canavan
- HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, University Road, Galway, Ireland
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyere, Maputo, Mozambique
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, 84 Castle Street, Glasgow, UK
| | - Alvaro Avezum
- Hospital Alemao Oswaldo Cruz, R. Treze de Maio, 1815-Bela Vista, Sao Paulo, Brazil
| | - Nana Pogosova
- National Medical Research Center of Cardiology, 3-Ya CherepkovskayaUlitsa, 15A, Moscow, Russia
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Dumlupinar Mahallesi, D100 Karayolu No. 98, Istanbul, Turkey
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada
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Hybrid Imaging to Assess the Impact of Vulnerable Plaque on Post Myocardial Infarction Myocardial Scar. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Multimodality imaging improves the accuracy of cardiac assessment in patients with prior myocardial infarction. The aim of this study was to investigate the association between coronary plaque vulnerability (PV) and myocardial viability in the territory irrigated by the infarct-related artery (IRA). Secondary objectives include evaluation of the systemic inflammation but also different cardiac risk scores (SYNTAX score, Duke jeopardy score, or calcium score) using hybrid imaging models of coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) in patients who have suffered a previous myocardial infarction (MI). Material and methods: The study included 45 subjects with documented MI in the 30 days prior to study enrolment, who underwent CCTA and CMR examinations. Computational postprocessing of CCTA and CMR images was used to generate fused imaging models. Based on the vulnerability degree of the associated non-culprit lesion located proximally in the IRA, the study population was divided into 3 groups: Group 1 – subjects with no sign of vulnerability (n = 7); Group 2 – subjects with 1 or 2 CT vulnerability features (n = 28); and Group 3 – subjects with >2 features of vulnerability (n = 12). Results: CCTA features indicative for the severity of coronary artery disease were not different between groups in terms of calcium scoring (460 ± 501 vs. 579 ± 430 vs. 432 ± 494, p = 0.7) or SYNTAX score (25 ± 9.2 vs. 24.9 ± 8.3 vs. 20.2 ± 11.9, p = 0.4). However, after 1 month, infarct size and the Duke jeopardy score were associated with increased PV (infarct size 8.77 ± 3.4 g in Group 1, compared to 20.87 ± 8.3 g in Group 2 and 27.99 ± 11.8 g in Group 3 (p = 0.007), while the Duke jeopardy score was 4.4 ± 1.6 in Group 1, vs. 7.07 ± 2.1 in Group 2 vs. 7.5 ± 1.73 in Group 3 (p = 0.01). Inflammatory biomarkers were directly associated with coronary plaque vulnerability (p = 0.007 for hs-CRP and p = 0.038 for MMP-9). Conclusion: In patients with prior myocardial infarction, the size of myocardial scar was directly correlated with the vulnerability degree of coronary plaques and with systemic inflammation quantified during the acute phase of the coronary event. Hybrid imaging may help to identify the hemodynamically significant plaques with superior accuracy.
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Ammann KR, Hossainy SFA, Hossainy S, Slepian MJ. Hemocompatibility of polymers for use in vascular endoluminal implants. J Appl Polym Sci 2021. [DOI: 10.1002/app.51277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kaitlyn R. Ammann
- Department of Medicine College of Medicine, University of Arizona Tucson Arizona USA
- Sarver Heart Center, Arizona Health Sciences Center University of Arizona Tucson Arizona USA
| | - Syed F. A. Hossainy
- Department of Bioengineering College of Engineering, University of California Berkeley Berkeley California USA
| | - Sahir Hossainy
- Sarver Heart Center, Arizona Health Sciences Center University of Arizona Tucson Arizona USA
| | - Marvin J. Slepian
- Department of Medicine College of Medicine, University of Arizona Tucson Arizona USA
- Sarver Heart Center, Arizona Health Sciences Center University of Arizona Tucson Arizona USA
- Department of Biomedical Engineering College of Engineering, University of Arizona Tucson Arizona USA
- Department of Materials Science and Engineering College of Engineering, University of Arizona Tucson Arizona USA
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15
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Takahashi N, Dohi T, Endo H, Takeuchi M, Doi S, Kato Y, Okai I, Iwata H, Okazaki S, Isoda K, Miyauchi K, Minamino T. Coronary lipid-rich plaque characteristics in Japanese patients with acute coronary syndrome and stable angina: A near infrared spectroscopy and intravascular ultrasound study. IJC HEART & VASCULATURE 2021; 33:100747. [PMID: 33748401 PMCID: PMC7957086 DOI: 10.1016/j.ijcha.2021.100747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asians have a much lower incidence of adverse coronary events than Caucasians. We sought to evaluate the characteristics of coronary lipid-rich plaques (LRP) in Asian patients with acute coronary syndrome (ACS) and stable angina (SA). We also aimed to identify surrogate markers for the extent of LRP. METHODS We evaluated 207 patients (ACS, n = 75; SA, n = 132) who underwent percutaneous coronary intervention under near infrared spectroscopy intravascular ultrasound (NIRS-IVUS). Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum lipid-core burden index (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed. RESULTS The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385-745] vs. 361 [174-527], p < 0.001) than the SA culprit lesions. On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥ 400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95-8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and systematic biomarkers (hs-CRP, IL-6, TNF-α), whereas the extent of LRP was positively correlated with IVUS plaque burden (r = 0.24, p < 0.001). CONCLUSIONS We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from SA culprit lesions, and that a threshold maxLCBI4mm ≥ 400 was clinically suitable in Japanese patients. No surrogate maker for a high-risk LRP was found; consequently, direct intravascular evaluation of plaque characteristics remains important.
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Key Words
- ACS, acute coronary syndrome
- Asian
- CI, confidence interval
- CKD, chronic kidney disease
- IL-6, interleukin-6
- IQR, interquartile range
- IVUS, intravascular ultrasound
- Intracoronary imaging
- LCBI
- LCBI, lipid core burden index
- LDL-C, low-density lipoprotein cholesterol
- LRP, lipid-rich plaque
- Lipid core burden index
- MDA-LDL, malondialdehyde-modified LDL
- MLA, minimum lumen area
- NIRS
- NIRS, near infrared spectroscopy
- NSTE-ACS, non-ST elevation acute coronary syndrome
- OR, odds ratio
- PCI, percutaneous coronary intervention
- PCSK9, proprotein convertase subtilisin / kexin type 9
- SA, stable angina
- STEMI, ST-elevation myocardial infarction
- TNF-α, tumor necrosis factor-α
- Vulnerable plaque
- hs-CRP, high-sensitive C reactive protein
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Affiliation(s)
- Norihito Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Japan Agency for Medical Research and Development Core Research for Evolutionary Medical Science and Technology (AMEDCREST), Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, Japan
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16
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Mitsutake Y, Yano H, Ishihara T, Matsuoka H, Ueda Y, Ueno T. Consensus document on the standard of coronary angioscopy examination and assessment from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2021; 37:35-39. [PMID: 33743168 DOI: 10.1007/s12928-021-00770-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
Coronary angioscopy (CAS) is a unique diagnostic device that allows direct visualization of the vascular luminal surface in living patients. CAS contributes to elucidate the pathology of coronary artery disease. This consensus document provides a standard for CAS examination and assessment.
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Affiliation(s)
- Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Hideto Yano
- Division of Cardiology, Gyotoku General Hospital, Chiba, Japan
| | | | - Hiroshi Matsuoka
- Department of General Medicine, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takafumi Ueno
- Division of Cardiology, Fukuoka Memorial Hospital, Fukuoka, Japan
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17
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Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med 2021; 135:483-495. [PMID: 33349905 PMCID: PMC7751746 DOI: 10.1007/s00414-020-02481-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Sudden cardiac death (SCD) is one of the most common causes of death worldwide with a higher frequency especially in the young. Therefore, SCD is represented frequently in forensic autopsy practice, whereupon pathological findings in the heart can explain acute death. These pathological changes may not only include myocardial infarction, coronary thrombosis, or all forms of myocarditis/endocarditis but also rare diseases such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system, or primary cardiac tumours.
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Affiliation(s)
- P Markwerth
- Institute for Forensic Medicine, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - T Bajanowski
- Institute for Forensic Medicine, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - I Tzimas
- Institute for Forensic Medicine, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - R Dettmeyer
- Institute for Forensic Medicine, University Hospital Gießen, Giessen, Germany
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18
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Shimizu K, Takahashi M, Sato S, Saiki A, Nagayama D, Harada M, Miyazaki C, Takahara A, Shirai K. Rapid Rise of Cardio-Ankle Vascular Index May Be a Trigger of Cerebro-Cardiovascular Events: Proposal of Smooth Muscle Cell Contraction Theory for Plaque Rupture. Vasc Health Risk Manag 2021; 17:37-47. [PMID: 33603388 PMCID: PMC7886257 DOI: 10.2147/vhrm.s290841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases have been recognized as the main cause of death all over the world. Recently, the established cardio-ankle vascular index (CAVI) has become known as an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle. CAVI reflects the progress of arteriosclerosis, and a rapid rise in CAVI indicates arterial smooth muscle cell contraction. Considering the vasculature of the atheroma where vasa vasorum penetrates the smooth muscle cell layer and supplies blood to the intimal atheromatous lesion, a rapid rise of CAVI means "choked" atheroma. Thus, we proposed a "smooth muscle cell contraction" hypothesis of plaque rupture.
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Affiliation(s)
- Kazuhiro Shimizu
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Mao Takahashi
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Shuji Sato
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Atsuhito Saiki
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Daiji Nagayama
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masashi Harada
- Department of Neurosurgery, Toho University Omori Medical Center, Omori, Tokyo, Japan
| | - Chikao Miyazaki
- Department of Neurosurgery, Toho University Omori Medical Center, Omori, Tokyo, Japan
| | - Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan
| | - Kohji Shirai
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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19
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Nissen SE. Vulnerable Plaque and Einstein's Definition of Insanity. J Am Coll Cardiol 2020; 75:1383-1385. [PMID: 32216906 DOI: 10.1016/j.jacc.2020.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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20
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Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography. J Interv Cardiol 2020; 2020:8263923. [PMID: 32774188 PMCID: PMC7395998 DOI: 10.1155/2020/8263923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. Results Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41–63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36–46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. Conclusions OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.
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21
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Kuku KO, Singh M, Ozaki Y, Dan K, Chezar-Azerrad C, Waksman R, Garcia-Garcia HM. Near-Infrared Spectroscopy Intravascular Ultrasound Imaging: State of the Art. Front Cardiovasc Med 2020; 7:107. [PMID: 32695796 PMCID: PMC7338425 DOI: 10.3389/fcvm.2020.00107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022] Open
Abstract
Acute coronary syndromes (ACS) secondary to coronary vessel plaques represent a major cause of cardiovascular morbidity and mortality worldwide. Advancements in imaging technology over the last 3 decades have continuously enabled the study of coronary plaques via invasive imaging methods like intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The introduction of near-infrared spectroscopy (NIRS) as a modality that could detect the lipid (cholesterol) content of atherosclerotic plaques in the early nineties, opened the potential of studying “vulnerable” or rupture-prone, lipid-rich coronary plaques in ACS patients. Most recently, the ability of NIRS-IVUS to identify patients at risk of future adverse events was shown in a prospective multicenter trial, the Lipid-Rich-plaque Study. Intracoronary NIRS-IVUS imaging offers a unique method of coronary lipid-plaque characterization and could become a valuable clinical diagnostic and treatment monitoring tool.
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Affiliation(s)
- Kayode O Kuku
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Manavotam Singh
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Yuichi Ozaki
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Kazuhiro Dan
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Ron Waksman
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Hector M Garcia-Garcia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
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22
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LI Z, HUANG H, ZHANG W, WANG M, FU G. [Prognosis of patients with vulnerable plaques indicated by coronary CT angiography]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:76-81. [PMID: 32621414 PMCID: PMC8800673 DOI: 10.3785/j.issn.1008-9292.2020.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/27/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the prognosis of patients with vulnerable plaque indicated by coronary CT angiography (CCTA). METHODS Totally 1963 patients underwent CCTA from February 2nd 2015 to September 13th 2015, and 2728 coronary borderline lesions (stenosis of 50%-70%) were detected. Among them 804 patients had vulnerable plaques and 1159 patients had stable plaques. The primary endpoint was major cardiac adverse events (MACE), including cardiac death, acute myocardial infarction and target lesion revascularization. RESULTS Patients were followed up for a mean follow-up of 27.4±2.3 months. The incidence of MACE in the vulnerable plaque group was significantly higher than that in the stable plaque group (10.8%vs 2.3%, P < 0.01). After adjusting for age, gender, smoking, hypertension, diabetes, hyperlipidemia, the MACE hazard ratio (HR) in the vulnerable plaque group was 5.022 (95% CI:3.254-7.751, P < 0.01).Subgroup analysis showed that in the vulnerable plaque group, the incidence of MACE in patients taking antiplatelet and statin ≤3 months and those taking antiplatelet and statin > 3 months was 17.0%and 5.8%, respectively (HR=3.149, 95% CI:1.987-4.992, P < 0.01); but the difference did not seen in stable plaque group (HR=1.721, 95% CI:0.798-3.712, P>0.05). CONCLUSIONS This study confirmed the risk of MACE in patients with vulnerable plaque detected by CCTA and the drug treatment may reduce the risk for patients with vulnerable plaque.
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23
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Birgisdóttir KH, Hauksdóttir A, Ruhm C, Valdimarsdóttir UA, Ásgeirsdóttir TL. The effect of the economic collapse in Iceland on the probability of cardiovascular events. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100861. [PMID: 32106017 DOI: 10.1016/j.ehb.2020.100861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
After several years of a booming economy in Iceland, the economic bubble burst in 2008 and affected most Icelanders in one way or another. We explore whether the economic collapse in 2008 and subsequent economic crisis affected the probability of ischemic heart disease (IHD) events, independent of regular cyclical effects that can be attributed to typical economic conditions. Moreover, we conduct a mediation analysis to study the potential mechanisms through which the relationship between the economic collapse and cardiovascular health travels. We estimate linear probability models using administrative data on IHD events, earnings and balance-sheet status, as well as unemployment for all Icelanders aged 16 and older in 2000-2014. We find that the sharp change in economic conditions in 2008 increased the probability of cardiovascular events in both males and females in the long term. In absolute terms, these effects were small in magnitude but often statistically significant, amounting to approximately 13-16 extra cases of IHD events in each of the two years following the collapse for males and 3-5 addition cases for females. Moreover, they contrast with the finding that general business-cycle fluctuations operated in the opposite direction. Several potential mediators were correlated with the probability of IHD events, but their inclusion had little impact on the estimated effects of the economic crisis. A statistically significant business-cycle effect is found for both genders indicating that in general, harder economic times are beneficial for heart health. Thus, the general business cycle and the economic collapse in 2008 and subsequent crisis can be thought of as separate phenomena with differing effects on IHD.
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Affiliation(s)
- Kristín Helga Birgisdóttir
- Faculty of Economics, University of Iceland, Reykjavik, Iceland, Oddi v/Sturlugötu, 101 Reykjavík, Iceland.
| | - Arna Hauksdóttir
- Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Christopher Ruhm
- Frank Batten School of Leadership and Public Policy, University of Virginia, VA, USA
| | - Unnur Anna Valdimarsdóttir
- Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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24
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Vigne J, Cabella C, Dézsi L, Rustique E, Couffin AC, Aid R, Anizan N, Chauvierre C, Letourneur D, Le Guludec D, Rouzet F, Hyafil F, Mészáros T, Fülöp T, Szebeni J, Cordaro A, Oliva P, Mourier V, Texier I. Nanostructured lipid carriers accumulate in atherosclerotic plaques of ApoE -/- mice. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 25:102157. [PMID: 31982616 DOI: 10.1016/j.nano.2020.102157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/04/2019] [Accepted: 01/18/2020] [Indexed: 12/20/2022]
Abstract
Nanostructured lipid carriers (NLC) might represent an interesting approach for the identification and targeting of rupture-prone atherosclerotic plaques. In this study, we evaluated the biodistribution, targeting ability and safety of 64Cu-fonctionalized NLC in atherosclerotic mice. 64Cu-chelating-NLC (51.8±3.1 nm diameter) with low dispersity index (0.066±0.016) were produced by high pressure homogenization at tens-of-grams scale. 24 h after injection of 64Cu-chelated particles in ApoE-/- mice, focal regions of the aorta showed accumulation of particles on autoradiography that colocalized with Oil Red O lipid mapping. Signal intensity was significantly greater in aortas isolated from ApoE-/- mice compared to wild type (WT) control (8.95 [7.58, 10.16]×108 vs 4.59 [3.11, 5.03]×108 QL/mm2, P < 0.05). Moreover, NLC seemed safe in relevant biocompatibility studies. NLC could constitute an interesting platform with high clinical translation potential for targeted delivery and imaging purposes in atherosclerosis.
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Affiliation(s)
- Jonathan Vigne
- Université de Paris, LVTS, INSERM U1148, Paris, France; Nuclear Medicine Department, X. Bichat Hospital, APHP and DHU FIRE, Paris, France; Université de Paris, UMS34 FRIM, Paris, France
| | - Claudia Cabella
- Centro Ricerche Bracco, Bracco Imaging SpA, Colleretto Giacosa, Italy
| | - László Dézsi
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | | | | | - Rachida Aid
- Université de Paris, UMS34 FRIM, Paris, France
| | | | | | | | - Dominique Le Guludec
- Université de Paris, LVTS, INSERM U1148, Paris, France; Nuclear Medicine Department, X. Bichat Hospital, APHP and DHU FIRE, Paris, France; Université de Paris, UMS34 FRIM, Paris, France
| | - François Rouzet
- Université de Paris, LVTS, INSERM U1148, Paris, France; Nuclear Medicine Department, X. Bichat Hospital, APHP and DHU FIRE, Paris, France; Université de Paris, UMS34 FRIM, Paris, France
| | - Fabien Hyafil
- Université de Paris, LVTS, INSERM U1148, Paris, France; Nuclear Medicine Department, X. Bichat Hospital, APHP and DHU FIRE, Paris, France; Université de Paris, UMS34 FRIM, Paris, France
| | - Tamás Mészáros
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - Tamás Fülöp
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - János Szebeni
- Nanomedicine Research and Education Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - Alessia Cordaro
- Centro Ricerche Bracco, Bracco Imaging SpA, Colleretto Giacosa, Italy
| | - Paolo Oliva
- Centro Ricerche Bracco, Bracco Imaging SpA, Colleretto Giacosa, Italy
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Buckley T, Soo Hoo SY, Shaw E, Hansen PS, Fethney J, Tofler GH. Triggering of Acute Coronary Occlusion by Episodes of Vigorous Physical Exertion. Heart Lung Circ 2019; 28:1773-1779. [DOI: 10.1016/j.hlc.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/21/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
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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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Waksman R, Di Mario C, Torguson R, Ali ZA, Singh V, Skinner WH, Artis AK, Cate TT, Powers E, Kim C, Regar E, Wong SC, Lewis S, Wykrzykowska J, Dube S, Kazziha S, van der Ent M, Shah P, Craig PE, Zou Q, Kolm P, Brewer HB, Garcia-Garcia HM. Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study. Lancet 2019; 394:1629-1637. [PMID: 31570255 DOI: 10.1016/s0140-6736(19)31794-5] [Citation(s) in RCA: 254] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can detect lipid-rich plaques (LRPs). LRPs are associated with acute coronary syndromes or myocardial infarction, which can result in revascularisation or cardiac death. In this study, we aimed to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. METHODS In this prospective, cohort study (LRP), patients from 44 medical centres were enrolled in Italy, Latvia, Netherlands, Slovakia, UK, and the USA. Patients with suspected coronary artery disease who underwent cardiac catheterisation with possible ad hoc percutaneous coronary intervention were eligible to be enrolled. Enrolled patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694. FINDINGS Between Feb 21, 2014, and March 30, 2016, 1563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0·4%) patients. 1271 patients (mean age 64 years, SD 10, 883 [69%] men, 388 [31%]women) with analysable maxLCBI4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1·21 (95% CI 1·09-1·35; p=0·0004) for each 100-unit increase maxLCBI4mm) and adjusted HR 1·18 (1·05-1·32; p=0·0043). In patients with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 2·18 (1·48-3·22; p<0·0001) and adjusted HR was 1·89 (1·26-2·83; p=0·0021). At the plaque level, the unadjusted HR was 1·45 (1·30-1·60; p<0·0001) for each 100-unit increase in maxLCBI4mm. For segments with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 4·22 (2·39-7·45; p<0·0001) and adjusted HR was 3·39 (1·85-6·20; p<0·0001). INTERPRETATION NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at higher risk for subsequent NC-MACE. NIRS-intravascular ultrasound imaging adds to the armamentarium as the first diagnostic tool able to detect vulnerable patients and plaques in clinical practice. FUNDING Infraredx.
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Affiliation(s)
- Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA.
| | | | | | - Ziad A Ali
- New York Presbyterian/Columbia University Medical Center, New York, NY & Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | | | - Eric Powers
- Medical University of South Carolina Hospital, Charleston, SC, USA
| | | | | | - S Chiu Wong
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | | | - Sandeep Dube
- Community Heart and Vascular, Indianapolis, IN, USA
| | | | | | | | - Paige E Craig
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Quan Zou
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Paul Kolm
- MedStar Washington Hospital Center, Washington, DC, USA
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Madureira J, Brancher EA, Costa C, Aurino de Pinho R, Teixeira JP. Cardio-respiratory health effects of exposure to traffic-related air pollutants while exercising outdoors: A systematic review. ENVIRONMENTAL RESEARCH 2019; 178:108647. [PMID: 31450147 DOI: 10.1016/j.envres.2019.108647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/26/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
Despite physical exercise provides numerous health benefits, outdoor exercisers are frequently exposed to traffic-related air pollutants (TRAP) known to be associated with respiratory and cardiovascular diseases. The aim of this systematic review was to investigate the effects of TRAP exposure, specifically particulate matter and nitrogen dioxide (NO2), during outdoor exercise on cardio-respiratory health effects. Systematic database searches of PubMed, Web of Science, Scopus and Medline were performed by two researchers to identify peer-reviewed studies from 2000 to 2018. Combinations of keywords related to cardio-respiratory health effects, physical exercise and ambient air pollution were used. Thirteen studies were included, originating predominantly from European countries but also the American. They suggested that exercising in an environment with high TRAP exposure increases markers of respiratory and systemic inflammation, as well as, impairs the vascular function and increases artery pressure, when compared with an environment with low-TRAP exposure. In addition, the smaller particles appear to have the most severe health consequences compared with the larger coarse particles and NO2. This study also provides evidence that specific groups of the population have enhanced susceptibility to adverse effects from particulate matter exposure while exercising. There is a need for more studies focused on the relationship between air pollution, physical exercise and health, as large societal benefits can be obtained from healthy environments that can promote outdoor physical exercise.
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Affiliation(s)
- Joana Madureira
- National Institute of Health, Environmental Health Department, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Emerson Antonio Brancher
- Laboratório de Fisiologia e Bioquímica do Exercício (LAFIBE), Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil; Departamento de Educação Física, Universidade Regional de Blumenau, Blumenau, Santa Catarina, Brazil
| | - Carla Costa
- National Institute of Health, Environmental Health Department, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Ricardo Aurino de Pinho
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - João Paulo Teixeira
- National Institute of Health, Environmental Health Department, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Takiguchi M, Ohira T, Nakano H, Yumiya Y, Yamaki T, Yoshihisa A, Nakazato K, Suzuki H, Ishikawa T, Yasumura S, Kamiya K, Takeishi Y. Trends in the Incidence of Sudden Deaths and Heart Diseases in Fukushima After the Great East Japan Earthquake. Int Heart J 2019; 60:1253-1258. [PMID: 31666454 DOI: 10.1536/ihj.19-110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
On March 11, 2011, a great earthquake, known as the Great East Japan Earthquake, hit northeastern Japan, resulting in a tsunami that caused a nuclear disaster, the Fukushima Daiichi Nuclear Power Plant accident, forcing about 160,000 people to evacuate. We, therefore, sought to examine the effects of this evacuation on the onset of cardiovascular diseases and sudden death (SD) in Fukushima Prefecture, three years after the earthquake. We divided the evacuation zone into two areas, whole evacuation zone (Area 1) and partial evacuation zone (Area 2), and we defined the north district of the prefecture as the control area (Area 3). We cross-referenced the death certificate data with data from the Fukushima Prefecture acute myocardial infarction registration survey. For each area, we tallied the number of people who fell into the SD, myocardial infarction (MI), and MI suspected groups. We calculated the age-adjusted incidence rates and analyzed the differences in the adjusted incidence rates across three years using a Poisson regression model. The age-adjusted death rate of the SD group was significantly higher in 2011 in all areas than in 2012 or 2013 (P < 0.05). The total death rate was higher in Area 1 in March 2011, just after the disaster, than in the other two areas. The rate of SD was also higher in Area 1 than in the other areas in March 2011. The incidence of sudden cardiac death might have increased just after the Great East Japan Earthquake in the evacuation area, but not in other areas in Fukushima Prefecture.
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Affiliation(s)
- Mai Takiguchi
- Department of Cardiovascular Medicine, Fukushima Medical University School of Medicine
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Epidemiology, Fukushima Medical University School of Medicine
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Epidemiology, Fukushima Medical University School of Medicine
| | - Yui Yumiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Epidemiology, Fukushima Medical University School of Medicine
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University School of Medicine
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University School of Medicine
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University School of Medicine
| | - Hitoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University School of Medicine
| | - Tetsuo Ishikawa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Radiation Physics and Chemistry, Fukushima Medical University School of Medicine
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Department of Public Health, Fukushima Medical University School of Medicine
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.,Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University School of Medicine
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Kim JH, Almuwaqqat Z, Hammadah M, Liu C, Ko YA, Lima B, Sullivan S, Alkhoder A, Abdulbaki R, Ward L, Bremner JD, Sheps DS, Raggi P, Sun YV, Shah AJ, Vaccarino V, Quyyumi AA. Peripheral Vasoconstriction During Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease. Circ Res 2019; 125:874-883. [PMID: 31550998 PMCID: PMC7134565 DOI: 10.1161/circresaha.119.315005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
RATIONALE Excessive vasoconstriction in response to mental stress may be a potential mechanism by which acute psychological stress leads to adverse cardiac events. OBJECTIVES We investigated whether excessive digital vasoconstriction during acute mental stress predicts adverse cardiovascular outcomes among patients with coronary artery disease. METHODS AND RESULTS Five hundred forty-nine patients with stable coronary artery disease (age 63±9, 76% male, 29% black) underwent mental stress testing with a standardized public speaking stressor and followed prospectively for cardiovascular end points. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during mental stress/baseline was calculated and dichotomized by the median value into low and high sPAT ratio groups. Upon 3-year follow-up, Fine and Gray's subdistribution hazard ratios were used to examine the association between sPAT ratio and the composite end point of cardiovascular death, myocardial infarction, revascularization, and hospitalization for heart failure. The median sPAT ratio was 0.68 (interquartile range, 0.48-0.88), indicating 32% vasoconstriction with mental stress. Men were more likely to have low sPAT ratio than women (odds ratio, 1.79; P=0.007) while those on β-blockers were less likely to have low sPAT ratio (odds ratio, 0.52; P=0.003). After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (subdistribution hazard ratio, 1.77 [95% CI, 1.12-2.80]). CONCLUSIONS Greater peripheral vasoconstriction with mental stress, denoted by a low sPAT ratio, is associated with a higher risk of adverse cardiovascular outcomes in patients with coronary artery disease.
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Affiliation(s)
- Jeong Hwan Kim
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Zakaria Almuwaqqat
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Chang Liu
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA.,Department of Biostatistics and Bioinformatics (C.L., Y.-A.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics (C.L., Y.-A.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Bruno Lima
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Samaah Sullivan
- Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ayman Alkhoder
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Rami Abdulbaki
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics (C.L., Y.-A.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA.,Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Decatur, Georgia (J.D.B., A.J.S.)
| | - David S Sheps
- Department of Epidemiology, University of Florida College of Medicine, Gainesville (D.S.S.)
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Yan V Sun
- Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Atlanta VA Medical Center, Decatur, Georgia (J.D.B., A.J.S.)
| | - Viola Vaccarino
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Arshed A Quyyumi
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
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Kloner RA. Lessons learned about stress and the heart after major earthquakes. Am Heart J 2019; 215:20-26. [PMID: 31260902 DOI: 10.1016/j.ahj.2019.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/26/2019] [Indexed: 01/27/2023]
Abstract
There is evidence that certain stressors can trigger cardiovascular events. Several studies have now demonstrated an increase in major adverse cardiac events associated with natural disasters such as an earthquake. The purpose of this paper is to review the literature on earthquakes and cardiovascular events. Reports from 13 major quakes were reported. Earthquakes have been associated with a number of cardiac events including sudden cardiac death, fatal myocardial infarction (MI), myocardial infarction, stress cardiomyopathy, heart failure, stroke, arrhythmias, hypertension and pulmonary embolism. Most reports were associated with earthquakes of magnitude 6.0 or greater. Cardiac events were reported within hours of the quakes. In some reports there was a sharp spike in cardiac events followed by a decrease; but in other quakes the increases in cardiac events lasted weeks, months and even years. There often was an association between the cardiac events and amount of personal property loss. The Great East Japan Earthquake was an unusual event in that it was associated with a major tsunami and cardiac events appeared worse in inundated areas due to flooding. Some but not all reports suggested more MIs associated with early morning earthquakes that woke up the population. Hospitals in earthquake-prone areas should consider developing plans for handling increases in myocardial infarctions and other cardiac events that are associated with earthquakes.
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Affiliation(s)
- Robert A Kloner
- Huntington Medical Research Institutes, Cardiovascular Research Institute, Pasadena, CA, and Keck School of Medicine of University of Southern California, Dept. of Medicine and Division of Cardiovascular Medicine, Los Angeles, CA..
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Macrophage-targeted, enzyme-triggered fluorescence switch-on system for detection of embolism-vulnerable atherosclerotic plaques. J Control Release 2019; 302:105-115. [DOI: 10.1016/j.jconrel.2019.03.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/08/2019] [Accepted: 03/27/2019] [Indexed: 01/21/2023]
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Ho AFW, Zheng H, Earnest A, Cheong KH, Pek PP, Seok JY, Liu N, Kwan YH, Tan JWC, Wong TH, Hausenloy DJ, Foo LL, Tan BYQ, Ong MEH. Time-Stratified Case Crossover Study of the Association of Outdoor Ambient Air Pollution With the Risk of Acute Myocardial Infarction in the Context of Seasonal Exposure to the Southeast Asian Haze Problem. J Am Heart Assoc 2019; 8:e011272. [PMID: 31112443 PMCID: PMC6475051 DOI: 10.1161/jaha.118.011272] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/25/2019] [Indexed: 12/27/2022]
Abstract
Background Prior studies have demonstrated the association of air pollution with cardiovascular deaths. Singapore experiences seasonal transboundary haze. We investigated the association between air pollution and acute myocardial infarction ( AMI ) incidence in Singapore. Methods and Results We performed a time-stratified case-crossover study on all AMI cases in the Singapore Myocardial Infarction Registry (2010-2015). Exposure on days where AMI occurred (case days) were compared with the exposure on days where AMI did not occur (control days). Control days were chosen on the same day of the week earlier and later in the same month and year. We fitted conditional Poisson regression models to daily AMI incidence to include confounders such as ambient temperature, rainfall, wind-speed, and Pollutant Standards Index. We assessed relationships between AMI incidence and Pollutant Standards Index in the entire cohort and subgroups of individual-level characteristics. There were 53 948 cases. Each 30-unit increase in Pollutant Standards Index was association with AMI incidence (incidence risk ratio [ IRR ] 1.04, 95% CI 1.03-1.06). In the subgroup of ST -segment-elevation myocardial infarction the IRR was 1.00, 95% CI 0.98 to 1.03, while for non-ST-segment-elevation myocardial infarction, the IRR was 1.08, 95% CI 1.05 to 1.10. Subgroup analyses showed generally significant. Moderate/unhealthy Pollutant Standards Index showed association with AMI occurrence with IRR 1.08, 95% CI 1.05 to 1.11 and IRR 1.09, 95% CI 1.01 to 1.18, respectively. Excess risk remained elevated through the day of exposure and for >2 years after. Conclusions We found an effect of short-term air pollution on AMI incidence, especially non-ST-segment-elevation myocardial infarction and inpatient AMI . These findings have public health implications for primary prevention and emergency health services during haze.
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Affiliation(s)
- Andrew Fu Wah Ho
- SingHealth Duke‐NUS Emergency Medicine Academic Clinical ProgrammeSingapore
- SingHealth Emergency Medicine Residency ProgrammeSingapore
- Cardiovascular & Metabolic Disorders ProgramDuke‐National University of Singapore Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Huili Zheng
- National Registry of Diseases OfficeHealth Promotion BoardSingapore
| | - Arul Earnest
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Kang Hao Cheong
- Engineering ClusterSingapore Institute of TechnologySingapore
- Science and Math ClusterSingapore University of Technology and DesignSingapore
| | - Pin Pin Pek
- Department of Emergency MedicineSingapore General HospitalSingapore
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Jeon Young Seok
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Nan Liu
- Health Services Research CentreSingapore Health ServicesSingapore
- Centre for Quantitative MedicineDuke‐NUS Medical SchoolSingapore
| | - Yu Heng Kwan
- Program in Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | | | - Ting Hway Wong
- Department of General SurgerySingapore General HospitalSingapore
| | - Derek J. Hausenloy
- Cardiovascular & Metabolic Disorders ProgramDuke‐National University of Singapore Medical SchoolSingapore
- National Heart Research Institute SingaporeNational Heart CentreSingapore
- Yong Loo Lin School of MedicineNational University SingaporeSingapore
- The Hatter Cardiovascular InstituteUniversity College LondonLondonUnited Kingdom
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & DevelopmentLondonUnited Kingdom
- Department of CardiologyBarts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
| | - Ling Li Foo
- National Registry of Diseases OfficeHealth Promotion BoardSingapore
| | | | - Marcus Eng Hock Ong
- Department of Emergency MedicineSingapore General HospitalSingapore
- Health Services Research CentreSingapore Health ServicesSingapore
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Singh M, Khan K, Fisch E, Frey C, Mathias K, Jneid H, Musher DM, Barshes NR. Acute Cardiac Events in Patients With Severe Limb Infection. INT J LOW EXTR WOUND 2018; 17:261-267. [PMID: 30461325 DOI: 10.1177/1534734618810944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recent studies have shown an association between infections, such as influenza, pneumonia, or bacteremia, and acute cardiac events. We studied the association between foot infection and myocardial infarction, arrhythmia, and/or congestive heart failure. We analyzed the records of 318 consecutive episodes of deep soft tissue infection, gangrene, and/or osteomyelitis in 274 patients referred to a vascular surgery service at a tertiary center. We identified 24 acute cardiac events in 21 of 318 (6.6%) episodes of foot infection or foot gangrene. These 24 events included 11 new myocardial infarctions (3.5%), 8 episodes of new onset or worsening congestive heart failure (2.5%), and 5 new arrhythmias (1.6%). Tachycardia and systemic inflammatory response syndrome were associated with acute cardiac events ( P < .05 for each). The 1-year survival of patients with acute cardiac events was 50.4%, significantly lower than the 91.7% 1-year survival of patients without acute cardiac events ( P < .0015). Acute cardiac complications are not uncommon among patients presenting with severe foot infection and are associated with a high 1-year mortality. Primary care physicians, cardiologists, and vascular and orthopedic surgeons must keep a high index of suspicion for the occurrence of an acute cardiac event.
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Affiliation(s)
| | | | - Evan Fisch
- 2 Baylor College of Medicine, Houston, TX, USA
| | | | | | - Hani Jneid
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Daniel M Musher
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Neal R Barshes
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Devault DA, Maguet H, Merle S, Péné-Annette A, Lévi Y. Wastewater-based epidemiology in low Human Development Index states: bias in consumption monitoring of illicit drugs. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:27819-27838. [PMID: 30109683 DOI: 10.1007/s11356-018-2864-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
Wastewater-based epidemiology is a promising approach worldwide, and its application is currently being developed in non-advanced economies. This technology, based on known toxicokinetic data initially used to detect illicit drugs in well-managed and maintained local sewer networks, has been extended to assess other products such as pesticides, alcohol, flame retardants, nicotine, and other substances. This technology is also used in countries with non-advanced economies. The present review aims to support future wastewater-based epidemiology in such countries by providing toxicokinetic data for locally used narcotic drugs that are expected or known to be emerging in developed countries, outlining the excretion differences due to human polymorphism, and summarising the practical obstacles due to the coverage, maintenance efficiency, or type of local sewage network.Case study feedback from Martinique is presented as an example; the Martinique field study complies with the Organisation for Economic Co-operation and Development standards for health issues, but not with regard to population and urban dynamics.
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Affiliation(s)
- Damien A Devault
- Faculté de Pharmacie, Univ. Paris Sud, Univ. Paris Saclay, UMR 8079, CNRS, AgroParisTech, France, 5 rue J. B. Clement, 92290, Chatenay-Malabry, France.
| | - Hadrien Maguet
- Centre Hospitalier Universitaire de Martinique, CS 90632 - 97261, Fort-de-France Cedex, France
| | - Sylvie Merle
- Observatoire de la Santé de la Martinique, Immeuble Objectif 3000, Acajou sud, 97232, Le Lamentin, Martinique
| | - Anne Péné-Annette
- Laboratoire EA 929 AIHP-GEODE-BIOSPHERES Campus Universitaire de Schœlcher, 97275, Schœlcher, France
| | - Yves Lévi
- Faculté de Pharmacie, Univ. Paris Sud, Univ. Paris Saclay, UMR 8079, CNRS, AgroParisTech, France, 5 rue J. B. Clement, 92290, Chatenay-Malabry, France
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Bazoukis G, Tse G, Naka KK, Kalfakakou V, Vlachos K, Saplaouras A, Letsas KP, Korantzopoulos P, Thomopoulos C, Michelongona P, Bazoukis X, González-Salvado V, Liu T, Michalis LK, Baranchuk A, Itoh T, Efremidis M, Tsioufis C, Stavrakis S. Impact of major earthquakes on the incidence of acute coronary syndromes - A systematic review of the literature. Hellenic J Cardiol 2018; 59:262-267. [PMID: 29807192 DOI: 10.1016/j.hjc.2018.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 01/13/2023] Open
Abstract
Natural disasters such as tsunami, hurricanes, and earthquakes may have a negative impact on cardiac health. The aim of our systematic review is to evaluate the impact of earthquakes on the incidence of acute coronary syndromes and cardiac mortality and to examine the impact of the time of earthquakes on the incidence of acute coronary syndromes. MEDLINE and Cochrane databases were searched for studies assessing the impact of earthquakes on acute coronary syndromes from inception until December 20, 2017. Reference lists of all included studies and relevant review studies were also searched. A total of 26 studies on 12 earthquake disasters were included in the systematic review. The existing data show a significant negative impact of the Great East Japan, Christchurch, Niigata-Chuetsu, Northridge, Great Hanshin-Awaji, Sichuan, Athens, Armenia, and Noto Peninsula earthquakes on the incidence of acute coronary syndromes. By contrast, studies on the Newcastle, Loma Prieta, and Thessaloniki earthquakes did not show a significant correlation with myocardial infarction and cardiac mortality. In conclusion, earthquakes may be associated with increased incidence of acute coronary syndromes and cardiovascular mortality. There are conflicting data about the impact of the timing of earthquakes on the occurrence of acute coronary syndromes. Preventive measures to promote the adjustment of healthcare systems to treat cardiovascular diseases after natural disasters should be immediately implemented particularly in high-risk regions.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Katerina K Naka
- Second Department of Cardiology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Vasiliki Kalfakakou
- Laboratory of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Vlachos
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | | | | | | | - Xenophon Bazoukis
- Department of Cardiology, 'G. Hatzikosta' General Hospital, Ioannina, Greece
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Institute of Health Research of Santiago (IDIS), Spain
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Lampros K Michalis
- Second Department of Cardiology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
| | - Tomonori Itoh
- Department of Internal Medicine, Iwate Medical University, Uchimaru, Morioka, 020-8505, Japan
| | - Michael Efremidis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas.Sofias Ave., 11527, Athens, Greece
| | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Boi A, Jamthikar AD, Saba L, Gupta D, Sharma A, Loi B, Laird JR, Khanna NN, Suri JS. A Survey on Coronary Atherosclerotic Plaque Tissue Characterization in Intravascular Optical Coherence Tomography. Curr Atheroscler Rep 2018; 20:33. [PMID: 29781047 DOI: 10.1007/s11883-018-0736-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Atherosclerotic plaque deposition within the coronary vessel wall leads to arterial stenosis and severe catastrophic events over time. Identification of these atherosclerotic plaque components is essential to pre-estimate the risk of cardiovascular disease (CVD) and stratify them as a high or low risk. The characterization and quantification of coronary plaque components are not only vital but also a challenging task which can be possible using high-resolution imaging techniques. RECENT FINDING Atherosclerotic plaque components such as thin cap fibroatheroma (TCFA), fibrous cap, macrophage infiltration, large necrotic core, and thrombus are the microstructural plaque components that can be detected with only high-resolution imaging modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Light-based OCT provides better visualization of plaque tissue layers of coronary vessel walls as compared to IVUS. Three dominant paradigms have been identified to characterize atherosclerotic plaque components based on optical attenuation coefficients, machine learning algorithms, and deep learning techniques. This review (condensation of 126 papers after downloading 150 articles) presents a detailed comparison among various methodologies utilized for plaque tissue characterization, classification, and arterial measurements in OCT. Furthermore, this review presents the different ways to predict and stratify the risk associated with the CVD based on plaque characterization and measurements in OCT. Moreover, this review discovers three different paradigms for plaque characterization and their pros and cons. Among all of the techniques, a combination of machine learning and deep learning techniques is a best possible solution that provides improved OCT-based risk stratification.
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Affiliation(s)
- Alberto Boi
- Department of Cardiology, University of Cagliari, Cagliari, Italy
| | - Ankush D Jamthikar
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology Nagpur, Nagpur, Maharashtra, India
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Deep Gupta
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology Nagpur, Nagpur, Maharashtra, India
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Bruno Loi
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | - Narendra N Khanna
- Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Jasjit S Suri
- Coronary Arterial Division, AtheroPoint™, Roseville, CA, USA.
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Abstract
OPINION STATEMENT Early identification of atherosclerosis and at-risk lesions plays a critical role in reducing the burden of cardiovascular disease. While invasive coronary angiography serves as the gold standard for diagnosing coronary artery disease, non-invasive imaging techniques provide visualization of both anatomical and functional atherosclerotic processes prior to clinical presentation. The development of cardiac positron emission tomography (PET) has greatly enhanced our capability to diagnose and treat patients with early stages of atherosclerosis. Cardiac PET is a powerful, versatile non-invasive diagnostic tool with utility in the identification of high-risk plaques, myocardial perfusion defects, and viable myocardial tissue. Cardiac PET allows for comparisons of myocardial function both at time of rest and stress, providing accurate assessments of both myocardial perfusion and viability. Furthermore, novel PET techniques with unique radiotracers yield clinically relevant data on high-risk plaques in active progressive atherosclerosis. While PET exercise stress tests were previously difficult to perform given short radiotracer half-life, the development of the novel radiotracer Flurpiridaz F-18 provides a promising future for PET exercise stress imaging. In addition, hybrid imaging with computed tomography angiography (CTA) and cardiac magnetic resonance (CMR) provides integration of cardiac function and structure. In this review article, we discuss the principles of cardiac PET, the clinical applications of PET in diagnosing and prognosticating patients at risk for future cardiovascular events, compare PET with other non-invasive cardiac imaging modalities, and discuss future applications of PET in CVD evaluation and management.
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Affiliation(s)
- Brian M Salata
- Weill Cornell Medicine, 520 E 70th Street, M-507, New York, NY, 10021, USA
| | - Parmanand Singh
- Department of Cardiology, Weill Cornell Medicine, 520 E 70th Street Starr Pavilion, 4th Floor, New York, NY, 10021, USA.
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Yonetsu T, Jang IK. Advances in Intravascular Imaging: New Insights into the Vulnerable Plaque from Imaging Studies. Korean Circ J 2017; 48:1-15. [PMID: 29171202 PMCID: PMC5764866 DOI: 10.4070/kcj.2017.0182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/11/2022] Open
Abstract
The term “vulnerable plaque” denotes the plaque characteristics that are susceptible to coronary thrombosis. Previous post-mortem studies proposed 3 major mechanisms of coronary thrombosis: plaque rupture, plaque erosion, and calcified nodules. Of those, characteristics of rupture-prone plaque have been extensively studied. Pathology studies have identified the features of rupture-prone plaque including thin fibrous cap, large necrotic core, expansive vessel remodeling, inflammation, and neovascularization. Intravascular imaging modalities have emerged as adjunctive tools of angiography to identify vulnerable plaques. Multiple devices have been introduced to catheterization laboratories to date, including intravascular ultrasound (IVUS), virtual-histology IVUS, optical coherence tomography (OCT), coronary angioscopy, and near-infrared spectroscopy. With the use of these modalities, our understanding of vulnerable plaque has rapidly grown over the past several decades. One of the goals of intravascular imaging is to better predict and prevent future coronary events, for which prospective observational data is still lacking. OCT delineates microstructures of plaques, whereas IVUS visualizes macroscopic vascular structures. Specifically, plaque erosion, which has been underestimated in clinical practice, is gaining an interest due to the potential of OCT to make an in vivo diagnosis. Another potential future avenue for intravascular imaging is its use to guide treatment. Feasibility of tailored therapy for acute coronary syndromes (ACS) guided by OCT is under investigation. If it is proven to be effective, it may potentially lead to major shift in the management of millions of patients with ACS every year.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Ik Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiology, Kyung-Hee University Hospital, Seoul, Korea.
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Mamdani N, Tung B, Wang Y, Jaffer FA, Tawakol A. Imaging the Coronary Artery Plaque: Approaches, Advances, and Challenges. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9419-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zuflacht JP, Shao Y, Kronish IM, Edmondson D, Elkind MSV, Kamel H, Boehme AK, Willey JZ. Psychiatric Hospitalization Increases Short-Term Risk of Stroke. Stroke 2017; 48:1795-1801. [PMID: 28536168 DOI: 10.1161/strokeaha.116.016371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recent evidence suggests that psychological distress, including the symptoms of psychiatric illness, may acutely increase the risk of stroke. However, existing studies are limited by small sample sizes, inherent recall bias, and poorly defined criteria for what constitutes psychological distress. METHODS We analyzed administrative data from the Healthcare Cost and Utilization Project for the state of California from 2007 to 2009 using a case-crossover design. Conditional logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for combined hemorrhagic and ischemic stroke risk occurring within 15, 30, 90, 180, and 365 days of a hospitalization for a psychiatric diagnosis (as defined by International Classification of Diseases, Ninth Revision, code) among adults. RESULTS Psychiatric hospitalizations within 1 year before stroke were found in 2585 (5.3%) of 48 558 stroke patients. Hospitalization for a psychiatric condition was associated with increased risk of stroke within all 5 time periods, with the highest odds of stroke occurring within 15 days (0-15 days: OR, 3.5; 95% confidence interval [CI], 2.6-4.8; 0-30 days: OR, 3.0; 95% CI, 2.4-3.8; 0-90 days: OR, 2.3; 95% CI, 2.0-2.7; 0-180 days: OR, 2.2; 95% CI, 2.0-2.5; and 0-365 days: OR, 2.6; 95% CI, 2.4-2.8). CONCLUSIONS Psychiatric hospitalization increases the short-term risk of stroke, particularly within the 15-day period after hospitalization.
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Affiliation(s)
- Jonah P Zuflacht
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.).
| | - Yuefan Shao
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
| | - Ian M Kronish
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
| | - Donald Edmondson
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
| | - Mitchell S V Elkind
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
| | - Hooman Kamel
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
| | - Amelia K Boehme
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
| | - Joshua Z Willey
- From the College of Physicians and Surgeons (J.P.Z.), Center for Behavioral Cardiovascular Health (I.M.K., D.E.), Department of Neurology, College of Physicians and Surgeons (M.S.V.E., A.K.B., J.Z.W.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E., A.K.B.), Columbia University, New York, NY; Department of Epidemiology, University of Michigan, Ann Arbor (Y.S.); and Department of Neurology, Cornell University, New York, NY (H.K.)
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Kalavakunta JK, Mittal MK, Janoudi A, Abela OG, Alreefi F, Abela GS. Role of Cholesterol Crystals During Acute Myocardial Infarction and Cerebrovascular Accident. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2017.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017; 6:JAHA.117.005543. [PMID: 28314799 PMCID: PMC5524044 DOI: 10.1161/jaha.117.005543] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Dimitrios Tsiachris
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| | - Panagiota Pietri
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
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Su Y, Xu C, Li K, Wang B, Chen J, Liu L, Lin L, Dong Q, Du L. TGF-β1 and TIMP1 double directional rAAV targeted by UTMD in atherosclerotic vulnerable plaque. Exp Ther Med 2017; 13:1465-1469. [PMID: 28413493 PMCID: PMC5377323 DOI: 10.3892/etm.2017.4101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022] Open
Abstract
In the present study, we determined whether ultrasound-targeted microbubble destruction (UTMD) combined with dual targeting of transforming growth factor (TGF)-β1 and tissue inhibitors of metalloproteinase (TIMP) 1 recombinant adeno-associated virus (rAAV) can stabilize atherosclerotic vulnerable plaques. First, we used rabbit model to detect the TGF-β1/TIMP1 virus therapy result. H&E staining was used to evaluate the tissues. The protein levels of TGF-β1 and TIMP1 were detected in rabbit models. The THP-1 cells were induced into macrophages, and transfected with TGF-β1 and TIMP1 rAAV under optimized UTMD. The expression of TGF-β1 and TIMP1 was measured by RT-PCR and western blotting. We found that the apoptotic rates were induced when compared to the control group. The rAAV virus group showed a significant decrease in the p-ERT and p-AKT expression. These data support the hypothesis that TGF-β1 and TIMP1 are crucial in the regulation of atherosclerotic plaques.
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Affiliation(s)
- Yijin Su
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Changsong Xu
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Kunyu Li
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Bo Wang
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Jufang Chen
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Long Liu
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Lizhou Lin
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Qingqing Dong
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
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Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients. J Psychosom Res 2017; 93:19-27. [PMID: 28107888 PMCID: PMC5260840 DOI: 10.1016/j.jpsychores.2016.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute high levels of anger and anxiety are associated with an elevated risk of myocardial infarction (MI) in the following two hours. MIs preceded by these acute negative emotions may also have a poor long-term prognosis, but information about high-risk patients is lacking. We examined whether young age and female sex are associated with MIs that are preceded by negative emotions and whether age and sex moderate the subsequent increased mortality risk following MI preceded by negative emotions. METHODS We conducted a secondary analysis of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age=60.1±12.3years, 29.2% women). Anxiety and anger immediately prior to (0-2h) MI and the day before (24-26h) MI were assessed using a structured interview. Subsequent 10-year all-cause mortality was determined using the US National Death Index. RESULTS Anxiety during the 0-2h pre-MI period was associated with younger age (OR=0.98,95% CI=0.96-0.99 per year) and female sex (OR=1.50,95% CI=1.11-2.02). Anger in the 0-2h pre-MI period was also associated with younger age (OR=0.95,95% CI=0.94-0.96) but not with sex (OR=0.93,95% CI=0.67-1.28). During follow-up, 580 (26.7%) patients died. Mortality rate was higher if MI occurred immediately after high anxiety, particularly in patients ≥65years (HR=1.80,95% CI=1.28-2.54) vs. younger patients (HR=0.87,95% CI=0.55-1.40; p-interaction=0.015). Other interactions with sex or anger were not significant. CONCLUSIONS Patients with high anxiety or anger levels in the critical 2-hour period prior to MI are younger than those without such emotional precipitants. In addition, pre-MI anxiety is associated with an elevated 10-year mortality risk in patients aged ≥65years.
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Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review. Phys Med 2017; 33:1-15. [DOI: 10.1016/j.ejmp.2016.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 02/08/2023] Open
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Abela OG, Ahsan CH, Alreefi F, Salehi N, Baig I, Janoudi A, Abela GS. Plaque Rupture and Thrombosis: the Value of the Atherosclerotic Rabbit Model in Defining the Mechanism. Curr Atheroscler Rep 2016; 18:29. [PMID: 27091328 DOI: 10.1007/s11883-016-0587-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Persistent inflammation and mechanical injury associated with cholesterol crystal accretion within atherosclerotic plaques typically precedes plaque disruption (rupture and/or erosion) and thrombosis--often the terminal events of atherosclerotic cardiovascular disease. To elucidate the mechanisms of these events, the atherosclerotic rabbit model provides a unique and powerful tool that facilitates studies of atherogenesis starting with plaque buildup to eventual disruption. Examination of human coronary arteries obtained from patients who died with myocardial infarction demonstrates evidence of cholesterol crystals perforating the plaque cap and intimal surface of the arterial wall that can lead to rupture. These observations were made possible by omitting ethanol, an avid lipid solvent, from the tissue processing steps. Importantly, the atherosclerotic rabbit model exhibits a similar pathology of cholesterol crystals perforating the intimal surface as seen in ruptured human plaques. Local and systemic inflammatory responses in the model are also similar to those observed in humans. The strong parallel between the rabbit and human pathology validates the atherosclerotic rabbit model as a predictor of human pathophysiology of atherosclerosis. Thus, the atherosclerotic rabbit model can be used with confidence to evaluate diagnostic imaging and efficacy of novel anti-atherosclerotic therapy.
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Affiliation(s)
- Oliver G Abela
- Department of Medicine, Division of Cardiovascular Medicine, University of Nevada, Las Vegas, NV, USA
| | - Chowdhury H Ahsan
- Department of Medicine, Division of Cardiovascular Medicine, University of Nevada, Las Vegas, NV, USA
| | - Fadi Alreefi
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Negar Salehi
- Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Imran Baig
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Abed Janoudi
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA.
- Department of Physiology, Division of Pathology, Michigan State University, East Lansing, MI, USA.
- Michigan State University, B208 Clinical Center, East Lansing, MI, 48824, USA.
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Scherer DJ, Psaltis PJ. Future imaging of atherosclerosis: molecular imaging of coronary atherosclerosis with (18)F positron emission tomography. Cardiovasc Diagn Ther 2016; 6:354-67. [PMID: 27500093 DOI: 10.21037/cdt.2015.12.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Atherosclerosis is characterized by the formation of complex atheroma lesions (plaques) in arteries that pose risk by their flow-limiting nature and propensity for rupture and thrombotic occlusion. It develops in the context of disturbances to lipid metabolism and immune response, with inflammation underpinning all stages of plaque formation, progression and rupture. As the primary disease process responsible for myocardial infarction, stroke and peripheral vascular disease, atherosclerosis is a leading cause of morbidity and mortality on a global scale. A precise understanding of its pathogenic mechanisms is therefore critically important. Integral to this is the role of vascular wall imaging. Over recent years, the rapidly evolving field of molecular imaging has begun to revolutionize our ability to image beyond just the anatomical substrate of vascular disease, and more dynamically assess its pathobiology. Nuclear imaging by positron emission tomography (PET) can target specific molecular and biological pathways involved in atherosclerosis, with the application of (18)Fluoride PET imaging being widely studied for its potential to identify plaques that are vulnerable or high risk. In this review, we discuss the emergence of (18)Fluoride PET as a promising modality for the assessment of coronary atherosclerosis, focusing on the strengths and limitations of the two main radionuclide tracers that have been investigated to date: 2-deoxy-2-((18)F)fluoro-D-glucose ((18)F-FDG) and sodium (18)F-fluoride ((18)F-NaF).
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Affiliation(s)
- Daniel J Scherer
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia 5000, Australia;; Royal Adelaide Hospital, South Australia 5000, Australia; ; School of Medicine, The University of Adelaide, South Australia 5000, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia 5000, Australia;; Royal Adelaide Hospital, South Australia 5000, Australia; ; School of Medicine, The University of Adelaide, South Australia 5000, Australia
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