1
|
Kurniawan RB, Saputra PBT, Haq AUDU, Purwati DD, Wungu CDK, Susilo H, Alsagaff MY, Amin IM, Oktaviono YH. Characteristics of calcified nodule attributable to culprit lesion in acute coronary syndrome: A systematic review and meta-analysis. iScience 2024; 27:110351. [PMID: 39092174 PMCID: PMC11292520 DOI: 10.1016/j.isci.2024.110351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/01/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Abstract
The presence of calcified nodule (CN) is a significant characteristic of atherothrombosis in acute coronary syndrome (ACS). However, its characteristics continue to be understudied. This review aimed to further investigate these characteristics. This study found that CN was a distinctive feature of an atheromatous plaque, representing 6.3% of ACS. CN was more common in NSTE-ACS than in STEMI patients (9.4% vs. 6.6%). CN was also chiefly observed in the left anterior descendant artery (48%), followed by the right coronary (40.4%) and left circumflex (14.5%) arteries. Higher prevalence of hypertension (78.8%), diabetes mellitus (50.8%), multivessel disease (71.7%), and kidney disease (26.43%) were noted in CN compared to non-CN patients. CN-associated ACS also 6-fold increased the risk of target lesion revascularization compared to those without CN.
Collapse
Affiliation(s)
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Indah Mohd Amin
- Center of Preclinical Science Studies, Faculty of Dentistry, Universiti Teknologi MARA, Selangor Darul Ehsan, Malaysia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
2
|
Homorodean C, Leucuta DC, Ober M, Homorodean R, Spinu M, Olinic M, Tataru D, Olinic DM. Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13671. [PMID: 34411283 DOI: 10.1111/eci.13671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients. METHODS A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models. RESULTS Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina. CONCLUSION Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non-culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.
Collapse
Affiliation(s)
- Calin Homorodean
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Ober
- Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | | | - Mihail Spinu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan Tataru
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| |
Collapse
|
3
|
Thin Cap Fibroatheroma Detection in Virtual Histology Images Using Geometric and Texture Features. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8091632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Atherosclerotic plaque rupture is the most common mechanism responsible for a majority of sudden coronary deaths. The precursor lesion of plaque rupture is thought to be a thin cap fibroatheroma (TCFA), or “vulnerable plaque”. Virtual Histology-Intravascular Ultrasound (VH-IVUS) images are clinically available for visualising colour-coded coronary artery tissue. However, it has limitations in terms of providing clinically relevant information for identifying vulnerable plaque. The aim of this research is to improve the identification of TCFA using VH-IVUS images. To more accurately segment VH-IVUS images, a semi-supervised model is developed by means of hybrid K-means with Particle Swarm Optimisation (PSO) and a minimum Euclidean distance algorithm (KMPSO-mED). Another novelty of the proposed method is fusion of different geometric and informative texture features to capture the varying heterogeneity of plaque components and compute a discriminative index for TCFA plaque, while the existing research on TCFA detection has only focused on the geometric features. Three commonly used statistical texture features are extracted from VH-IVUS images: Local Binary Patterns (LBP), Grey Level Co-occurrence Matrix (GLCM), and Modified Run Length (MRL). Geometric and texture features are concatenated in order to generate complex descriptors. Finally, Back Propagation Neural Network (BPNN), kNN (K-Nearest Neighbour), and Support Vector Machine (SVM) classifiers are applied to select the best classifier for classifying plaque into TCFA and Non-TCFA. The present study proposes a fast and accurate computer-aided method for plaque type classification. The proposed method is applied to 588 VH-IVUS images obtained from 10 patients. The results prove the superiority of the proposed method, with accuracy rates of 98.61% for TCFA plaque.
Collapse
|
4
|
The Role of Virtual Histology Intravascular Ultrasound in the Identification of Coronary Artery Plaque Vulnerability in Acute Coronary Syndromes. Cardiol Rev 2017; 24:303-309. [PMID: 26886467 DOI: 10.1097/crd.0000000000000100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Markers of coronary plaque vulnerability, such as a high lipid burden, increased inflammatory activity, and a thin fibrous cap, have been identified in histological studies. In vivo, grayscale intravascular ultrasound (IVUS) provides more in-depth information on coronary artery plaque burden than conventional angiography but is unable to accurately distinguish between noncalcific tissue types within the plaque. An analysis of IVUS radiofrequency backscatter based on spectral pattern recognition, such as virtual histology IVUS, allows detailed scrutiny of plaque composition and classification of coronary lesions. This review discusses the virtual histology IVUS technology and its accuracy in identifying vulnerable plaque features, focusing on its use in predicting patient outcomes after acute coronary syndrome, and its limitations in clinical practice.
Collapse
|
5
|
Souza CF, Maehara A, Mintz GS, Matsumura M, Alves CMR, Carlos Carvalho A, Caixeta A. Tissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study. Catheter Cardiovasc Interv 2017; 90:1107-1114. [PMID: 28191713 DOI: 10.1002/ccd.26954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 01/01/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We sought to assess a new modality of radiofrequency intravascular ultrasound (IVUS) called iMAP-IVUS (Boston Scientific, Santa Clara, California) during the evaluation of patients presenting with high-risk acute coronary syndromes. BACKGROUND There are limited data on plaque tissue characterization and phenotype classification using iMAP-IVUS. METHODS In the iWonder study patients presenting with ST-elevation myocardial infarction (STEMI) or non-STEMI underwent three-vessel grayscale IVUS and iMAP-IVUS tissue characterization prior to percutaneous intervention. In total 385 lesions from 100 patients were divided into culprit (n = 100) and nonculprit (n = 285) lesions. Lesion phenotype was classified as (i) thin-cap fibroatheroma (iMAP-derived TCFA); (ii) thick-cap fibroatheroma; (iii) pathological intimal thickening; (iv) fibrotic plaque; and (v) fibrocalcific plaque. RESULTS Culprit lesions had smaller minimum lumen cross-sectional area (MLA) with greater plaque burden compared to non-culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non-culprit lesions. iMAP-IVUS revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the MLA site (all P < 0.001). Any fibroatheroma was more frequently identified in culprit lesions compared with non-culprit lesions (93% vs. 78.9%, P = 0.001), anywhere within the lesion 19.0%, P < 0.001) as well as at the MLA site (18.0% vs. 9.5%, P = 0.07). CONCLUSIONS Three-vessel radiofrequency iMAP-IVUS demonstrated a greater plaque burden and higher prevalence of any fibroatheroma as well as iMAP-derived TCFAs in culprit versus non-culprit lesions in patients presenting with STEMI or non-STEMI undergoing percutaneous coronary intervention. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Cristiano F Souza
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | - Akiko Maehara
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York.,Department of Interventional Cardiology, Columbia University Medical Center, New York, New York
| | - Gary S Mintz
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York
| | - Mitsuaki Matsumura
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York
| | - Claudia M R Alves
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Adriano Caixeta
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil.,Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
6
|
Kang J, Jeon KH, Kim SW, Park JJ, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH, Choi DJ. Evolution of nonculprit coronary atherosclerotic plaques assessed by serial virtual histology intravascular ultrasound in patients with ST-segment elevation myocardial infarction and chronic total occlusion. Coron Artery Dis 2016; 27:650-657. [PMID: 27501406 PMCID: PMC5087572 DOI: 10.1097/mca.0000000000000419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The pathophysiology and natural course of coronary nonculprit plaques remain unclear. We investigated whether the short-term natural course of nonculprit plaques differs between ST-segment elevation myocardial infarction (STEMI) and chronic total occlusion (CTO) patients. METHODS We performed serial virtual histology intravascular ultrasound on nonculprit plaques in 26 STEMI and 11 CTO lesions at baseline and the 6-month follow-up. RESULTS At baseline, more lesions in the STEMI group were virtual histology intravascular ultrasound-derived thin-cap fibroatheromas (TCFA; 76.9 vs. 18.1%, P=0.002). During the follow-up period, the plaque composition changed dynamically in the STEMI group (fibrofatty: 9.8±1.9 to 17.3±2.9%, P=0.030; dense calcium: 12.7±1.8 to 8.1±1.7%, P=0.026; necrotic core: 21.1±1.8 to 15.4±2.2%, P=0.052), with a consistent plaque size. In the CTO group, the plaque composition and plaque size remained consistent without a significant change. Also, more lesions in the STEMI group remained as or progressed to TCFA, compared with the CTO group (67 vs. 11%, P=0.089). Factors associated with a persistent TCFA or with a new development of TCFA were a large necrotic core volume index and the diagnosis of STEMI, whereas new statin usage was a protective factor. CONCLUSION Nonculprit lesions in STEMI patients were more unstable at the baseline compared with those in CTO patients. During follow-up, nonculprit lesions in STEMI and CTO patients showed a distinct pattern of change; the former were stabilized in plaque composition, whereas the latter remained consistent. The diagnosis of STEMI and a large necrotic core volume were predictors of evolution to a TCFA, and new statin usage was a protective factor.
Collapse
Affiliation(s)
- Jeehoon Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Hyun Jeon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Seong-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| |
Collapse
|