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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.
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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
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Li Y, Liang X, Zhang W, Qiao X, Wang Z. The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Interv Cardiol 2021; 2021:6699812. [PMID: 33935601 PMCID: PMC8055432 DOI: 10.1155/2021/6699812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. METHODS PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. RESULTS 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45-1.00; P = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05-2.12; P = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40-1.26; P = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51-3.83; P = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21-1.80; P = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54-2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93-1.35; P = 0.24) between two groups. CONCLUSIONS The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).
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Affiliation(s)
- Yan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Xiying Liang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Wenjiao Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Xuan Qiao
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Zhilu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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The Napkin-Ring Sign – the Story Behind Invasive Coronary Angiography. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0006] [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
Coronary artery disease (CAD) represents one of the leading causes of morbidity and mortality across Europe. Most of the patients do not experience any warning sign before the coronary event develops, therefore screening this group of patients is essential to prevent major cardiac events. Coronary computed tomography angiography (CCTA) offers a noninvasive approach of the coronary arteries, providing information not only on the presence and severity of the coronary stenosis, but is also able to characterize the structure of the coronary wall. CCTA allows complex evaluation of the extension of CAD, and by assessing the structure of the atherosclerotic plaque, it can identify its degree of vulnerability. The napkin-ring sign (NRS) represents a ring-like attenuation of the non-calcified portion of the coronary lesion and has a high specificity (96–100%) for the identification of thin cap fibroatheroma (TCFA) or culprit lesion in acute coronary syndromes (ACS). It is also an independent predictor for ACS events and the strongest predictor for future ACS. Modern CCTA can provide submillimeter isotropic spatial resolution. Thus, CT attenuation-based tissue interpretation enables the assessment of total coronary plaque burden and individual plaque components, with a similar accuracy as intravascular ultrasoud-based investigations. This review aims to present the important role of CCTA as a potent screening tool for patients with CAD, and the current evidences in the detection and quantification of vulnerable plaques.
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Rao K R, Reddy S, Kashyap JR, Ramalingam V, Dash D, Kadiyala V, Kumar S, Reddy H, Kaur J, Kumar A, Kaur N, Gupta A. Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study. Egypt Heart J 2020; 72:86. [PMID: 33296051 PMCID: PMC7726087 DOI: 10.1186/s43044-020-00121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background Not every patient achieves normal coronary flow following fibrinolysis in STEMI (ST-segment elevation myocardial infarction). The culprit lesion plaque characteristics play a prominent role in the coronary flow before and during percutaneous coronary intervention. The main purpose was to determine the culprit lesion plaque features by virtual histology-intravascular ultrasound (VH-IVUS) in patients with STEMI following fibrinolysis in relation to baseline coronary angiogram TIMI (thrombolysis in myocardial infarction) flow. Pre-intervention IVUS was undertaken in 61 patients with STEMI after successful fibrinolysis. After the coronary angiogram, they were separated into the TIMI1–2 flow group (n = 31) and TIMI 3 flow group (n = 30). Culprit lesion plaque composition was evaluated by VH-IVUS. Results On gray-scale IVUS, the lesion external elastic membrane cross-sectional area (EEM CSA) was significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group (15.71 ± 3.73 mm2 vs 13.91 ± 2.94 mm2, p = 0.041) with no significant difference in plaque burden (82.42% vs. 81.65%, p = 0.306) and plaque volume (108.3 mm3 vs. 94.3 mm3, p = 0.194). On VH-IVUS, at the minimal luminal area site (MLS), the fibrous area (5.83 mm2 vs. 4.37 mm2, p = 0.024), necrotic core (NC) area (0.95 mm2 vs. 0.59 mm2, p < 0.001), and NC percentage (11% vs. 7.1%, p = 0.024) were higher in the TIMI 1–2 groups in contrast to the TIMI 3 group. The absolute necrotic core (NC) volume (8.3 mm3 vs. 3.65 mm3, p < 0.001) and NC percentage (9.3% vs. 6.0%, p = 0.007) were significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group. Absolute dense calcium (DC) volume was higher in TIMI 1–2 groups with a trend towards significance (1.0 mm3 vs.0.75 mm3, p = 0.051). In multivariate analysis, absolute NC volume was the only independent predictor of TIMI 1–2 flow (odds ratio = 1.561; 95% CI 1.202–2.026, p = 0.001). Receiver operating characteristic curves showed absolute NC volume has best diagnostic accuracy (AUC = 0.816, p < 0.001) to predict TIMI 1–2 flow with an optimal cutoff value of 4.5 mm3 with sensitivity and specificity of 79% and 61%, respectively. Conclusions This study exemplifies that the necrotic core component of the culprit lesion plaque in STEMI is associated with the coronary flow after fibrinolysis. The absolute necrotic core volume is a key determinant of flow restoration post-fibrinolysis and aids in prognostication of less than TIMI 3 flow.
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Affiliation(s)
- Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Debabrata Dash
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Ashok Kumar
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Anish Gupta
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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Reddy S, Kadiyala V, Kashyap JR, Rao R, Reddy H, Kaur J, Kaur N, Ramalingam V. Comparison of Intravascular Ultrasound Virtual Histology Parameters in Diabetes versus Non-Diabetes with Acute Coronary Syndrome. Cardiology 2020; 145:570-577. [PMID: 32726774 DOI: 10.1159/000508886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The progression and pattern of coronary atherosclerosis in diabetes mellitus (DM) is different from non-DM, leading to a higher rate of vascular complications in DM. OBJECTIVE This study aims to assess and compare the high-risk plaque characteristics in the culprit artery of DM and non-DM patients with acute coronary syndrome (ACS) using virtual histology intravascular ultrasound (VH-IVUS). METHODS A total of 158 ACS patients were included, 63 of whom were known to have DM. IVUS analysis was done in the de novo target vessel and culprit lesion for which percutaneous coronary intervention was planned. Culprit lesions with a visual-estimate angiographic stenosis of <70% were excluded. RESULTS The mean age of patients was 52.4 ± 11.6 years. The study group comprised 82% men, 31% with hypertension, and 39.87% with DM. No significant difference was observed between the DM and non-DM groups in relation to quantitative IVUS parameters like lesion length, minimal lumen area, and plaque area. However, there was a significant difference in VH-IVUS parameters like higher necrotic core and dense calcium in the DM patients than in the non-DM patients (p < 0.01). The occurrence of VH-derived thin-cap fibroatheroma (VH-TCFA) in the culprit vessel was significantly higher in the DM group than in the non-DM group (25.3 vs. 5.2%; p < 0.01). Positive vessel-wall remodeling was noted in both groups without any significant difference (p = 0.74). CONCLUSION The DM patients had high-risk plaque composition features like a higher necrotic core, which is a marker of plaque vulnerability. Thus, aggressive medical therapy targeting vascular inflammation using high-dose statins would help in the stabilization of unstable plaque morphology and the reduction of major cardiovascular events.
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Affiliation(s)
- Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India,
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Raghavendra Rao
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammaal Medical College Hospital and Research Institute, Madurai, India
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Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci 2020; 21:ijms21082992. [PMID: 32340284 PMCID: PMC7216001 DOI: 10.3390/ijms21082992] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.
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Bittner DO, Mayrhofer T, Puchner SB, Lu MT, Maurovich-Horvat P, Ghemigian K, Kitslaar PH, Broersen A, Bamberg F, Truong QA, Schlett CL, Hoffmann U, Ferencik M. Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. Circ Cardiovasc Imaging 2019; 11:e007657. [PMID: 30354493 DOI: 10.1161/circimaging.118.007657] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.
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Affiliation(s)
- Daniel O Bittner
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Massachusetts General Hospital and Harvard Medical School, Boston. Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Germany (D.O.B.)
| | - Thomas Mayrhofer
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.)
| | - Stefan B Puchner
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria (S.B.P.)
| | - Michael T Lu
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)
| | - Pal Maurovich-Horvat
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary (P.M.-H.)
| | - Khristine Ghemigian
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)
| | - Pieter H Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.).,Medis Medical Imaging Systems B.V, Leiden, the Netherlands (P.H.K.)
| | - Alexander Broersen
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.)
| | | | - Quynh A Truong
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.)
| | | | - Udo Hoffmann
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.)
| | - Maros Ferencik
- Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).,Department of Radiology, University of Tuebingen, Germany (F.B.)
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Yang G, Wang W, Sheng X, Yang F, Kong L, He J, Ding S, Shan P, Shang Y, Xiu J, Yang Y, Mintz GS, Pu J. Tissue characteristics of culprit lesion and myocardial tissue-level perfusion in non-ST-segment elevation acute coronary syndromes: The EARLY-MYO-ACS study. Int J Cardiol 2019; 287:32-38. [DOI: 10.1016/j.ijcard.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 01/01/2019] [Accepted: 02/07/2019] [Indexed: 12/30/2022]
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9
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Hougaard M, Hansen HS, Thayssen P, Antonsen L, Jensen LO. Uncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap. JACC Cardiovasc Imaging 2018; 11:859-867. [DOI: 10.1016/j.jcmg.2017.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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10
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Puchner SB, Mayrhofer T, Park J, Lu MT, Liu T, Maurovich-Horvat P, Ghemigian K, Bittner DO, Fleg JL, Udelson JE, Truong QA, Hoffmann U, Ferencik M. Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: The coronary calcium paradox. Atherosclerosis 2018; 274:251-257. [PMID: 29703635 DOI: 10.1016/j.atherosclerosis.2018.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Total coronary artery calcium (CAC) burden is associated with an increased cardiovascular risk, while local CAC may represent stable plaques. We determined differences in relationship of total CAC with acute coronary syndrome (ACS) and local CAC with culprit lesions in patients with suspected ACS. METHODS We performed computed tomography (CT) for CAC and CT angiography to assess the presence of significant stenosis and high-risk plaque (positive remodeling, low CT attenuation, napkin-ring sign, spotty calcium) in 37 patients with ACS and 223 controls. Total and segmental Agatston scores were measured. Culprit lesions were assessed in subjects with ACS. RESULTS Patients (n = 260) with vs. without ACS had higher total CAC score (median 229, 25th-75th percentile 75-517 vs. 27, 25th-75th percentile 0-99, p<0.001), higher prevalence of significant stenosis (78% vs. 7%, p<0.001) and high-risk plaque (95% vs. 59%, p<0.001). In those with ACS, culprit (n = 41) vs. non-culprit (n = 200) lesions, had similar segmental CAC score (median 22, 25th-75th percentile 4-71 vs. 14, 25th-75th percentile 0-51; p=0.37), but higher prevalence of significant stenosis (81% vs. 11%, p<0.001) and high-risk plaque (76% vs. 51%, p=0.005). Significant stenosis (odds ratio 40.2, 95%CI 15.6-103.9, p<0.001) and high-risk plaque (odds ratio 3.4, 95%CI 1.3-9.1, p=0.02), but not segmental CAC score (odds ratio 1.0, 95%CI 1.0-1.0, p=0.47), were associated with culprit lesions of ACS. CONCLUSIONS Total CAC burden was associated with ACS but segmental CAC was not associated with culprit lesions. Our findings suggest that total but not local CAC is a marker of ACS risk and support the hypothesis that extensive local CAC is a marker of plaque stability.
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Affiliation(s)
- Stefan B Puchner
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Mayrhofer
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Jakob Park
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael T Lu
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ting Liu
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Khristine Ghemigian
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel O Bittner
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Germany
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - James E Udelson
- Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA
| | - Quynh A Truong
- Department of Radiology and Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Maros Ferencik
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
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11
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Hong SJ, Ahn CM, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Her AY, Kim YH, Jang Y, Hong MK. Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events. Korean Circ J 2017; 47:694-704. [PMID: 28955388 PMCID: PMC5614946 DOI: 10.4070/kcj.2017.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives The effectiveness of adjunct balloon dilation after drug-eluting stent (DES) deployment has not been sufficiently evaluated. We evaluated whether adjunct balloon dilation was associated with a reduction in major adverse cardiac events (MACEs) after long everolimus-eluting stents (EESs) implantation. Subjects and Methods Drawing from 2 randomized trials, a total of 1,672 patients treated with long EES were analyzed. Of 1,672 patients, 1,061 patients (64%) received post-stent adjunct balloon dilation. MACE, defined as a composite of cardiac death, myocardial infarction, and target-lesion revascularization (TLR), was compared between patients who received post-stent adjunct balloon dilation and patients who did not in 595 propensity score-matched pairs. Results For the matched population, MACE occurred in 29 patients (4.9%) who received adjunct balloon dilation and in 29 patients (4.9%) who did not (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.60–1.69; p=0.972). However, significant interactions were observed among the subgroups for clinical presentation and vessel size. Adjunct balloon dilation was more favored within the subset of patients with stable angina vs. the subset of patients with acute coronary syndrome (p for interaction=0.037), and within the subset of lesions with small vessel diameter (reference vessel diameter [RVD] <3 mm) vs. the subset of lesions with larger vessel diameter (RVD ≥3 mm; p for interaction=0.027). Conclusion Adjunct balloon dilation was not associated with MACE reduction at 1 year among patients requiring long EES implantation. However, post-stent adjunct balloon dilation may be necessary for patients requiring long EES implantation who present with stable angina or for lesions with small vessel diameters.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Ae-Young Her
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yong Hoon Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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12
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Relationship between quantities of tissue prolapse after percutaneous coronary intervention and neointimal hyperplasia at follow-up on serial optical coherence tomography examination. Int J Cardiol 2017; 241:470-477. [DOI: 10.1016/j.ijcard.2017.01.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/16/2017] [Indexed: 11/22/2022]
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13
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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.
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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
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14
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Baquet M, Brenner C, Wenzler M, Eickhoff M, David J, Brunner S, Theiss H, Massberg S, Guagliumi G, Mehilli J. Impact of Clinical Presentation on Early Vascular Healing After Bioresorbable Vascular Scaffold Implantation. J Interv Cardiol 2016; 30:16-23. [DOI: 10.1111/joic.12359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Christoph Brenner
- Department of Internal Medicine III; Medical University of Innsbruck; Innsbruck Austria
| | - Maximilian Wenzler
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Madeleine Eickhoff
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Jochheim David
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Stefan Brunner
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Hans Theiss
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
| | - Steffen Massberg
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- Munich Heart Alliance at DZHK; Munich Germany
| | - Giulio Guagliumi
- Interventional Cardiology Unit; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- Munich Heart Alliance at DZHK; Munich Germany
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15
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Ohwada T, Yokokawa T, Kanno Y, Hotsuki Y, Sakamoto T, Watanabe K, Nakazato K, Takeishi Y. Vascular composition data supporting the role of N-3 polyunsaturated fatty acids in the prevention of cardiovascular disease events. Data Brief 2016; 7:1237-47. [PMID: 27222841 PMCID: PMC4867859 DOI: 10.1016/j.dib.2016.03.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/15/2016] [Accepted: 03/30/2016] [Indexed: 11/25/2022] Open
Abstract
N-3 polyunsaturated fatty acids (PUFAs) are thought to have protective effects against cardiovascular disease. Here, we report the relationship between serum PUFA concentrations and plaque composition, as evaluated by virtual histology-intravascular ultrasound (VH-IVUS). Consecutive patients (n=61) who underwent percutaneous coronary intervention (PCI) were pre-operatively examined using VH-IVUS to assess the composition of culprit plaques. Gray-scale IVUS and VH-IVUS data of fibrous, fibro-fatty, necrotic core, and dense calcium regions of plaques were estimated at the minimal luminal area sites of culprit lesions. Serum levels of high-sensitivity C-reactive protein (hsCRP) and PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA), were compared between patients with (ACS, n=27) and without acute coronary syndrome (non-ACS, n=34) before PCI. Multiple logistic regression analysis of the data showed that EPA/AA under the median was more highly associated with ACS than hsCRP over the median. In addition, EPA/AA was negatively correlated with the percentage of fibrous plaque regions and EPA/AA and DHA/AA were positively correlated with the percentage of dense calcium regions in plaques. Furthermore, the correlation index of EPA/AA was the most highly (R=0.513) correlated with the percentage of dense calcium regions in plaques.
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Affiliation(s)
- Takayuki Ohwada
- Fukushima Red Cross Hospital, Department of Cardiology, Fukushima, Japan
| | - Tetsuro Yokokawa
- Fukushima Medical University, Department of Cardiology and Hematology, Fukushima, Japan
| | - Yuki Kanno
- Fukushima Medical University, Department of Cardiology and Hematology, Fukushima, Japan
| | - Yu Hotsuki
- Fukushima Red Cross Hospital, Department of Cardiology, Fukushima, Japan
| | - Takayuki Sakamoto
- Fukushima Red Cross Hospital, Department of Cardiology, Fukushima, Japan
| | - Kenichi Watanabe
- Fukushima Red Cross Hospital, Department of Cardiology, Fukushima, Japan
| | - Kazuhiko Nakazato
- Fukushima Medical University, Department of Cardiology and Hematology, Fukushima, Japan
| | - Yasuchika Takeishi
- Fukushima Medical University, Department of Cardiology and Hematology, Fukushima, Japan
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16
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Dai J, Tian J, Hou J, Xing L, Liu S, Ma L, Yu H, Ren X, Dong N, Yu B. Association between cholesterol crystals and culprit lesion vulnerability in patients with acute coronary syndrome: An optical coherence tomography study. Atherosclerosis 2016; 247:111-7. [DOI: 10.1016/j.atherosclerosis.2016.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 12/11/2022]
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17
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Celeng C, Takx RAP, Ferencik M, Maurovich-Horvat P. Non-invasive and invasive imaging of vulnerable coronary plaque. Trends Cardiovasc Med 2016; 26:538-47. [PMID: 27079893 DOI: 10.1016/j.tcm.2016.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/28/2016] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
Vulnerable plaque is characterized by a large necrotic core and an overlying thin fibrous cap. Non-invasive imaging modalities such as computed tomography angiography (CTA) and magnetic resonance imaging (MRI) allow for the assessment of morphological plaque characteristics, while positron emission tomography (PET) enables the detection of metabolic activity within the atherosclerotic lesions. Invasive imaging modalities such as intravascular ultrasound (IVUS), optical-coherence tomography (OCT), and intravascular MRI (IV-MRI) display plaques at a high spatial resolution. Near-infrared spectroscopy (NIRS) allows for the detection of chemical components of atherosclerotic plaques. In this review, we describe state-of-the-art non-invasive and invasive imaging modalities and stress the combination of their advantages to identify vulnerable plaque features.
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Affiliation(s)
- Csilla Celeng
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Richard A P Takx
- Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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18
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Lee NJ, Litt H. Cardiac CT angiography for evaluation of acute chest pain. Int J Cardiovasc Imaging 2015; 32:101-12. [PMID: 26342713 DOI: 10.1007/s10554-015-0763-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/31/2015] [Indexed: 01/23/2023]
Abstract
Chest pain is the second most common emergency department (ED) presentation in the United States. Cardiac computed tomography angiography (CCTA) now plays an important role in the evaluation of patients with suspected acute coronary syndrome in the ED setting. In this article, we review the available techniques focused on the use of CCTA to evaluate patients fosr coronary atherosclerosis for timely triage of acute chest pain.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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19
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Murray SW, Stables RH, Garcia-Garcia HM, Grayson AD, Shaw MA, Perry RA, Serruys PW, Palmer ND. Construction and validation of a plaque discrimination score from the anatomical and histological differences in coronary atherosclerosis: the Liverpool IVUS-V-HEART (Intra Vascular UltraSound-Virtual-Histology Evaluation of Atherosclerosis Requiring Treatment) study. EUROINTERVENTION 2015; 10:815-23. [PMID: 24472736 DOI: 10.4244/eijv10i7a141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS New markers to help stratify coronary atherosclerosis are needed. Although attempts have been made to differentiate active lesions from those that are stable, none of these has ever been formalised into a discriminatory score. The aim of this study was to analyse the differences between culprit ACS lesions and culprit stable angina lesions with intravascular ultrasound-derived virtual histology and to construct and validate a plaque score. METHODS AND RESULTS Prior to percutaneous coronary intervention (PCI), we performed volumetric, intravascular ultrasound-derived virtual histology (IVUS-VH) analysis in acute coronary syndrome (ACS) culprit lesions (AC - n=70) and stable angina culprit lesions (SC - n=35). A direct statistical comparison of IVUS-VH data and multiple logistic regression analysis was undertaken. Four main factors were found to be associated (p<0.05) with an AC lesion phenotype: necrotic core/dense calcium (NC/DC) ratio; minimum lumen area <4 mm2 (MLA <4); remodelling index @MLA >1.05 and VH-TCFA presence. Calculation of each logistic regression coefficient and the equation produces an active plaque discrimination score with an AUC of 0.96 on receiver operating characteristics (ROC) analysis. Validation of the score in 50 independent plaques from the Thoraxcenter in Rotterdam revealed an AUC of 0.71, confirming continued diagnostic ability. CONCLUSIONS We have found four features on IVUS and VH that can predict and discriminate ACS culprit lesion phenotypes from those that are clinically stable. Subsequently, we have constructed and validated the Liverpool Active Plaque Score based upon these features. It is hoped this score may help diagnose active coronary plaques, in the future, to help prevent major adverse cardiac events.
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Affiliation(s)
- Scott W Murray
- Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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20
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Hong YJ, Ahn Y, Jeong MH. Role of Intravascular Ultrasound in Patients with Acute Myocardial Infarction. Korean Circ J 2015; 45:259-65. [PMID: 26240578 PMCID: PMC4521102 DOI: 10.4070/kcj.2015.45.4.259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 11/11/2022] Open
Abstract
Rupture of a vulnerable plaque and subsequent thrombus formation are important mechanisms leading to the development of an acute myocardial infarction (AMI). Typical intravascular ultrasound (IVUS) features of AMI include plaque rupture, thrombus, positive remodeling, attenuated plaque, spotty calcification, and thin-cap fibroatheroma. No-reflow phenomenon was attributable to the embolization of thrombus and plaque debris that results from mechanical fragmentation of the vulnerable plaque by percutaneous coronary intervention (PCI). Several grayscale IVUS features including plaque rupture, thrombus, positive remodeling, greater plaque burden, decreased post-PCI plaque volume, and tissue prolapse, and virtual histology-IVUS features such as large necrotic corecontaining lesion and thin-cap fibroatheroma were the independent predictors of no-reflow phenomenon in AMI patients. Non-culprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of ≥70%, a minimal luminal area of ≤4.0 mm(2), or to be classified as thin-cap fibroatheromas.
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Affiliation(s)
- Young Joon Hong
- Division of Cardiology of Chonnam National University Hospital, Heart Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology of Chonnam National University Hospital, Heart Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology of Chonnam National University Hospital, Heart Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
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21
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Irving J. CTO pathophysiology: how does this affect management? Curr Cardiol Rev 2015; 10:99-107. [PMID: 24694103 PMCID: PMC4021289 DOI: 10.2174/1573403x10666140331142349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022] Open
Abstract
Chronic total occlusion (CTO)
pathophysiology has been described in a few, small studies using post mortem
histology, and more recently, in vivo intravascular ultrasound (IVUS) to
analyse the constituents of occluded segments. Recent improvements in equipment
and techniques have revealed new insights into physical characteristics of
occluded coronaries, which in turn enable predictable procedural success. The
purpose of this review is to consider the published evidence describing CTO
pathophysiology from the perspective of the hybrid algorithm approach to CTO
PCI. Methods: Literature
searches using “Chronic Occlusion”, “angioplasty”, and” pathology” as keywords.
Further searches on “coronary” “collateral”, “Viability”. Bibliographies were
scrutinised for further key publications in an iterative process. Papers
describing animal models were excluded.
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22
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Noto T, Kameyama T, Satoh T, Nonomura M, Nozawa T, Inoue H. Association Between Virtual Histology Intravascular Ultrasound Findings and Subsequent Coronary Events in Patients With Acute Coronary Syndrome. Int Heart J 2015; 56:157-62. [DOI: 10.1536/ihj.14-222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takahisa Noto
- Second Department of Internal Medicine, Toyama University Hospital
| | | | - Takao Satoh
- Second Department of Internal Medicine, Toyama University Hospital
| | | | - Takashi Nozawa
- Second Department of Internal Medicine, Toyama University Hospital
| | - Hiroshi Inoue
- Second Department of Internal Medicine, Toyama University Hospital
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23
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Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, Nagurney JT, Udelson JE, Hoffmann U, Ferencik M. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014; 64:684-92. [PMID: 25125300 DOI: 10.1016/j.jacc.2014.05.039] [Citation(s) in RCA: 403] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/26/2014] [Accepted: 05/12/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND It is not known whether high-risk plaque, as detected by coronary computed tomography angiography (CTA), permits improved early diagnosis of acute coronary syndromes (ACS) independently to the presence of significant coronary artery disease (CAD) in patients with acute chest pain. OBJECTIVES The primary aim of this study was to determine whether high-risk plaque features, as detected by CTA in the emergency department (ED), may improve diagnostic certainty of ACS independently and incrementally to the presence of significant CAD and clinical risk assessment in patients with acute chest pain but without objective evidence of myocardial ischemia or myocardial infarction (MI). METHODS We included patients randomized to the coronary CTA arm of the ROMICAT-II (Rule Out Myocardial Infarction/Ischemia Using Computer-Assisted Tomography II) trial. Readers assessed coronary CTA qualitatively for the presence of nonobstructive CAD (1% to 49% stenosis), significant CAD (≥50% or ≥70% stenosis), and the presence of at least 1 of the high-risk plaque features (positive remodeling, low <30 Hounsfield units plaque, napkin-ring sign, spotty calcium). In logistic regression analysis, we determined the association of high-risk plaque with ACS (MI or unstable angina pectoris) during the index hospitalization and whether this was independent of significant CAD and clinical risk assessment. RESULTS Overall, 37 of 472 patients who underwent coronary CTA with diagnostic image quality (mean age 53.9 ± 8.0 years; 52.8% men) had ACS (7.8%; MI n = 5; unstable angina pectoris n = 32). CAD was present in 262 patients (55.5%; nonobstructive CAD in 217 patients [46.0%] and significant CAD with ≥50% stenosis in 45 patients [9.5%]). High-risk plaques were more frequent in patients with ACS and remained a significant predictor of ACS (odds ratio [OR]: 8.9; 95% CI: 1.8 to 43.3; p = 0.006) after adjustment for ≥50% stenosis (OR: 38.6; 95% CI: 14.2 to 104.7; p < 0.001) and clinical risk assessment (age, sex, number of cardiovascular risk factors). Similar results were observed after adjustment for ≥70% stenosis. CONCLUSIONS In patients presenting to the ED with acute chest pain but negative initial electrocardiogram and troponin, presence of high-risk plaques on coronary CTA increased the likelihood of ACS independent of significant CAD and clinical risk assessment (age, sex, and number of cardiovascular risk factors). (Multicenter Study to Rule Out Myocardial Infarction by Cardiac Computed Tomography [ROMICAT-II]; NCT01084239).
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Affiliation(s)
- Stefan B Puchner
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Ting Liu
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Thomas Mayrhofer
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Quynh A Truong
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hang Lee
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James E Udelson
- Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Udo Hoffmann
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Maros Ferencik
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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24
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Murray SW, Patel B, Stables RH, Perry RA, Palmer ND. Site-specific intravascular ultrasound analysis of remodelling index and calcified necrosis patterns reveals novel blueprints for coronary plaque instability. Cardiovasc Diagn Ther 2014; 4:287-98. [PMID: 25276614 DOI: 10.3978/j.issn.2223-3652.2014.07.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/25/2014] [Indexed: 09/27/2022]
Abstract
AIMS Post-mortem pathological studies have shown that a "vulnerable" plaque is the dominant patho-physiological mechanism responsible for acute coronary syndromes (ACS). One way to improve our understanding of these plaques in vivo is by using histological "surrogates" created by intravascular ultrasound derived virtual histology (IVUS-VH). Our aim in this analysis was to determine the relationship between site-specific differences in individual plaque areas between ACS plaques and stable plaques (SP), with a focus on remodelling index and the pattern of calcifying necrosis. METHODS AND RESULTS IVUS-VH was performed before percutaneous intervention in both ACS culprit plaques (CP) n=70 and stable disease (SP) n=35. A total of 210 plaque sites were examined in 105 lesions at the minimum lumen area (MLA) and the maximum necrotic core site (MAX NC). Each plaque site had multiple measurements made including some novel calculations to ascertain the plaque calcification equipoise (PCE) and the calcified interface area (CIA). CP has greater amounts of positive remodelling at the MLA (RI@MLA): 1.1 (±0.17) vs. 0.95 (±0.14) (P<0.001); lower values for PCE 30% vs. 54% (P<0.001) but a higher CIA 5.38 (±2.72) vs. 3.58 (±2.26) (P=0.001). These features can provide discriminatory ability between plaque types with area under the curve (AUC) measurements between 0.65-0.86. The cut-off values with greatest sensitivity and specificity to discriminate CP morphologies were: RI @ MLA >1.12; RI @ MAX NC >1.22; PCE @ MLA <47.1%; PCE @MAX NC <47.3%; CIA @ MLA >2.6; CIA @ MAX NC >3.1. CONCLUSIONS Determining the stage of calcifying necrosis, along with the remodelling index can discriminate between stable and ACS related plaques. These findings could be applied in the future to help detect plaques that have a vulnerable phenotype.
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Affiliation(s)
- Scott W Murray
- 1 Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK ; 2 Department of Critical Care Research, University of Liverpool, Liverpool, UK
| | - Billal Patel
- 1 Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK ; 2 Department of Critical Care Research, University of Liverpool, Liverpool, UK
| | - Rodney H Stables
- 1 Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK ; 2 Department of Critical Care Research, University of Liverpool, Liverpool, UK
| | - Raphael A Perry
- 1 Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK ; 2 Department of Critical Care Research, University of Liverpool, Liverpool, UK
| | - Nicholas D Palmer
- 1 Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK ; 2 Department of Critical Care Research, University of Liverpool, Liverpool, UK
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Guddeti RR, Matsuo Y, Matsuzawa Y, Aoki T, Lennon RJ, Lerman LO, Kushwaha SS, Lerman A. Ischemic cardiomyopathy is associated with coronary plaque progression and higher event rate in patients after cardiac transplantation. J Am Heart Assoc 2014; 3:jah3634. [PMID: 25095871 PMCID: PMC4310404 DOI: 10.1161/jaha.114.001091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Cardiac allograft vasculopathy is the leading cause of graft failure and death in heart transplant (HTx) recipients; however, the association between the etiology of heart failure (ischemic cardiomyopathy [ICM] or non‐ICM) that led to HTx and progression of cardiac allograft vasculopathy, and adverse events after HTx has not been explored. Methods and Results We retrospectively included 165 HTx patients, who were followed‐up with at least 2 virtual histology–intravascular ultrasound examinations after HTx, and grouped them as ICM (n=46) or non‐ICM (n=119). Coronary artery plaque volume was analyzed using virtual histology–intravascular ultrasound, and cardiovascular event data—a composite of myocardial infarction, hospitalization for heart failure and arrhythmia, revascularization, retransplantation, and death including cardiovascular death—were collected from the medical records of all study subjects. ICM patients had significantly higher plaque volume at both first (P=0.040) and follow‐up (P=0.015) intravascular ultrasound examinations. After multivariate adjustment for traditional coronary risk factors, ICM was significantly associated with plaque progression (odds ratio 3.10; CI 1.17 to 9.36; P=0.023). Ten‐year cardiovascular event‐free survival was 50% in ICM patients compared with 84% in non‐ICM patients (log‐rank test P=0.003). In multivariate Cox proportional hazard analysis, ICM was significantly associated with a higher event rate after HTx (hazard ratio 2.02; 95% CI 1.01 to 4.00; P=0.048). Conclusion Our study demonstrates that ischemic etiology of cardiomyopathy prior to HTx may be independently associated with plaque progression and higher event rate after HTx.
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Affiliation(s)
- Raviteja R Guddeti
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.)
| | - Yoshiki Matsuo
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.)
| | - Yasushi Matsuzawa
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.)
| | - Tatsuo Aoki
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.)
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN (R.J.L.)
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.)
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.)
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26
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Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, Nagurney JT, Udelson JE, Hoffmann U, Ferencik M. High-Risk Plaque Detected on Coronary CT Angiography Predicts Acute Coronary Syndromes Independent of Significant Stenosis in Acute Chest Pain. J Am Coll Cardiol 2014. [DOI: 78495111110.1016/j.jacc.2014.05.039' target='_blank'>'"<>78495111110.1016/j.jacc.2014.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1016/j.jacc.2014.05.039','', '10.1016/j.amjcard.2007.04.034')">Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
78495111110.1016/j.jacc.2014.05.039" />
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27
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Fenning RS, Wilensky RL. New Insights into the Vulnerable Plaque from Imaging Studies. Curr Atheroscler Rep 2014; 16:397. [DOI: 10.1007/s11883-014-0397-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Legutko J, Jakala J, Mintz GS, Kaluza GL, Mrevlje B, Partyka L, Wizimirski M, Rzeszutko L, Richter A, Margolis P, Dudek D. Radiofrequency-intravascular ultrasound assessment of lesion coverage after angiography-guided emergent percutaneous coronary intervention in patients with non-ST elevation myocardial infarction. Am J Cardiol 2013; 112:1854-9. [PMID: 24063826 DOI: 10.1016/j.amjcard.2013.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
Using radiofrequency-intravascular ultrasound (VH-IVUS), we have previously demonstrated that in 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with optimal angiographic result, the stent does not fully cover the whole VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) related to the culprit lesion. Presently, we set out to extend these findings to 20 patients with non-STEMI with Thrombolysis In Myocardial Infarction flow 3 in the infarct-related artery before intervention who were then treated with angiography-guided direct stent implantation. The lesion was imaged with VH-IVUS before and after intervention, but the results were blinded to the operator. Plaque rupture site was identified in 8 lesions (40%), all proximal to the minimum lumen area (MLA) site. The maximum necrotic core site was found proximal to MLA in 18 lesions and at the MLA in 2 lesions. Although the plaque rupture site was fully covered with the stent in all lesions, an uncovered VH-TCFA was found in 7 lesions (35%), 4 in the proximal reference segment, 1 in the distal reference segment, and 2 in both the proximal and distal reference segments. In conclusion, in 35% of patients with non-STEMI undergoing angiography-guided emergent percutaneous coronary intervention, the stent does not fully cover a VH-TCFA related to the culprit lesion.
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Nozue T, Yamamoto S, Tohyama S, Fukui K, Umezawa S, Onishi Y, Kunishima T, Sato A, Nozato T, Miyake S, Takeyama Y, Morino Y, Yamauchi T, Muramatsu T, Hibi K, Terashima M, Michishita I. Comparison of the effects of pitavastatin versus pravastatin on coronary artery plaque phenotype assessed by tissue characterization using serial virtual histology intravascular ultrasound. Heart Vessels 2013; 30:36-44. [DOI: 10.1007/s00380-013-0453-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/29/2013] [Indexed: 11/25/2022]
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30
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Madder R, Busman M, Banga S. Plaque characterization to identify patients at high risk of acute complications during PCI. Interv Cardiol 2013. [DOI: 10.2217/ica.13.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Reith S, Battermann S, Hoffmann R, Marx N, Burgmaier M. Optical coherence tomography derived differences of plaque characteristics in coronary culprit lesions between type 2 diabetic patients with and without acute coronary syndrome. Catheter Cardiovasc Interv 2013; 84:700-7. [DOI: 10.1002/ccd.25267] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/17/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Sebastian Reith
- Department of Cardiology; Medical Clinic I, University Hospital of the RWTH Aachen; Germany
| | - Simone Battermann
- Department of Cardiology; Medical Clinic I, University Hospital of the RWTH Aachen; Germany
| | - Rainer Hoffmann
- Department of Cardiology; Medical Clinic I, University Hospital of the RWTH Aachen; Germany
| | - Nikolaus Marx
- Department of Cardiology; Medical Clinic I, University Hospital of the RWTH Aachen; Germany
| | - Mathias Burgmaier
- Department of Cardiology; Medical Clinic I, University Hospital of the RWTH Aachen; Germany
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Hong YJ, Jeong MH, Choi YH, Park SY, Rhew SH, Jeong HC, Cho JY, Jang SY, Lee KH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Comparison of Coronary Plaque Components between Non-Culprit Lesions in Patients with Acute Coronary Syndrome and Target Lesions in Patients with Stable Angina: Virtual Histology-Intravascular Ultrasound Analysis. Korean Circ J 2013; 43:607-14. [PMID: 24174961 PMCID: PMC3808856 DOI: 10.4070/kcj.2013.43.9.607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/22/2013] [Accepted: 08/12/2013] [Indexed: 01/18/2023] Open
Abstract
Background and Objectives The differences in plaque characteristics between non-culprit lesions (NCL) in acute coronary syndrome (ACS) patients (ACS-NCL) and target lesions (TL) in stable angina (SA) patients (SA-TL) are not well understood. We used a virtual histology-intravascular ultrasound (VH-IVUS) to compare the plaque components between ACS-NCL and SA-TL. Subjects and Methods We compared VH-IVUS findings between 290 ACS-NCL and 276 SA-TL. VH-IVUS classified the color-coded tissue into four major components: green (fibrotic); yellow-green (fibro-fatty); white {dense calcium (DC)}; and red {necrotic core (NC)}. Thin-cap fibroatheroma (TCFA) was defined as a NC ≥10% of the plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of ≥40% plaque burden. Results Although the plaque burden was significantly smaller (52±13% vs. 54±14%, p=0.044), ACS-NCL had a greater %NC area (17.9±11.6% vs. 14.3±8.7%, p<0.001) and %DC area (9.7±9.8% vs. 8.1±8.0%, p=0.032) compared with SA-TL at the minimum lumen site. By volumetric analysis, ACS-NCL had a greater %NC volume (15.8±9.2% vs. 13.9±7.4%, p=0.006) compared with SA-TL. TCFA was observed more frequently in ACS-NCL compared with SA-TL (27.6% vs. 18.1%, p=0.032). Independent predictors of TCFA by multivariate analysis were ACS {odds ratio (OR): 2.204, 95% CI: 1.321-3.434, p=0.021} and high-sensitivity C-reactive protein (OR: 1.101; 95% CI 1.058-1.204, p=0.035). Conclusion Although the plaque burden was significantly smaller, ACL-NCL had more vulnerable plaque components compared with SA-TL, and ACS and high-sensitivity C-reactive protein were the independent predictors of TCFA.
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Gwangju, Korea. ; Korea Cardiovascular Stent Institute of Chonnam National University, Gwangju, Korea
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Kozuki A, Shinke T, Otake H, Shite J, Matsumoto D, Kawamori H, Nakagawa M, Nagoshi R, Hariki H, Inoue T, Nishio R, Hirata KI. Feasibility of a novel radiofrequency signal analysis for in-vivo plaque characterization in humans: Comparison of plaque components between patients with and without acute coronary syndrome. Int J Cardiol 2013; 167:1591-6. [DOI: 10.1016/j.ijcard.2012.04.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 04/09/2012] [Accepted: 04/15/2012] [Indexed: 12/01/2022]
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Guo J, Maehara A, Guo N, Ashida K, Chirumamilla A, Shang Y, Pu J, Sanidas E, Moses JW, Leon MB, Weisz G, Stone GW, Mintz GS, Ochiai M. Virtual histology intravascular ultrasound comparison of coronary chronic total occlusions versus non-occlusive lesions. Int J Cardiovasc Imaging 2013; 29:1249-54. [PMID: 23609550 DOI: 10.1007/s10554-013-0222-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Guo
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10022, USA
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Seo YH, Lee CS, Yuk HB, Yang DJ, Park HW, Kim KH, Kim WH, Kwon TG, Bae JH. Hypercholesterolemia and in-vivo coronary plaque composition in patients with coronary artery disease: a virtual histology - intravascular ultrasound study. Korean Circ J 2013; 43:23-8. [PMID: 23408780 PMCID: PMC3569563 DOI: 10.4070/kcj.2013.43.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 08/06/2012] [Accepted: 09/05/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. SUBJECTS AND METHODS Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (≥200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). RESULTS Hypercholesterolemic patients were younger (59.7±13.3 years vs. 62.6±11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23±0.85 mm(3)/mm vs. 1.02±0.80 mm(3)/mm, p=0.029) as well as percent necrotic core volume (20.5±8.5% vs. 18.0±9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4±10.5% vs. 18.4±11.3%, p=0.019) and necrotic core area (1.63±1.09 mm(2) vs. 1.40±1.20 mm(2), p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). CONCLUSION Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
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Affiliation(s)
- Young Hoon Seo
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Chung Seop Lee
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Hyung Bin Yuk
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Dong Ju Yang
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Hyun Woong Park
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Ki Hong Kim
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Wan Ho Kim
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Taek-Geun Kwon
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Jang-Ho Bae
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
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Characteristics of High-Risk Plaques as Identified on Coronary Computed Tomography Angiography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Murray SW, Stables RH, Hart G, Palmer ND. Defining the magnitude of measurement variability in the virtual histology analysis of acute coronary syndrome plaques. Eur Heart J Cardiovasc Imaging 2012; 14:167-74. [DOI: 10.1093/ehjci/jes138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Takano M, Murakami D, Yamamoto M, Seino Y, Mizuno K. Natural history of a thin-cap fibroatheroma: serial observations by optical coherence tomography. Circ Cardiovasc Interv 2012; 4:638-9. [PMID: 22186108 DOI: 10.1161/circinterventions.111.962829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Masamichi Takano
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inzai, Chiba, Japan.
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Legutko J, Jakala J, Mintz GS, Wizimirski M, Rzeszutko L, Partyka L, Mrevlje B, Richter A, Margolis P, Kaluza GL, Dudek D. Virtual histology-intravascular ultrasound assessment of lesion coverage after angiographically-guided stent implantation in patients with ST Elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2012; 109:1405-10. [PMID: 22381156 DOI: 10.1016/j.amjcard.2012.01.348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/03/2012] [Accepted: 01/03/2012] [Indexed: 11/18/2022]
Abstract
An occlusion or severe stenosis (angiographic culprit lesion) of the infarct-related artery is frequently located at the site of the maximum thrombus burden, whereas the origin of the plaque rupture (the true culprit) can be situated proximal or distal to it. The aim of this study was to examine stent coverage of true culprit lesions in 20 patients who underwent primary percutaneous coronary intervention and had Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow restored in the infarct-related artery by angiographically guided direct stenting. Images of lesions were obtained using virtual histology-intravascular ultrasound before and after intervention (blinded to the operator). Plaque rupture sites were identified by intravascular ultrasound in 12 lesions (60%), 11 proximal and 1 distal to the minimum luminal area (MLA). Maximum necrotic core sites were found proximal to the MLA in 16 lesions, at the MLA in 3 lesions, and distal to the MLA in 1 lesion. Plaque rupture sites were fully covered by stents in 11 lesions. Virtual histology-intravascular ultrasound-derived thin-cap fibroatheroma longitudinal geographic misses were found in 10 lesions, 7 in the proximal reference segment and in 3 patients in the proximal and distal reference segments. In conclusion, in about 50% of patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction with optimal angiographic results, the stent does not fully cover the maximum necrotic core site related to the culprit lesion.
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Affiliation(s)
- Jacek Legutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland.
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Lee MG, Jeong MH, Kim DH, Lee KH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Can metabolic syndrome predict the vulnerable plaque in patients with stable angina pectoris? Virtual histology-intravascular ultrasound analysis. J Cardiol 2012; 59:266-74. [DOI: 10.1016/j.jjcc.2011.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 10/16/2011] [Accepted: 11/02/2011] [Indexed: 11/24/2022]
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Ko YG, Le VC, Kim BH, Shin DH, Kim JS, Kim BK, Choi D, Jang Y, Hong MK. Correlations between coronary plaque tissue composition assessed by virtual histology and blood levels of biomarkers for coronary artery disease. Yonsei Med J 2012; 53:508-16. [PMID: 22476993 PMCID: PMC3343421 DOI: 10.3349/ymj.2012.53.3.508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We investigated correlations of coronary plaque composition determined by virtual histology (VH) intravascular ultrasound (IVUS) and blood levels of biomarkers that represent the vulnerability of coronary plaques. MATERIALS AND METHODS Pre- and postprocedural blood levels of high sensitivity C-reactive protein, soluble CD40 ligand (sCD40L), matrix metalloproteinase-9, and neopterin were measured in 70 patients with stable angina (SA) or unstable angina (UA) who were undergoing percutaneous coronary intervention (PCI) for single lesions. We evaluated the data for correlations between these biomarkers and necrotic core contents in PCI target lesions analyzed by VH. RESULTS Clinical characteristics, IVUS, VH, and biomarker blood levels were not different between the SA and the UA group except for more frequent previous statin use (52.3% vs. 23.1%, p=0.017) and lower remodeling index in the SA group (0.98±0.09 vs. 1.10±0.070, p<0.001). Among the biomarkers evaluated, only pre-PCI neopterin level showed a weakly significant correlation with the absolute volume of the necrotic core (r=0.320, p=0.008). Pre- and post-PCI blood levels of sCD40L (r=0.220, p=0.072; r=0.231, p=0.062) and post-PCI blood level of neopterin (r=0.238, p=0.051) showed trends toward weakly positive correlations with the absolute volume of necrotic core. CONCLUSION We found a weakly positive correlation between the pre-PCI neopterin level and necrotic core volume in the PCI-target lesion. The clinical implications of our findings need to be investigated in further studies.
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Affiliation(s)
- Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Van Cuong Le
- General Hospital of Thanh Hoa Province, Thanh Hoa City, Vietnam
| | - Bo Hyun Kim
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital & Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Kim JH, Jeong MH, Hong YJ, Lee KH, Kim IS, Choi YH, Lee MG, Park KH, Sim DS, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Low density lipoprotein-cholesterol/high density lipoprotein-cholesterol ratio predicts plaque vulnerability in patients with stable angina. Korean Circ J 2012; 42:246-51. [PMID: 22563337 PMCID: PMC3341421 DOI: 10.4070/kcj.2012.42.4.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/04/2011] [Accepted: 10/11/2011] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between lipid profile and coronary plaque tissue characteristics in patients with stable angina pectoris (SAP) is unclear. The aim of this study was to evaluate the relationship between tissue characteristics and lipid profile and predictors of unstable plaques (UPs) in patients with SAP by virtual histology intravascular ultrasonography (VH-IVUS). SUBJECTS AND METHODS VH-IVUS was performed for target lesions in patients with SAP (61.7±9.2 years, 174 males, n=266) at the time of coronary angiography. UPs are characterized by thin-cap fibroatheroma, ruptured plaque, or remaining thrombus with VH-IVUS. RESULTS The present study showed that 34 SAP patients had UPs (61.6±9.2 years, 24 males, 12.8%). The percentage of plaque area in the minimum luminal area in high low density lipoprotein-cholesterol (LDL-C)/high density lipoprotein-cholesterol (HDL-C) ratio patients was significantly higher than in low LDL-C/HDL-C ratio patients (72.7±9.5% vs. 69.9±9.3%, p=0.035). An LDL-C/HDL-C ratio >2.0 was an independent predictor for UPs in SAP patients (odds ratio 5.252, 95% confidence interval 1.132-24.372, p=0.034). CONCLUSION An elevated LDL-C/HDL-C ratio is a positive predictor for coronary plaque vulnerability in patients with SAP.
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Affiliation(s)
- Jeong Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Research Institute of Chonnam National University, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ki Hong Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - In Soo Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Yun Ha Choi
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Min Goo Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Hong YJ, Jeong MH, Choi YH, Song JA, Kim DH, Lee KH, Yamanaka F, Lee MG, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Relation between anemia and vulnerable coronary plaque components in patients with acute coronary syndrome: virtual histology-intravascular ultrasound analysis. J Korean Med Sci 2012; 27:370-6. [PMID: 22468099 PMCID: PMC3314848 DOI: 10.3346/jkms.2012.27.4.370] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/26/2012] [Indexed: 12/26/2022] Open
Abstract
The aim of the present study was to evaluate the plaque components and the predictors of thin-cap fibroatheroma (TCFA) in anemic patients with acute coronary syndrome using virtual histology-intravascular ultrasound (VH-IVUS). Anemia was defined according to criteria of the World Health Organization, (i.e. , hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) and we compared VH-IVUS findings between anemia group (171 patients, 260 lesions) and non-anemia group (569 patients, 881 lesions). Anemia group had greater % necrotic core (NC) volume (21% ± 9% vs 19% ± 9%, P = 0.001) compared with non-anemia group. Hemoglobin level correlated negatively with absolute NC volume (r = -0.235, P < 0.001) and %NC volume (r = -0.209, P < 0.001). Independent predictors of TCFA by multivariate analysis were diabetes mellitus (odds ratio [OR], 2.213; 95% confidence interval [CI], 1.403-3.612, P = 0.006), high-sensitivity C-reactive protein (OR, 1.143; 95% CI, 1.058-1.304, P = 0.012), microalbuminuria (albumin levels of 30 to 300 mg/g of creatinine) (OR, 2.124; 95% CI, 1.041-3.214, P = 0.018), and anemia (OR: 2.112; 95% CI 1.022-3.208, P = 0.028). VH-IVUS analysis demonstrates that anemia at the time of clinical presentation is associated with vulnerable plaque component in patients with acute coronary syndrome.
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Affiliation(s)
- Young Joon Hong
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Yun Ha Choi
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jin A Song
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Han Kim
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Hong Lee
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Futoshi Yamanaka
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min Goo Lee
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Yoon
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- Heart Research Center, Chonnam National University Hospital, Gwangju, Korea
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Guo J, Maehara A, Mintz GS, Ashida K, Pu J, Shang Y, Leon MB, Stone GW, Moses JW, Ochiai M. A virtual histology intravascular ultrasound analysis of coronary chronic total occlusions. Catheter Cardiovasc Interv 2012; 81:464-70. [PMID: 22431273 DOI: 10.1002/ccd.24356] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 01/29/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We used virtual histology intravascular ultrasound (VH-IVUS) to investigate plaque composition of chronic total occlusions (CTO). BACKGROUND There are limited data on the composition of CTOs, especially in vivo. METHODS VH-IVUS was performed in 50 CTO lesions (49 patients) after guidewire crossing or pre-dilation using a 1.5-2 mm balloon. Plaque composition in the proximal reference, distal reference, and CTO segment (subsequently divided into proximal, middle, and distal subsegments) was analyzed and reported as median and interquartile range. VH-IVUS phenotype was also assessed. The definition of a fibroatheroma was >10% confluent necrotic core (NC) in more than three consecutive frames. RESULTS Overall, the maximum NC within the CTO [35.5% (28.7, 44.3%)] was similar to the proximal reference [35.6% (24.1, 42.1%)] and greater than the distal reference [31.5% (22.6, 35.2%), P < 0.01]. There was no difference in maximum NC observed among proximal [31.4% (25.2, 10.4%)], middle [31.0% (23.3, 38.3%)], and distal CTO subsegments [30.4% (22.0, 39.5%)]. Overall, 42/50 CTOs contained a VH-fibroathroma; and 8/50 did not. CTOs containing a VH-fibroatheroma had more NC and dense calcium while CTOs not containing a fibroatheroma had more fibrotic and fibrofatty plaque. Importantly, 60.5% of VH-fibroatheroma-containing CTOs had a thin-cap fibroatheroma (NC abutted to the lumen) in the proximal reference. CONCLUSIONS Using VH-IVUS, CTO morphology can be divided into two patterns: (1) CTO with VH-fibroatheroma or (2) CTO without VH-fibroatheroma. This suggests two mechanisms of CTO formation-the majority evolving from acute coronary syndrome and thrombosis and the minority from atherosclerosis progression.
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Affiliation(s)
- Jun Guo
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
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Hong YJ, Jeong MH, Choi YH, Song JA, Ahmed K, Lee KH, Kim DH, Lee MG, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Positive remodeling is associated with vulnerable coronary plaque components regardless of clinical presentation: virtual histology-intravascular ultrasound analysis. Int J Cardiol 2012; 167:871-6. [PMID: 22370367 DOI: 10.1016/j.ijcard.2012.01.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 10/24/2011] [Accepted: 01/28/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary artery remodeling pattern and plaque components in 1133 patients. METHODS We divided the patients into two groups according to the remodeling pattern as positive remodeling (PR, remodeling index>1.05) (n=192) and intermediate remodeling (IR, remodeling index ≤ 1.05 and ≥ 0.95)/negative remodeling (NR, remodeling index<0.95) (n=941). VH-IVUS analysis classified the color-coded tissue into four major components: green (fibrotic, FT); yellow-green (fibro-fatty); white (dense calcium); and red (necrotic core, NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥ 10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥ 40%. RESULTS At the minimum lumen site, PR group had greater plaque plus media area (12.8 ± 4.9 vs. 9.9 ± 3.8mm(2), p<0.001) and greater %NC area (21.7 ± 12.3 vs. 18.2 ± 11.6%, p<0.001) and smaller %FT area (57.0 ± 14.5 vs. 59.4 ± 14.6%, p=0.037) compared with IR/NR group. PR group had greater plaque volume (188 ± 150 vs. 135 ± 130 mm(3), p<0.001) and greater %NC volume (19.1 ± 9.6 vs. 16.6 ± 9.2%, p=0.001) and smaller %FT volume (58.3 ± 11.7 vs. 60.6 ± 11.0%, p=0.009) compared with IR/NR group. PR group had more TCFA compared with IR/NR group (21% vs. 13%, p=0.006). Similar findings about plaque components were observed in terms of greater %NC volume and smaller %FT volume in PR group compared with IR/NR group in patients with both acute coronary syndrome and stable angina. CONCLUSIONS VH-IVUS analysis demonstrates that PR was associated with more vulnerable plaque components compared with IR/NR regardless of their clinical presentation.
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Affiliation(s)
- Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea Cardiovascular Stent Research Institute, Republic of Korea
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Kim WH, Park HW, Kim KH, Song IG, Yang DJ, Lee CS, Seo YH, Kwon TG, Bae JH. Fibro-Fatty Component is Important for the Long-Term Clinical Events in Patients Who Have Undergone Primary Percutaneous Coronary Intervention. Korean Circ J 2012; 42:33-9. [PMID: 22363381 PMCID: PMC3283752 DOI: 10.4070/kcj.2012.42.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/02/2011] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives We evaluated which plaque components are associated with long-term clinical events in patients who underwent primary percutaneous coronary intervention (PCI). Subjects and Methods The study subjects consisted of 57 consecutive patients (mean age, 58.5±14.5 years; 45 males) who underwent primary PCI and a virtual histology-intravascular ultrasound examination. Major adverse cardiac events (MACEs) including death, acute myocardial infarction, stroke, and revascularization were evaluated during the mean 28 month follow-up period. Results Patients with high fibro-fatty volume (FFV >13.4 mm3, n=29; mean age, 61.3 years) had a lower ejection fraction (52.7% vs. 59.4%, p=0.022), a higher incidence of multi-vessel disease (69.0% vs. 28.6%, p=0.002), larger plaque area (25.7 mm2 vs. 15.9 mm2, p<0.001), and larger plaque volume (315 mm3 vs. 142 mm3, p<0.001) than those with a low FFV (≤13.4 mm3, n=28; mean age, 55.6 years). Patients with high FFV had a significantly higher incidence (32.1% vs. 8.3%, p=0.036) of MACE than those with low FFV. When we divided the study population according to the necrotic core volume (NCV), fibrous volume, or dense calcified volume, no significant findings in terms of demographics and MACE rates were observed. A Cox regression analysis revealed that the independent factor for MACE was FFV (hazard ratio, 6.748; 95% confidence interval, 1.168-38.971, p=0.033) in this study population. Conclusion The coronary plaque component, particularly FFV, but not NCV, was important in long-term clinical outcomes in patients who underwent primary PCI.
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Affiliation(s)
- Wan Ho Kim
- Division of Cardiology, Konyang University College of Medicine, Daejeon, Korea
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Moroi M, Nakazato R, Jesmin S, Akter S, Kunimasa T, Masai H, Furuhashi T, Fukuda H, Kohda E, Sugi K. Coronary Artery CT Low-Density Plaque Area and Its Ratio to the Whole Area of a Non-Calcified Plaque at the Culprit Lesion in Patients With Unstable and Stable Coronary Artery Disease. Int Heart J 2012; 53:341-6. [DOI: 10.1536/ihj.53.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
- Department of Cardiology, National Center for Global Health and Medicine
| | | | - Subrina Jesmin
- Department of Cardiology, National Center for Global Health and Medicine
| | - Shamima Akter
- Department of Cardiology, National Center for Global Health and Medicine
| | - Taeko Kunimasa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hirofumi Masai
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | - Hiroshi Fukuda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Ehiichi Kohda
- Department of Radiology, Toho University Ohashi Medical Center
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Fuchs S, Lavi I, Tzang O, Bessler H, Brosh D, Bental T, Dvir D, Einav S, Kornowski R. Intracoronary Monocyte Chemoattractant Protein 1 and Vascular Endothelial Growth Factor Levels Are Associated with Necrotic Core, Calcium and Fibrous Tissue Atherosclerotic Plaque Components: An Intracoronary Ultrasound Radiofrequency Study. Cardiology 2012; 123:125-32. [DOI: 10.1159/000342050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/18/2012] [Indexed: 11/19/2022]
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Kojima S, Ogawa H. Clinical significance of microalbuminuria in high-risk patients with coronary artery disease. Circ J 2011; 75:2765-6. [PMID: 22040939 DOI: 10.1253/circj.cj-11-1167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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García-García C, Subirana I, Sala J, Bruguera J, Sanz G, Valle V, Arós F, Fiol M, Molina L, Serra J, Marrugat J, Elosua R. Long-term prognosis of first myocardial infarction according to the electrocardiographic pattern (ST elevation myocardial infarction, non-ST elevation myocardial infarction and non-classified myocardial infarction) and revascularization procedures. Am J Cardiol 2011; 108:1061-7. [PMID: 21791326 DOI: 10.1016/j.amjcard.2011.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 06/02/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study was to describe differences in the characteristics and short- and long-term prognoses of patients with first acute myocardial infarction (MI) according to the presence of ST-segment elevation or non-ST-segment elevation. From 2001 and 2003, 2,048 patients with first MI were consecutively admitted to 6 participating Spanish hospitals and categorized as having ST-segment elevation MI (STEMI), non-ST-segment elevation MI (NSTEMI), or unclassified MI (pacemaker or left bundle branch block) according to electrocardiographic results at admission. The proportions of female gender, hypercholesterolemia, hypertension, and diabetes were higher among NSTEMI patients than in the STEMI group. NSTEMI 28-day case fatality was lower (2.99% vs 5.26%, p = 0.02). On multivariate analysis, the odds ratio of 28-day case fatality was 2.23 for STEMI patients compared to NSTEMI patients (95% confidence interval 1.29 to 3.83, p = 0.004). The multivariate adjusted 7-year mortality for 28-day survivors was higher in NSTEMI than in STEMI patients (hazard ratio 1.31, 95% confidence interval 1.02 to 1.68, p = 0.035). However, patients with unclassified MI presented the highest short- and long-term mortality (11.8% and 35.4%, respectively). The excess of short-term mortality in unclassified and STEMI patients was mainly observed in those patients not treated with revascularization procedures. In conclusion, patients with first NSTEMI were older and showed a higher proportion of previous coronary risk factors than STEMI patients. NSTEMI patients had lower 28-day case fatality but a worse 7-year mortality rate than STEMI patients. Unclassified MI presented the worst short- and long-term prognosis. These results support the invasive management of patients with acute coronary syndromes to reduce short-term case fatality.
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