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Kataoka Y, Kitahara S, Funabashi S, Makino H, Matsubara M, Matsuo M, Omura-Ohata Y, Koezuka R, Tochiya M, Tamanaha T, Tomita T, Honda-Kohmo K, Noguchi M, Murai K, Sawada K, Iwai T, Matama H, Honda S, Fujino M, Nakao K, Yoneda S, Takagi K, Otsuka F, Asaumi Y, Hosoda K, Nicholls SJ, Yasuda S, Noguchi T. Glucagon-like Peptide-1 analogues and delipidation of coronary atheroma in statin-treated type 2 diabetic patients with coronary artery disease: The prespecified sub-analysis of the OPTIMAL randomized clinical trial. ATHEROSCLEROSIS PLUS 2024; 56:1-6. [PMID: 38617596 PMCID: PMC11015340 DOI: 10.1016/j.athplu.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024]
Abstract
Background and aims Randomized clinical trials have demonstrated the ability of glucagon-like peptide-1 analogues (GLP-1RAs) to reduce atherosclerotic cardiovascular disease events in patients with type 2 diabetes (T2D). How GLP-1RAs modulate diabetic atherosclerosis remains to be determined yet. Methods The OPTIMAL study was a prospective randomized controlled study to compare the efficacy of 48-week continuous glucose monitoring- and HbA1c-guided glycemic control on near infrared spectroscopty (NIRS)/intravascular ultrasound (IVUS)-derived plaque measures in 94 statin-treated patients with T2D (jRCT1052180152, UMIN000036721). Of these, 78 patients with evaluable serial NIRS/IVUS images were analyzed to compare plaque measures between those treated with (n = 16) and without GLP-1RAs (n = 72). Results All patients received a statin, and on-treatment LDL-C levels were similar between the groups (66.9 ± 11.6 vs. 68.1 ± 23.2 mg/dL, p = 0.84). Patients receiving GLP-1RAs demonstrated a greater reduction of HbA1c [-1.0 (-1.4 to -0.5) vs. -0.4 (-0.6 to -0.2)%, p = 0.02] and were less likely to demonstrate a glucose level >180 mg/dL [-7.5 (-14.9 to -0.1) vs. 1.1 (-2.0 - 4.2)%, p = 0.04], accompanied by a significant decrease in remnant cholesterol levels [-3.8 (-6.3 to -1.3) vs. -0.1 (-0.8 - 1.1)mg/dL, p = 0.008]. On NIRS/IVUS imaging analysis, the change in percent atheroma volume did not differ between the groups (-0.9 ± 0.25 vs. -0.2 ± 0.2%, p = 0.23). However, GLP-1RA treated patients demonstrated a greater frequency of maxLCBI4mm regression (85.6 ± 0.1 vs. 42.0 ± 0.6%, p = 0.01). Multivariate analysis demonstrated that the GLP-1RA use was independently associated with maxLCBI4mm regression (odds ratio = 4.41, 95%CI = 1.19-16.30, p = 0.02). Conclusions In statin-treated patients with T2D and CAD, GLP-1RAs produced favourable changes in lipidic plaque materials, consistent with its stabilization.
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Affiliation(s)
- Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Satoshi Kitahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Kashiwa Kousei General Hospital, Kashiwa, Japan
| | - Sayaka Funabashi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Hisashi Makino
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Miki Matsuo
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Omura-Ohata
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Ryo Koezuka
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Mayu Tochiya
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Tamiko Tamanaha
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Tsutomu Tomita
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kyoko Honda-Kohmo
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Michio Noguchi
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Masashi Fujino
- Victorian Heart Institute, Monash University, Melbourne, Australia
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
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Ozkan E, Erdogan A, Karagoz A, Tanboğa IH. Comparison of Systemic Immune-Inflammation Index and Naples Prognostic Score for Prediction Coronary Artery Severity Patients Undergoing Coronary Computed Tomographic Angiography. Angiology 2024; 75:62-71. [PMID: 37060352 DOI: 10.1177/00033197231170979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
This study compared the predictive power of the systemic immune-inflammation index (SII) and Naples prognostic score (NPS) in determining the severity of coronary artery disease (CAD). The study included 1138 patients who underwent coronary computed tomographic angiography (CCTA). The primary outcome was the evaluation of CAD severity, determined by the Coronary Artery Disease-Reporting and Data System (CAD-RADS) obtained from the CCTA scans. A basic statistical model including age, gender, chest pain, diabetes mellitus, hypertension, hyperlipidemia, and smoking was built, and categorical variables, NPS (Naples 3,4 vs 0,1,2) and SII, were added to the basic statistical model. The net benefits of the predictive parameters were determined by a decision curve analysis, and the association between CAD-RADS and NPS, SII was quantified by odds ratios (OR) and 95% confidence intervals (CI). The decision curve analysis showed that adding SII to the statistical model had a better full range of probability of clinical net benefit compared with the baseline model (OR: 5.77, 95% CI 4.15-8.02, P < .001). However, adding the NPS (P = .11) to the model did not outperform the basic statistical model. In conclusion, the SII may have a net predictive effect on top of traditional risk factors.
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Affiliation(s)
- Eyup Ozkan
- Clinic of Cardiology, Cam and Sakura City Hospital, Istanbul, Turkey
| | - Aslan Erdogan
- Clinic of Cardiology, Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Clinic of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
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Kataoka Y, Kitahara S, Funabashi S, Makino H, Matsubara M, Matsuo M, Omura-Ohata Y, Koezuka R, Tochiya M, Tamanaha T, Tomita T, Honda-Kohmo K, Noguchi M, Maruki M, Kanai E, Murai K, Iwai T, Sawada K, Matama H, Honda S, Fujino M, Yoneda S, Takagi K, Otsuka F, Asaumi Y, Hosoda K, Nicholls SJ, Yasuda S, Noguchi T. The effect of continuous glucose monitoring-guided glycemic control on progression of coronary atherosclerosis in type 2 diabetic patients with coronary artery disease: The OPTIMAL randomized clinical trial. J Diabetes Complications 2023; 37:108592. [PMID: 37741088 DOI: 10.1016/j.jdiacomp.2023.108592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/20/2023] [Accepted: 08/19/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) improves glycemic fluctuation and reduces hypoglycemic risk. Whether CGM-guided glycemic control favorably modulates coronary atherosclerosis in patients with type 2 diabetes (T2DM) remains unknown. METHODS The OPTIMAL trial was a prospective, randomized, single-center trial in which 94 T2DM patients with CAD were randomized to CGM- or HbA1c-guided glycemic control for 48 weeks (jRCT1052180152). The primary endpoint was the nominal change in total atheroma volume (TAV) measured by serial IVUS. The secondary efficacy measure was the nominal change in maxLCBI4mm on near-infrared spectroscopy imaging. RESULTS Among the 94 randomized patients, 82 had evaluable images at 48 weeks. Compared to HbA1c-guided glycemic control, CGM-guided control achieved a greater reduction in %coefficient of variation [-0.1 % (-1.8 to 1.6) vs. -3.3 % (-5.1 to -1.5), p = 0.01] and a greater increase in the duration with glucose between 70 and 180 mg/dL [-1.5 % (-6.0 to 2.9) vs. 6.7 % (1.9 to 11.5), p = 0.02]. TAV increased by 0.11 ± 1.9 mm3 in the HbA1c-guided group and decreased by -3.29 ± 2.00 mm3 in the CGM-guided group [difference = -3.4 mm3 (95%CI: -8.9 to 2.0 mm3), p = 0.22]. MaxLCBI4mm, increased by 90.1 ± 25.6 in the HbA1c-guided group and by 50.6 ± 25.6 in the CGM-guided group (difference = -45.6 (95%CI: -118.1 to 26.7) p = 0.21]. A post-hoc exploratory analysis showed a greater regression of maxLCBI4mm in the CGM-guided group [difference = 20.4 % (95%CI:1.3 to 39.5 %), p = 0.03]. CONCLUSIONS CGM-guided control for 48 weeks did not slow disease progression in T2DM patients with CAD. A greater regression of lipidic plaque under CGM-guided glycemic control in the post-hoc analysis requires further investigation.
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Affiliation(s)
- Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan.
| | - Satoshi Kitahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Kashiwa Kousei General Hospital, Kashiwa, Japan
| | - Sayaka Funabashi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Hisashi Makino
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Miki Matsuo
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Omura-Ohata
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Ryo Koezuka
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Mayu Tochiya
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Tamiko Tamanaha
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Tsutomu Tomita
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kyoko Honda-Kohmo
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Michio Noguchi
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Maki Maruki
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Emi Kanai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Syuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
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4
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Tanisawa H, Matsumoto H, Cadet S, Higuchi S, Ohya H, Isodono K, Irie D, Kaneko K, Sumida A, Hirano T, Otaki Y, Kitamura R, Slomka PJ, Dey D, Shinke T. Quantification of Low-Attenuation Plaque Burden from Coronary CT Angiography: A Head-to-Head Comparison with Near-Infrared Spectroscopy Intravascular US. Radiol Cardiothorac Imaging 2023; 5:e230090. [PMID: 37908555 PMCID: PMC10613924 DOI: 10.1148/ryct.230090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 11/02/2023]
Abstract
Purpose To determine the association between low-attenuation plaque (LAP) burden at coronary CT angiography (CCTA) and plaque morphology determined with near-infrared spectroscopy intravascular US (NIRS-IVUS) and to compare the discriminative ability for NIRS-IVUS-verified high-risk plaques (HRPs) between LAP burden and visual assessment of LAP. Materials and Methods This Health Insurance Portability and Accountability Act-compliant retrospective study included consecutive patients who underwent CCTA before NIRS-IVUS between October 2019 and October 2022 at two facilities. LAPs were visually identified as having a central focal area of less than 30 HU using the pixel lens technique. LAP burden was calculated as the volume of voxels with less than 30 HU divided by vessel volume. HRPs were defined as plaques with one of the following NIRS-IVUS-derived high-risk features: maximum 4-mm lipid core burden index greater than 400 (lipid-rich plaque), an echolucent zone (intraplaque hemorrhage), or echo attenuation (cholesterol clefts). Multivariable analysis was performed to evaluate NIRS-IVUS-derived parameters associated with LAP burden. The discriminative ability for NIRS-IVUS-verified HRPs was compared using receiver operating characteristic analysis. Results In total, 273 plaques in 141 patients (median age, 72 years; IQR, 63-78 years; 106 males) were analyzed. All the NIRS-IVUS-derived high-risk features were independently linked to LAP burden (P < .01 for all). LAP burden increased with the number of high-risk features (P < .001) and had better discriminative ability for HRPs than plaque attenuation by visual assessment (area under the receiver operating characteristic curve, 0.93 vs 0.89; P = .02). Conclusion Quantification of LAP burden improved HRP assessment compared with visual assessment. LAP burden was associated with the accumulation of HRP morphology.Keywords: Coronary CT Angiography, Intraplaque Hemorrhage, Lipid-Rich Plaque, Low Attenuation Plaque, Near-Infrared Spectroscopy Intravascular Ultrasound Supplemental material is available for this article. See also the commentary by Ferencik in this issue.© RSNA, 2023.
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Affiliation(s)
- Hiroki Tanisawa
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Hidenari Matsumoto
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Sebastien Cadet
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Satoshi Higuchi
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Hidefumi Ohya
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Koji Isodono
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Daisuke Irie
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Kyoichi Kaneko
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Arihiro Sumida
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Takaho Hirano
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Yuka Otaki
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Ryoji Kitamura
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Piotr J Slomka
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Damini Dey
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
| | - Toshiro Shinke
- From the Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo 142-8555, Japan (H.T., H.M., S.H., K.K., A.S., T.S.); Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (S.C., P.J.S., D.D.); Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan (H.O., K.I., D.I., R.K.); Department of Radiological Technology, Showa University Hospital, Tokyo, Japan (T.H.); and Department of Radiology, Sakakibara Heart Institute, Tokyo, Japan (Y.O.)
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5
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Ota H, Matsuo H, Imai S, Nakashima Y, Kawase Y, Okubo M, Takahashi H, Kawai H, Sobue Y, Kawasaki M, Kondo T, Muramatsu T, Izawa H. Multimodality imaging to identify lipid-rich coronary plaques and predict periprocedural myocardial injury: Association between near-infrared spectroscopy and coronary computed tomography angiography. Front Cardiovasc Med 2023; 10:1127121. [PMID: 37077746 PMCID: PMC10108678 DOI: 10.3389/fcvm.2023.1127121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThis study compares the efficacy of coronary computed tomography angiography (CCTA) and near-infrared spectroscopy intravascular ultrasound (NIRS–IVUS) in patients with significant coronary stenosis for predicting periprocedural myocardial injury during percutaneous coronary intervention (PCI).MethodsWe prospectively enrolled 107 patients who underwent CCTA before PCI and performed NIRS–IVUS during PCI. Based on the maximal lipid core burden index for any 4-mm longitudinal segments (maxLCBI4mm) in the culprit lesion, we divided the patients into two groups: lipid-rich plaque (LRP) group (maxLCBI4mm ≥ 400; n = 48) and no-LRP group (maxLCBI4mm < 400; n = 59). Periprocedural myocardial injury was a postprocedural cardiac troponin T (cTnT) elevation of ≥5 times the upper limit of normal.ResultsThe LRP group had a significantly higher cTnT (p = 0.026), lower CT density (p < 0.001), larger percentage atheroma volume (PAV) by NIRS–IVUS (p = 0.036), and larger remodeling index measured by both CCTA (p = 0.020) and NIRS–IVUS (p < 0.001). A significant negative linear correlation was found between maxLCBI4mm and CT density (rho = −0.552, p < 0.001). Multivariable logistic regression analysis identified maxLCBI4mm [odds ratio (OR): 1.006, p = 0.003] and PAV (OR: 1.125, p = 0.014) as independent predictors of periprocedural myocardial injury, while CT density was not an independent predictor (OR: 0.991, p = 0.22).ConclusionCCTA and NIRS–IVUS correlated well to identify LRP in culprit lesions. However, NIRS–IVUS was more competent in predicting the risk of periprocedural myocardial injury.
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Affiliation(s)
- Hideaki Ota
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
- Correspondence: Hideaki Ota
| | - Hitoshi Matsuo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Shunsuke Imai
- Department of Radiology, Gifu Heart Center, Gifu, Japan
| | | | | | - Munenori Okubo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshihiro Sobue
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | - Takeshi Kondo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
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Zhao J, Zhang H, Liu C, Zhang Y, Xie C, Wang M, Wang C, Wang S, Xue Y, Liang S, Gao Y, Cong H, Li C, Zhou J. Identification of vulnerable non-culprit lesions by coronary computed tomography angiography in patients with chronic coronary syndrome and diabetes mellitus. Front Cardiovasc Med 2023; 10:1143119. [PMID: 37034343 PMCID: PMC10076802 DOI: 10.3389/fcvm.2023.1143119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background Among patients with diabetes mellitus (DM) and chronic coronary syndrome (CCS), non-culprit lesions (NCLs) are responsible for a substantial number of future major adverse cardiovascular events (MACEs). Thus, we aimed to establish the natural history relationship between adverse plaque characteristics (APCs) of NCLs non-invasively identified by coronary computed tomography angiography (CCTA) and subsequent MACEs in these patients. Methods Between January 2016 and January 2019, 523 patients with DM and CCS were included in the present study after CCTA and successful percutaneous coronary intervention (PCI). All patients were followed up for MACEs (the composite of cardiac death, myocardial infarction, and unplanned coronary revascularization) until January 2022, and the independent clinical event committee classified MACEs as indeterminate, culprit lesion (CL), and NCL-related. The primary outcome was MACEs arising from untreated NCLs during the follow-up. The association between plaque characteristics detected by CCTA and primary outcomes was determined by Marginal Cox proportional hazard regression. Results Overall, 1,248 NCLs of the 523 patients were analyzed and followed up for a median of 47 months. The cumulative rates of indeterminate, CL, and NCL-related MACEs were 2.3%, 14.5%, and 20.5%, respectively. On multivariate analysis, NCLs associated with recurrent MACEs were more likely to be characterized by a plaque burden >70% [hazard ratio (HR), 4.35, 95% confidence interval (CI): 2.92-6.44], a low-density non-calcified plaque (LDNCP) volume >30 mm3 (HR: 3.40, 95% CI: 2.07-5.56), a minimal luminal area (MLA) <4 mm2 (HR: 2.30, 95% CI: 1.57-3.36), or a combination of three APCs (HR: 13.69, 95% CI: 9.34-20.12, p < 0.0001) than those not associated with recurrent MACEs. Sensitivity analysis regarding all indeterminate MACEs as NCL-related ones demonstrated similar results. Conclusions In DM patients who presented with CCS and underwent PCI, half of the MACEs occurring during the follow-up were attributable to recurrence at the site of NCLs. NCLs responsible for unanticipated MACEs were frequently characterized by a large plaque burden and LDNCP volume, a small MLA, or a combination of these APCs, as determined by CCTA.
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Affiliation(s)
- Jia Zhao
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Hong Zhang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - Chang Liu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Ying Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Cun Xie
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Minghui Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chengjian Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Shuo Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Yuanyuan Xue
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Shuo Liang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - Yufan Gao
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - Hongliang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chunjie Li
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
- Correspondence: Chunjie Li Jia Zhou
| | - Jia Zhou
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
- Correspondence: Chunjie Li Jia Zhou
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Zhang G, Gao X, Zhu Z, Zhou F, Yu D. Determination of the location of the needle entry point based on an improved pruning algorithm. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:7952-7977. [PMID: 35801452 DOI: 10.3934/mbe.2022372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Since the emergence of new coronaviruses and their variant virus, a large number of medical resources around the world have been put into treatment. In this case, the purpose of this article is to develop a handback intravenous intelligence injection robot, which reduces the direct contact between medical staff and patients and reduces the risk of infection. The core technology of hand back intravenous intelligent robot is a handlet venous vessel detection and segmentation and the position of the needle point position decision. In this paper, an image processing algorithm based on U-Net improvement mechanism (AT-U-Net) is proposed for core technology. It is investigated using a self-built dorsal hand vein database and the results show that it performs well, with an F1-score of 93.91%. After the detection of a dorsal hand vein, this paper proposes a location decision method for the needle entry point based on an improved pruning algorithm (PT-Pruning). The extraction of the trunk line of the dorsal hand vein is realized through this algorithm. Considering the vascular cross-sectional area and bending of each vein injection point area, the optimal injection point of the dorsal hand vein is obtained via a comprehensive decision-making process. Using the self-built dorsal hand vein injection point database, the accuracy of the detection of the effective injection area reaches 96.73%. The accuracy for the detection of the injection area at the optimal needle entry point is 96.50%, which lays a foundation for subsequent mechanical automatic injection.
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Affiliation(s)
- Guangyuan Zhang
- School of Information Science and Electrical Engineering, Shan Dong Jiao Tong University, Jinan 250000, China
| | - Xiaonan Gao
- School of Information Science and Electrical Engineering, Shan Dong Jiao Tong University, Jinan 250000, China
| | - Zhenfang Zhu
- School of Information Science and Electrical Engineering, Shan Dong Jiao Tong University, Jinan 250000, China
| | - Fengyv Zhou
- School of Control Science and Engineering, Shandong University, Jinan 250000, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250000, China
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Williams MC, Earls JP, Hecht H. Quantitative assessment of atherosclerotic plaque, recent progress and current limitations. J Cardiovasc Comput Tomogr 2022; 16:124-137. [PMID: 34326003 DOI: 10.1016/j.jcct.2021.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
An important advantage of computed tomography coronary angiography (CCTA) is its ability to visualize the presence and severity of atherosclerotic plaque, rather than just assessing coronary artery stenoses. Until recently, assessment of plaque subtypes on CCTA relied on visual assessment of the extent of calcified/non-calcified plaque, or visually identifying high-risk plaque characteristics. Recent software developments facilitate the quantitative assessment of plaque volume or burden on CCTA, and the identification of subtypes of plaque based on their attenuation density. These techniques have shown promise in single and multicenter studies, demonstrating that the amount and type of plaque are associated with subsequent cardiac events. However, there are a number of limitations to the application of these techniques, including the limitations imposed by the spatial resolution of current CT scanners, challenges from variations between reconstruction algorithms, and the additional time to perform these assessments. At present, these are a valuable research technique, but not yet part of routine clinical practice. Future advances that improve CT resolution, standardize acquisition techniques and reconstruction algorithms and automate image analysis will improve the clinical utility of these techniques. This review will discuss the technical aspects of quantitative plaque analysis and present pro and con arguments for the routine use of quantitative plaque analysis on CCTA.
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Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - James P Earls
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Harvey Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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