1
|
Bass RD, Phillips J, Sánchez JS, Shah P, Sum S, Waksman R, Garcia-Garcia HM. The Ability of Near-Infrared Spectroscopy to Identify Vulnerable Patients and Plaques: A Systematic Review and Meta-Analysis. Heart Fail Clin 2024; 20:101-112. [PMID: 37953017 DOI: 10.1016/j.hfc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Previous studies have analyzed the efficacy of near-infrared spectroscopy-derived lipid core burden index (LCBI) in quantifying and identifying high-risk plaques and patients at increased risk of future major adverse cardiac outcomes/major adverse cardiovascular and cerebrovascular events. A maxLCBI4mm of 400 or greater seems to be an effective threshold for classifying at-risk plaques. This meta-analysis provides a more precise odds ratio with a narrow standard deviation that can be used to guide future studies.
Collapse
Affiliation(s)
- Ronald D Bass
- School of Medicine, Georgetown University, 3800 Reservoir Road, NorthWest, Washington, DC 20007, USA
| | - Joseph Phillips
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive Iowa City, IA 52242, USA
| | - Jorge Sanz Sánchez
- Hospital Universitari I Politecnic La Fe, Avinguda de Fernando Abril Martorell, no 106, 46026 València, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Avenue, Monforte de Lemos, 3-5. Pabellón 11. Planta 0. 28029 Madrid, Spain
| | - Priti Shah
- InfraRedx, A Nipro Company, 28 Crosby Drive, Suite 100, Bedford, MA 01730, USA
| | - Stephen Sum
- InfraRedx, A Nipro Company, 28 Crosby Drive, Suite 100, Bedford, MA 01730, USA
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street, Suite 4B-1, Washington, DC, 20010, USA
| | - Hector M Garcia-Garcia
- Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street, Suite 4B-1, Washington, DC, 20010, USA.
| |
Collapse
|
2
|
Parikh MJ, Madder RD. Near-Infrared Spectroscopy-Guided Percutaneous Coronary Intervention: Practical Applications and Available Evidence. Interv Cardiol Clin 2023; 12:257-268. [PMID: 36922066 DOI: 10.1016/j.iccl.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Intracoronary near-infrared spectroscopy (NIRS) has been extensively validated against the gold standard of histopathology to identify lipid-rich plaque. NIRS is currently in clinical use as a combined multimodality imaging catheter with intravascular ultrasonography. When used before PCI, NIRS has clinical utility in determining the mechanism underlying acute coronary syndromes and can be used to guide stent length selection and identify the risk of periprocedural myocardial infarction. When used after PCI, NIRS can identify vulnerable patients at increased risk of future patient-level cardiovascular events and can detect vulnerable plaques at increased risk of future site-specific coronary events.
Collapse
Affiliation(s)
- Malav J Parikh
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA.
| |
Collapse
|
3
|
The Ability of Near-Infrared Spectroscopy to Identify Vulnerable Patients and Plaques: A Systematic Review and Meta-Analysis. Interv Cardiol Clin 2023; 12:245-256. [PMID: 36922065 DOI: 10.1016/j.iccl.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Previous studies have analyzed the efficacy of near-infrared spectroscopy-derived lipid core burden index (LCBI) in quantifying and identifying high-risk plaques and patients at increased risk of future major adverse cardiac outcomes/major adverse cardiovascular and cerebrovascular events. A maxLCBI4mm of 400 or greater seems to be an effective threshold for classifying at-risk plaques. This meta-analysis provides a more precise odds ratio with a narrow standard deviation that can be used to guide future studies.
Collapse
|
4
|
Vesterbekkmo EK, Aamot Aksetøy IL, Follestad T, Nilsen HO, Hegbom K, Wisløff U, Wiseth R, Madssen E. High intensity interval training induces beneficial effects on coronary atheromatous plaques - a randomized trial. Eur J Prev Cardiol 2022; 30:384-392. [PMID: 36562212 DOI: 10.1093/eurjpc/zwac309] [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: 10/13/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary atheroma volume is associated with risk of coronary events in coronary artery disease (CAD). Exercise training is a cornerstone in primary and secondary prevention of CAD, but the effect of exercise on coronary atheromatous plaques is largely unknown. PURPOSE We assessed the effect of six months supervised high intensity interval training (HIIT) on coronary plaque geometry using intravascular ultrasound in patients with stable CAD following percutaneous coronary intervention (PCI). METHODS Sixty patients were randomized to two sessions of weekly supervised HIIT at 85-95% of peak heart rate (n = 30) or to follow contemporary preventive guidelines (control group, n = 30). The study endpoints were change in percent atheroma volume (PAV) and total atheroma volume (TAV) normalized for segment length (TAVnorm) at six-month follow-up. RESULTS The change in average PAV for matched coronary segments from baseline to follow-up showed a significant between-group difference (-1.4, 95% CI: -2.7 to -0.1, p = 0.036). There was a significant reduction in the HIIT group (-1.2, 95% CI: -2.1 to -0.2, p = 0.017) while not in the control group (0.2, 95% CI: -0.7 to 1.1, p = 0.616). TAVnorm was reduced (-9 mm3, 95% CI: -14.7 to -3.4, p = 0.002) after HIIT, with a significant between-group difference (-12.0 mm3, 95% CI: -19.9 to -4.2, p = 0.003). CONCLUSION In patients with established CAD, a regression of atheroma volume was observed in those undergoing six months of supervised HIIT compared with patients following contemporary preventive guidelines. Our study indicates that high intensity interval training counteracts atherosclerotic coronary disease progression and reduces atheroma volume in residual coronary atheromatous plaques following PCI.
Collapse
Affiliation(s)
- Elisabeth Kleivhaug Vesterbekkmo
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging at Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Exercise Training as Medicine for Cardiopulmonary Conditions, Trondheim, Norway
| | - Inger-Lise Aamot Aksetøy
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging at Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Exercise Training as Medicine for Cardiopulmonary Conditions, Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Queensland, Australia
| | - Hans Olav Nilsen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging at Norwegian University of Science and Technology, Trondheim, Norway
| | - Knut Hegbom
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging at Norwegian University of Science and Technology, Trondheim, Norway.,School of Human Movement and Nutrition Science, University of Queensland, Queensland, Australia
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging at Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Madssen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging at Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
5
|
Epicardial Adipose Tissue Thickness Is Related to Plaque Composition in Coronary Artery Disease. Diagnostics (Basel) 2022; 12:diagnostics12112836. [PMID: 36428896 PMCID: PMC9689801 DOI: 10.3390/diagnostics12112836] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: Currently, limited data are available regarding the relationship between epicardial fat and plaque composition. The aim of this study was to assess the relationship between visceral fat surrounding the heart and the lipid core burden in patients with coronary artery diseases; (2) Methods: Overall, 331 patients undergoing coronary angiography with combined near-infrared spectroscopy and intravascular ultrasound imaging were evaluated for epicardial adipose tissue (EAT) thickness using transthoracic echocardiography. Patients were divided into thick EAT and thin EAT groups according to the median value; (3) Results: There was a positive correlation between EAT thickness and maxLCBI4mm, and maxLCBI4mm was significantly higher in the thick EAT group compared to the thin EAT group (437 vs. 293, p < 0.001). EAT thickness was an independent predictor of maxLCBI4mm ≥ 400 along with age, low-density lipoprotein-cholesterol level, acute coronary syndrome presentation, and plaque burden in a multiple linear regression model. Receiver operating characteristic curve analysis showed that EAT thickness was a predictor for maxLCBI4mm ≥ 400; (4) Conclusions: In the present study, EAT thickness is related to the lipid core burden assessed by NIRS-IVUS in patients with CAD which suggests that EAT may affect the stability of the plaques in coronary arteries.
Collapse
|
6
|
Legutko J, Bryniarski KL, Kaluza GL, Roleder T, Pociask E, Kedhi E, Wojakowski W, Jang IK, Kleczynski P. Intracoronary Imaging of Vulnerable Plaque-From Clinical Research to Everyday Practice. J Clin Med 2022; 11:jcm11226639. [PMID: 36431116 PMCID: PMC9699515 DOI: 10.3390/jcm11226639] [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: 10/18/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
The introduction into clinical practice of intravascular imaging, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and their derivatives, allowed for the in vivo assessment of coronary atherosclerosis in humans, including insights into plaque evolution and progression process. Intravascular ultrasound, the most commonly used intravascular modality in many countries, due to its low resolution cannot assess many features of vulnerable plaque such as lipid plaque or thin-cap fibroatheroma. Thus, novel methods were introduced to facilitate this problem including virtual histology intravascular ultrasound and later on near-infrared spectroscopy and OCT. Howbeit, none of the currently used modalities can assess all known characteristics of plaque vulnerability; hence, the idea of combining different intravascular imaging methods has emerged including NIRS-IVUS or OCT-IVUS imaging. All of those described methods may allow us to identify the most vulnerable plaques, which are prone to cause acute coronary syndrome, and thus they may allow us to introduce proper treatment before plaque destabilization.
Collapse
Affiliation(s)
- Jacek Legutko
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Krzysztof L. Bryniarski
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Grzegorz L. Kaluza
- Skirball Center for Innovation, Cardiovascular Research Foundation, Orangeburg, NY 10019, USA
| | - Tomasz Roleder
- Department of Cardiology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Elzbieta Pociask
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Kraków, Poland
| | - Elvin Kedhi
- Clinique Hopitaliere Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, Boston, MA 02115, USA
- Division of Cardiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Pawel Kleczynski
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
- Correspondence: ; Tel.: +48-12-614-35-01
| |
Collapse
|
7
|
Vesterbekkmo EK, Madssen E, Aamot Aksetøy I, Follestad T, Nilsen HO, Hegbom K, Wisløff U, Wiseth R. CENIT (Impact of Cardiac Exercise Training on Lipid Content in Coronary Atheromatous Plaques Evaluated by Near‐Infrared Spectroscopy): A Randomized Trial. J Am Heart Assoc 2022; 11:e024705. [PMID: 35574968 PMCID: PMC9238565 DOI: 10.1161/jaha.121.024705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The effect of physical exercise on lipid content of coronary artery plaques is unknown. With near infrared spectroscopy we measured the effect of high intensity interval training (HIIT) on lipid content in coronary plaques in patients with stable coronary artery disease following percutaneous coronary intervention. Methods and Results In CENIT (Impact of Cardiac Exercise Training on Lipid Content in Coronary Atheromatous Plaques Evaluated by Near‐Infrared Spectroscopy) 60 patients were randomized to 6 months supervised HIIT or to a control group. The primary end point was change in lipid content measured as maximum lipid core burden index at 4 mm (maxLCBI4mm). A predefined cutoff of maxLCBI4mm >100 was required for inclusion in the analysis. Forty‐nine patients (HIIT=20, usual care=29) had maxLCBI4mm >100 at baseline. Change in maxLCBI4mm did not differ between groups (−1.2, 95% CI, −65.8 to 63.4, P=0.97). The estimated reduction in maxLCBI4mm was −47.7 (95% CI, −100.3 to 5.0, P=0.075) and −46.5 (95% CI, −87.5 to −5.4, P=0.027) after HIIT and in controls, respectively. A negative correlation was observed between change in peak oxygen uptake (VO2peak) and change in lipid content (Spearman’s correlation −0.44, P=0.009). With an increase in VO2peak above 1 metabolic equivalent task, maxLCBI4mm was on average reduced by 142 (−8 to −262), whereas the change was −3.2 (154 to −255) with increased VO2peak below 1 metabolic equivalent task. Conclusions Six months of HIIT following percutaneous coronary intervention did not reduce lipid content in coronary plaques compared with usual care. A moderate negative correlation between increase in VO2peak and change in lipid content generates the hypothesis that exercise with a subsequent increase in fitness may reduce lipid content in coronary atheromatous plaques. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02494947.
Collapse
Affiliation(s)
- Elisabeth Kleivhaug Vesterbekkmo
- Clinic of Cardiology St. Olavs University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
- National Advisory Unit on Exercise Training as Medicine for Cardiopulmonary Conditions Trondheim Norway
| | - Erik Madssen
- Clinic of Cardiology St. Olavs University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | - Inger‐Lise Aamot Aksetøy
- Clinic of Cardiology St. Olavs University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
- National Advisory Unit on Exercise Training as Medicine for Cardiopulmonary Conditions Trondheim Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Hans Olav Nilsen
- Clinic of Cardiology St. Olavs University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | - Knut Hegbom
- Clinic of Cardiology St. Olavs University Hospital Trondheim Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
- School of Human Movement and Nutrition Science University of Queensland Australia
| | - Rune Wiseth
- Clinic of Cardiology St. Olavs University Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| |
Collapse
|
8
|
Yamaguchi M, Hoshino M, Sugiyama T, Kanaji Y, Nagamine T, Misawa T, Hada M, Araki M, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Association of near-infrared spectroscopy-defined lipid rich plaque with lesion morphology and peri-coronary inflammation on computed tomography angiography. Atherosclerosis 2022; 346:109-116. [DOI: 10.1016/j.atherosclerosis.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/24/2021] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
|
9
|
Torguson R, Shlofmitz E, Mintz GS, Mario CD, Cate TT, Ali ZA, Singh V, Skinner W, Zhang C, Shea C, Garcia-Garcia HM, Waksman R. Frequency of Lipid-Rich Coronary Plaques in Stable Angina Pectoris versus Acute Coronary Syndrome (from the Lipid Rich Plaque Study). Am J Cardiol 2021; 158:1-5. [PMID: 34465457 DOI: 10.1016/j.amjcard.2021.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
The multicenter prospective Lipid Rich Plaque (LRP) registry showed that nonculprit (NC) lipid-rich plaques identified by near-infrared spectroscopy (maxLCBI4mm >400) with an intravascular ultrasound plaque burden (PB) >70% and/or minimum lumen area (MLA) <4 mm2 within the maxLCBI4mm segment were more frequently associated with major adverse cardiac events (MACE) within 2 years. The aim of this sub-study was to report the relationship between initial clinical presentation and subsequent NC-MACE. Patients enrolled in the LRP study were stratified post hoc as having a stable angina pectoris or silent ischemia presentation versus acute coronary syndrome, excluding patients presenting with acute ST-elevation myocardial infarction. Among the 1552 patients, 717 presented with stable angina pectoris or silent ischemia. Patients presenting with acute coronary syndrome were more likely to be younger and Black, current smokers, and have less chronic kidney disease. Of the scanned nonculprit vessels, there was no difference between the 2 clinical presentation groups regarding lipidic content, and the rate of lipid-rich plaques (maxLCBI4mm >400) was 31.9% in both groups. Finally, there was no difference in NC-MACE at 2 years' follow-up, although within each group (stable versus acute coronary syndrome), the NC-MACE rate associated with maxLCBI4mm >400 was significantly higher than maxLCBI4mm ≤400 (stable 13.8% vs 6.5%; acute patients 11.6% vs 6.3%, respectively). In conclusion, in patient groups that present with stable angina pectoris or silent ischemia versus acute coronary syndrome, the NC lipidic content was similar, as was NC-MACE, through 2 years of follow-up.
Collapse
|
10
|
Bambagioni G, Di Mario C, Torguson R, Demola P, Ali Z, Singh V, Skinner W, Artis A, Cate TT, Zhang C, Garcia-Garcia HM, Doros G, Mintz GS, Waksman R. Lipid-rich plaques detected by near-infrared spectroscopy predict coronary events irrespective of age: A Lipid Rich Plaque sub-study. Atherosclerosis 2021; 334:17-22. [PMID: 34455112 DOI: 10.1016/j.atherosclerosis.2021.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS In this Lipid Rich Plaque (LRP) sub-study, 1551 patients undergoing coronary angiography for acute coronary syndromes or stable angina were examined with near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS). We aimed to assess the correlation of patient age with the presence of high-risk plaques, defined as maximum 4-mm Lipid Core Burden Index (maxLCBI4mm) >400 and plaque burden >70%, and 2-year incidence of non-culprit major adverse cardiovascular events (NC-MACE). METHODS The study population was divided into four groups according to age: <50 years (122), 50-64 years (700), 65-74 years (502), and ≥75 years (227). The primary outcome was NC-MACE from index procedure to event or the end of the study. Cox regression and mixed-effects Cox regression models were used to assess the effect of age on the association between LCBI and NC-MACE at the patient and plaque levels. RESULTS Average maxLCBI4mm and percentage of patients with at least one segment with maxLCBI4mm > 400 were similar across the four age groups at both the patient and coronary segment levels. Having at least one segment with maxLCBI4mm > 400 was strongly associated with NC-MACE, and that association did not differ significantly across age subgroups. Although less common (prevalence of 0.8%-1.3%), a similar trend toward greater NC-MACE rates was seen in patients with plaque burden >70% at the maximum LCBI site across age subgroups. CONCLUSIONS Lipid-rich plaques were as frequent in older as in younger patients and predicted a higher incidence of NC-MACE over 2-year follow-up irrespective of age.
Collapse
Affiliation(s)
- Gabriele Bambagioni
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
| | - Rebecca Torguson
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierluigi Demola
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Ziad Ali
- St Francis Hospital & Heart Center, Roslyn, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Tim Ten Cate
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Cheng Zhang
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | - Gary S Mintz
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
11
|
Li J, Montarello NJ, Hoogendoorn A, Verjans JW, Bursill CA, Peter K, Nicholls SJ, McLaughlin RA, Psaltis PJ. Multimodality Intravascular Imaging of High-Risk Coronary Plaque. JACC Cardiovasc Imaging 2021; 15:145-159. [PMID: 34023267 DOI: 10.1016/j.jcmg.2021.03.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 03/22/2021] [Indexed: 01/13/2023]
Abstract
The majority of coronary atherothrombotic events presenting as myocardial infarction (MI) occur as a result of plaque rupture or erosion. Understanding the evolution from a stable plaque into a life-threatening, high-risk plaque is required for advancing clinical approaches to predict atherothrombotic events, and better treat coronary atherosclerosis. Unfortunately, none of the coronary imaging approaches used in clinical practice can reliably predict which plaques will cause an MI. Currently used imaging techniques mostly identify morphological features of plaques, but are not capable of detecting essential molecular characteristics known to be important drivers of future risk. To address this challenge, engineers, scientists, and clinicians have been working hand-in-hand to advance a variety of multimodality intravascular imaging techniques, whereby 2 or more complementary modalities are integrated into the same imaging catheter. Some of these have already been tested in early clinical studies, with other next-generation techniques also in development. This review examines these emerging hybrid intracoronary imaging techniques and discusses their strengths, limitations, and potential for clinical translation from both an engineering and clinical perspective.
Collapse
Affiliation(s)
- Jiawen Li
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, Australia; Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
| | - Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Ayla Hoogendoorn
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, Australia; Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia; Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Johan W Verjans
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia; Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Christina A Bursill
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, Australia; Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia; Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Australia
| | - Robert A McLaughlin
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, Australia; Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia
| | - Peter J Psaltis
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia; Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
| |
Collapse
|
12
|
Waksman R, Torguson R. The vulnerable plaque detected: time to consider treatment. Lancet 2021; 397:943-945. [PMID: 33714375 DOI: 10.1016/s0140-6736(21)00504-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010, USA.
| | - Rebecca Torguson
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
13
|
Erlinge D, Maehara A, Ben-Yehuda O, Bøtker HE, Maeng M, Kjøller-Hansen L, Engstrøm T, Matsumura M, Crowley A, Dressler O, Mintz GS, Fröbert O, Persson J, Wiseth R, Larsen AI, Okkels Jensen L, Nordrehaug JE, Bleie Ø, Omerovic E, Held C, James SK, Ali ZA, Muller JE, Stone GW. Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study. Lancet 2021; 397:985-995. [PMID: 33714389 DOI: 10.1016/s0140-6736(21)00249-x] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) and intravascular ultrasound are promising imaging modalities to identify non-obstructive plaques likely to cause coronary-related events. We aimed to assess whether combined NIRS and intravascular ultrasound can identify high-risk plaques and patients that are at risk for future major adverse cardiac events (MACEs). METHODS PROSPECT II is an investigator-sponsored, multicentre, prospective natural history study done at 14 university hospitals and two community hospitals in Denmark, Norway, and Sweden. We recruited patients of any age with recent (within past 4 weeks) myocardial infarction. After treatment of all flow-limiting coronary lesions, three-vessel imaging was done with a combined NIRS and intravascular ultrasound catheter. Untreated lesions (also known as non-culprit lesions) were identified by intravascular ultrasound and their lipid content was assessed by NIRS. The primary outcome was the covariate-adjusted rate of MACEs (the composite of cardiac death, myocardial infarction, unstable angina, or progressive angina) arising from untreated non-culprit lesions during follow-up. The relations between plaques with high lipid content, large plaque burden, and small lumen areas and patient-level and lesion-level events were determined. This trial is registered with ClinicalTrials.gov, NCT02171065. FINDINGS Between June 10, 2014, and Dec 20, 2017, 3629 non-culprit lesions were characterised in 898 patients (153 [17%] women, 745 [83%] men; median age 63 [IQR 55-70] years). Median follow-up was 3·7 (IQR 3·0-4·4) years. Adverse events within 4 years occurred in 112 (13·2%, 95% CI 11·0-15·6) of 898 patients, with 66 (8·0%, 95% CI 6·2-10·0) arising from 78 untreated non-culprit lesions (mean baseline angiographic diameter stenosis 46·9% [SD 15·9]). Highly lipidic lesions (851 [24%] of 3500 lesions, present in 520 [59%] of 884 patients) were an independent predictor of patient-level non-culprit lesion-related MACEs (adjusted odds ratio 2·27, 95% CI 1·25-4·13) and non-culprit lesion-specific MACEs (7·83, 4·12-14·89). Large plaque burden (787 [22%] of 3629 lesions, present in 530 [59%] of 898 patients) was also an independent predictor of non-culprit lesion-related MACEs. Lesions with both large plaque burden by intravascular ultrasound and large lipid-rich cores by NIRS had a 4-year non-culprit lesion-related MACE rate of 7·0% (95% CI 4·0-10·0). Patients in whom one or more such lesions were identified had a 4-year non-culprit lesion-related MACE rate of 13·2% (95% CI 9·4-17·6). INTERPRETATION Combined NIRS and intravascular ultrasound detects angiographically non-obstructive lesions with a high lipid content and large plaque burden that are at increased risk for future adverse cardiac outcomes. FUNDING Abbott Vascular, Infraredx, and The Medicines Company.
Collapse
Affiliation(s)
| | - Akiko Maehara
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA; University of California San Diego, San Diego, CA, USA
| | | | | | | | | | | | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ole Fröbert
- Faculty of Health, Örebro University, Sweden
| | - Jonas Persson
- Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Rune Wiseth
- St Olavs Hospital, Trondheim University Hospital, Norway
| | | | | | | | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Held
- Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Stefan K James
- Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Ziad A Ali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | | | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
14
|
Omatsu T, Sotomi Y, Kobayashi T, Hamanaka Y, Hirata A, Hirayama A, Ueda Y, Sakata Y, Higuchi Y. Quantitative Validation of the Coronary Angioscopic Yellow Plaque with Lipid Core Burden Index Assessed by Intracoronary Near-Infrared Spectroscopy. J Atheroscler Thromb 2021; 29:362-369. [PMID: 33487618 PMCID: PMC8894116 DOI: 10.5551/jat.60566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim:
We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate each other’s drawbacks.
Methods:
This is a single-center prospective observational study. Patients undergoing a planned follow-up coronary angiography after percutaneous coronary intervention were prospectively enrolled from January 2018 to April 2019. The major three vessels were examined by NIRS-intravascular ultrasound, followed by coronary angioscopic evaluation. Yellow color grade on angioscopy was classified into four grades (0, white; 1, slight yellow; 2, yellow; and 3, intensive yellow) at a location of maximal lipid core burden index over 4 mm [LCBI (4)] on NIRS in each vessel.
Results:
A total of 95 lesions in 44 patients (72.6±6.7 years, 75% male) were analyzed. LCBI (4) was significantly different among different yellow color grades by coronary angioscopy (ANOVA,
p
<0.001). Positive correlation was found between angioscopic yellow color grade and LCBI (4) (beta coefficient 164.8, 95% confidence interval 122.9–206.7;
p
<0.001). The best cutoff value of LCBI (4) to predict the presence of yellow plaque (yellow color grade ≥ 2) was 448 (sensitivity 79.3%, specificity 69.7%, C-statistic 0.800, 95% confidence interval 0.713–0.887,
p
<0.001).
Conclusion:
The qualitative angioscopic assessment was objectively validated by the quantitative NIRS evaluation, which would be helpful for the reinterpretation of the existing evidences of both imaging modalities.
Collapse
Affiliation(s)
| | - Yohei Sotomi
- Cardiovascular Division, Osaka Police Hospital.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | | | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | |
Collapse
|
15
|
Nashawi M, Sheikh O, Mir M, Te T, Chilton R. The systemic implication of novel non-statin therapies in cardiovascular diabetology: PCSK9 as a case model. Cardiovasc Endocrinol Metab 2020; 9:143-152. [PMID: 33225229 PMCID: PMC7673769 DOI: 10.1097/xce.0000000000000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022]
Abstract
PCSK9, like other novel non-statin drugs were primarily developed to help patients achieve low-density lipoprotein cholesterol targets, especially in patients with dyslipidemia not achieving lipid goals with statins due to poor tolerance or inadequate response. PCSK9 inhibitors, in addition to modulating lipid metabolism, improve mortality outcomes in cardiovascular disease. These benefits are markedly pronounced in patients with type 2 diabetes mellitus. However, these benefits do not come without associated risk. Multiple trials, studies, and case reports have attempted to explain observed outcomes with PCSK9 expression and administration of PCSK9 inhibitors from multiple perspectives, such as their effects on insulin sensitivity and glucose tolerance, changes in renal physiology, thyroid physiology, vascular tone, intestinal regulation of lipids, and improved cardiovascular function. These agents represent an opportunity for physicians to exercise prudence by using appropriate clinical judgement when managing comorbidities in the hyperglycemic patient, a concept that extends to other novel non-statin drugs.
Collapse
Affiliation(s)
- Mouhamed Nashawi
- Division of Medicine-Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Omar Sheikh
- Division of Medicine-Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Mahnoor Mir
- Division of Medicine-Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Tri Te
- Division of Medicine-Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| | - Robert Chilton
- Division of Medicine-Cardiology, UT Health San Antonio, San Antonio, Texas, USA
| |
Collapse
|
16
|
Montarello NJ, Nelson AJ, Verjans J, Nicholls SJ, Psaltis PJ. The role of intracoronary imaging in translational research. Cardiovasc Diagn Ther 2020; 10:1480-1507. [PMID: 33224769 DOI: 10.21037/cdt-20-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This has helped further our appreciation of the natural history of coronary artery disease (CAD) and the risk for major adverse cardiovascular events (MACE), evaluate the responsiveness to conventional and experimental therapeutic interventions, and assist in guiding percutaneous coronary intervention (PCI). Here we review the use of different imaging modalities for these purposes and the lessons they have provided thus far.
Collapse
Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J Nelson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Duke Clinical Research Institute, Durham, NC, USA
| | - Johan Verjans
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| |
Collapse
|
17
|
Johnson TW, Räber L, di Mario C, Bourantas C, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas K, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2020; 40:2566-2584. [PMID: 31112213 DOI: 10.1093/eurheartj/ehz332] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
Collapse
Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, UK
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Alessio Mattesini
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Nieves Gonzalo
- Department of Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation Rome, Italy
| | - Konstantinos Koskinas
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Joner
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Maria D Radu
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Erlinge
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Evelyn Regar
- Department of Cardiovascular Surgery, Zürich University Hospital, Zürich, Switzerland
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Akiko Maehara
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Robert A Byrne
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Gary S Mintz
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
18
|
Kitahara S, Kataoka Y, Sugane H, Otsuka F, Asaumi Y, Noguchi T, Yasuda S. In vivo imaging of vulnerable plaque with intravascular modalities: its advantages and limitations. Cardiovasc Diagn Ther 2020; 10:1461-1479. [PMID: 33224768 DOI: 10.21037/cdt-20-238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In vivo imaging of plaque instability has been considered to have a great potential to predict future coronary events and evaluate the stabilization effect of novel anti-atherosclerotic medical therapies. Currently, there are several intravascular imaging modalities which enable to visualize plaque components associated with its vulnerability. These include virtual histology intravascular ultrasound (VH-IVUS), integrated backscatter IVUS (IB-IVUS), optical coherence tomography (OCT), near-infrared spectroscopy and coronary angioscopy. Recent studies have shown that these tools are applicable for risk stratification of cardiovascular events as well as drug efficacy assessment. However, several limitation exists in each modality. The current review paper will outline advantages and limitation of VH-IVUS, IB-IVUS, OCT, NIRS and coronary angioscopy imaging.
Collapse
Affiliation(s)
- Satoshi Kitahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroki Sugane
- Department of Cardiovascular Medicine, Chikamori Hospital, Kochi, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| |
Collapse
|
19
|
Horváth M, Hájek P, Štěchovský C, Honěk J, Veselka J. Carotid artery plaque composition and distribution: near-infrared spectroscopy and intravascular ultrasound analysis. Eur Heart J Suppl 2020; 22:F38-F43. [PMID: 32694952 PMCID: PMC7361666 DOI: 10.1093/eurheartj/suaa097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
Most atherosclerotic plaques (APs) form in typical predilection areas of low endothelial shear stress (ESS). On the contrary, previous data hinted that plaques rupture in their proximal parts where accelerated blood flow causes high ESS. It was postulated that high ESS plays an important role in the latter stages of AP formation and in its destabilization. Here, we used near-infrared spectroscopy (NIRS) to analyse the distribution of lipid core based on the presumed exposure to ESS. A total of 117 carotid arteries were evaluated using NIRS and intravascular ultrasound (IVUS) prior to carotid artery stenting. The point of minimal luminal area (MLA) was determined using IVUS. A stepwise analysis of the presence of lipid core was then performed using NIRS. The lipid core presence was quantified as the lipid core burden index (LCBI) within 2 mm wide segments both proximally and distally to the MLA. The analysed vessel was then divided into three 20 mm long thirds (proximal, middle, and distal) for further analysis. The maximal value of LCBI (231.9 ± 245.7) was noted in the segment localized just 2 mm proximally to MLA. The mean LCBI in the middle third was significantly higher than both the proximal (121.4 ± 185.6 vs. 47.0 ± 96.5, P < 0.01) and distal regions (121.4 ± 185.6 vs. 32.4 ± 89.6, P < 0.01). Lipid core was more common in the proximal region when compared with the distal region (mean LCBI 47.0 ± 96.5 vs. 32.4 ± 89.6, P < 0.01).
Collapse
Affiliation(s)
- Martin Horváth
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Petr Hájek
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Cyril Štěchovský
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Jakub Honěk
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| |
Collapse
|
20
|
Kuku KO, Singh M, Ozaki Y, Dan K, Chezar-Azerrad C, Waksman R, Garcia-Garcia HM. Near-Infrared Spectroscopy Intravascular Ultrasound Imaging: State of the Art. Front Cardiovasc Med 2020; 7:107. [PMID: 32695796 PMCID: PMC7338425 DOI: 10.3389/fcvm.2020.00107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022] Open
Abstract
Acute coronary syndromes (ACS) secondary to coronary vessel plaques represent a major cause of cardiovascular morbidity and mortality worldwide. Advancements in imaging technology over the last 3 decades have continuously enabled the study of coronary plaques via invasive imaging methods like intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The introduction of near-infrared spectroscopy (NIRS) as a modality that could detect the lipid (cholesterol) content of atherosclerotic plaques in the early nineties, opened the potential of studying “vulnerable” or rupture-prone, lipid-rich coronary plaques in ACS patients. Most recently, the ability of NIRS-IVUS to identify patients at risk of future adverse events was shown in a prospective multicenter trial, the Lipid-Rich-plaque Study. Intracoronary NIRS-IVUS imaging offers a unique method of coronary lipid-plaque characterization and could become a valuable clinical diagnostic and treatment monitoring tool.
Collapse
Affiliation(s)
- Kayode O Kuku
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Manavotam Singh
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Yuichi Ozaki
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Kazuhiro Dan
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Ron Waksman
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Hector M Garcia-Garcia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| |
Collapse
|
21
|
Muller J, Madder R. OCT-NIRS Imaging for Detection of Coronary Plaque Structure and Vulnerability. Front Cardiovasc Med 2020; 7:90. [PMID: 32582767 PMCID: PMC7287010 DOI: 10.3389/fcvm.2020.00090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
A combination optical coherence tomography and near-infrared spectroscopy (OCT-NIRS) coronary imaging system is being developed to improve the care of coronary patients. While stenting has improved, complications continue to occur at the stented site and new events are caused by unrecognized vulnerable plaques. An OCT-NIRS device has potential to improve secondary prevention by optimizing stenting and by identifying vulnerable patients and vulnerable plaques. OCT is already in widespread use world-wide to optimize coronary artery stenting. It provides automated lumen detection and can identify features of coronary plaques not accurately identified by angiography or intravascular ultrasound. The ILUMIEN IV study, to be completed in 2022, will determine if OCT-guided stenting will yield better clinical outcomes than angiographic guidance alone. While the superb spatial resolution of OCT enables the identification of many plaque structural features, the detection by OCT of lipids, an important component of vulnerable plaques, is limited by suboptimal specificity and interobserver agreement. In contrast, NIRS has been extensively validated for lipid-rich plaque detection against the gold-standard of histology and is the only FDA-approved method to identify coronary lipids. Studies in patients have demonstrated that NIRS detects lipid in culprit lesions causing coronary events. In 2019, the positive results of the prospective Lipid-Rich Plaque Study led to FDA approval of NIRS for detection of high-risk plaques and patients. The complementarity of OCT for plaque structure and NIRS for plaque composition led to the sequential performance of NIRS and OCT imaging in patients. NIRS identified lipid while OCT determined the thickness of the cap over the lipid pool. The positive results obtained with OCT and NIRS imaging led to development of a prototype combined OCT-NIRS catheter that can provide co-registered OCT and NIRS data in a single pullback. The data will provide structural and chemical information likely to improve stenting and deliver more accurate identification of vulnerable plaques and vulnerable patients. More precise diagnosis will then lead to OCT-NIRS guided treatment trials to improve secondary prevention. Success in secondary prevention will then facilitate development of improved primary prevention with invasive imaging and effective treatment of patients identified by non-invasive methods.
Collapse
Affiliation(s)
- James Muller
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ryan Madder
- Spectrum Health, Grand Rapids, MI, United States
| |
Collapse
|
22
|
Tashiro H, Tanaka A, Ishii H, Sakakibara K, Tobe A, Kataoka T, Miki Y, Hitora Y, Niwa K, Furusawa K, Murohara T. Lipid-rich large plaques in a non-culprit left main coronary artery and long-term clinical outcomes. Int J Cardiol 2020; 305:5-10. [PMID: 32029305 DOI: 10.1016/j.ijcard.2020.01.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/26/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND An integrated backscatter (IB) intravascular ultrasound (IVUS) provides an information about tissue components and vulnerability of coronary plaques. The presence of vulnerable plaque in non-culprit lesion is associated with future clinical events. The purpose of this study was to assess the association between the characteristics of non-culprit left main coronary artery (LMCA) plaques evaluated by IB-IVUS and long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). METHODS Among the patients who underwent non-LMCA PCI, we studied 366 patients with adequate LMCA IVUS images. Conventional and IB-IVUS analyses of the LMCA segment were performed. Lipid-rich large plaque was defined as the presence of both a lager plaque volume and a higher percentage of the lipid component than the obtained median values. Major adverse cardiovascular events (MACE) included cardiac death, myocardial infarction, and unplanned revascularization. RESULTS The mean age of the patients was 68.5 ± 10.2 years, 79.8% were men. Median follow-up period was 6.0 years (IQR: 4.2-8.1 years). The incidence of MACE was significantly higher in patients with lipid-rich large plaques (P = .006). The incidence rates of cardiac death, myocardial infarction, and unplanned revascularization were significantly higher in patients with lipid-rich large plaques (P = .02, 0.004, and 0.02, respectively). Multivariate Cox regression analysis showed that the presence of a lipid-rich large plaque was significantly associated with MACE (HR: 1.74; 95%CI: 1.17-2.58; P = .006). CONCLUSION The presence of lipid-rich large plaques in a non-culprit LMCA can be associated with the long-term MACE in patients who have undergone PCI.
Collapse
Affiliation(s)
- Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Sakakibara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Miki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Hitora
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyoshi Niwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
23
|
Mori N, Saito Y, Saito K, Matsuoka T, Tateishi K, Kadohira T, Kitahara H, Fujimoto Y, Kobayashi Y. Relation of Plasma Xanthine Oxidoreductase Activity to Coronary Lipid Core Plaques Assessed by Near-Infrared Spectroscopy Intravascular Ultrasound in Patients With Stable Coronary Artery Disease. Am J Cardiol 2020; 125:1006-1012. [PMID: 31955828 DOI: 10.1016/j.amjcard.2019.12.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023]
Abstract
Previous studies reported that elevated serum uric acid level was associated with greater coronary lipid plaque. Xanthine oxidoreductase (XOR) is a rate-limiting enzyme in purine metabolism and is believed to play important roles in coronary atherosclerosis. However, the relation between XOR and coronary lipid plaque is unclear. Patients with stable coronary artery disease who underwent elective percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were prospectively included. They were divided into 3 groups according to plasma XOR activities based on a previous report: low, normal, and high. Quantitative coronary angiography and gray-scale IVUS were analyzed. The primary end point was coronary lipid plaques in a nontarget vessel assessed by NIRS-IVUS with lipid core burden index (LCBI) and maximum LCBI in 4 mm (maxLCBI4mm). Out of 68 patients, 26, 31, and 11 patients were classified as low, normal, and high XOR activity groups. Quantitative coronary angiography demonstrated that the high XOR activity group had longer lesion length, smaller minimum lumen diameter, and higher percentage of diameter stenosis in a nontarget vessel among the 3 groups. Gray-scale IVUS analysis also showed smaller lumen area in the high XOR activity group than the others. LCBI (102.1 ± 56.5 vs 65.6 ± 48.5 vs 55.6 ± 37.8, p = 0.04) and maxLCBI4mm (474.4 ± 171.6 vs 347.4 ± 181.6, 294.0 ± 155.9, p = 0.04) in a nontarget vessel were significantly higher in the high XOR group than in the normal and low groups. In conclusion, elevated XOR activity was associated with coronary lipid-rich plaque in a nontarget vessel in patients with stable coronary artery disease.
Collapse
|
24
|
Yamamoto MH, Maehara A, Stone GW, Kini AS, Brilakis ES, Rizik DG, Shunk K, Powers ER, Tobis JM, Maini BS, Dixon SR, Goldstein JA, Petersen JL, Généreux P, Shah PR, Crowley A, Nicholls SJ, Mintz GS, Muller JE, Weisz G. 2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques. J Am Coll Cardiol 2020; 75:1371-1382. [DOI: 10.1016/j.jacc.2020.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
|
25
|
Waksman R, Di Mario C, Torguson R, Ali ZA, Singh V, Skinner WH, Artis AK, Cate TT, Powers E, Kim C, Regar E, Wong SC, Lewis S, Wykrzykowska J, Dube S, Kazziha S, van der Ent M, Shah P, Craig PE, Zou Q, Kolm P, Brewer HB, Garcia-Garcia HM. Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study. Lancet 2019; 394:1629-1637. [PMID: 31570255 DOI: 10.1016/s0140-6736(19)31794-5] [Citation(s) in RCA: 254] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can detect lipid-rich plaques (LRPs). LRPs are associated with acute coronary syndromes or myocardial infarction, which can result in revascularisation or cardiac death. In this study, we aimed to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. METHODS In this prospective, cohort study (LRP), patients from 44 medical centres were enrolled in Italy, Latvia, Netherlands, Slovakia, UK, and the USA. Patients with suspected coronary artery disease who underwent cardiac catheterisation with possible ad hoc percutaneous coronary intervention were eligible to be enrolled. Enrolled patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694. FINDINGS Between Feb 21, 2014, and March 30, 2016, 1563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0·4%) patients. 1271 patients (mean age 64 years, SD 10, 883 [69%] men, 388 [31%]women) with analysable maxLCBI4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1·21 (95% CI 1·09-1·35; p=0·0004) for each 100-unit increase maxLCBI4mm) and adjusted HR 1·18 (1·05-1·32; p=0·0043). In patients with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 2·18 (1·48-3·22; p<0·0001) and adjusted HR was 1·89 (1·26-2·83; p=0·0021). At the plaque level, the unadjusted HR was 1·45 (1·30-1·60; p<0·0001) for each 100-unit increase in maxLCBI4mm. For segments with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 4·22 (2·39-7·45; p<0·0001) and adjusted HR was 3·39 (1·85-6·20; p<0·0001). INTERPRETATION NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at higher risk for subsequent NC-MACE. NIRS-intravascular ultrasound imaging adds to the armamentarium as the first diagnostic tool able to detect vulnerable patients and plaques in clinical practice. FUNDING Infraredx.
Collapse
Affiliation(s)
- Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA.
| | | | | | - Ziad A Ali
- New York Presbyterian/Columbia University Medical Center, New York, NY & Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | | | - Eric Powers
- Medical University of South Carolina Hospital, Charleston, SC, USA
| | | | | | - S Chiu Wong
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | | | - Sandeep Dube
- Community Heart and Vascular, Indianapolis, IN, USA
| | | | | | | | - Paige E Craig
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Quan Zou
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Paul Kolm
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | |
Collapse
|
26
|
Erlinge D. NIRS-intravascular imaging to predict coronary events. Lancet 2019; 394:1594-1595. [PMID: 31570256 DOI: 10.1016/s0140-6736(19)32217-2] [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] [Received: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, S-221 85 Lund, Sweden.
| |
Collapse
|
27
|
Johnson TW, Räber L, Di Mario C, Bourantas CV, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas KC, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2019; 15:434-451. [PMID: 31258132 DOI: 10.4244/eijy19m06_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
Collapse
Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Role of Near-Infrared Spectroscopy (NIRS) in Intracoronary Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9510-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
29
|
Kole A, Cao Y, Hui J, Bolad IA, Alloosh M, Cheng JX, Sturek M. Comparative Quantification of Arterial Lipid by Intravascular Photoacoustic-Ultrasound Imaging and Near-Infrared Spectroscopy-Intravascular Ultrasound. J Cardiovasc Transl Res 2019; 12:211-220. [PMID: 30488332 PMCID: PMC6611754 DOI: 10.1007/s12265-018-9849-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/19/2018] [Indexed: 01/04/2023]
Abstract
Intravascular photoacoustic-ultrasound (IVPA-US) imaging and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) are two hybrid modalities that detect arterial lipid, with comparison necessary to understand the relative advantages of each. We performed in vivo and ex vivo IVPA-US imaging of the iliac arteries of Ossabaw swine with metabolic syndrome (MetS) and lean swine to investigate sensitivity for early-stage atherosclerosis. We repeated imaging ex vivo with NIRS-IVUS for comparison to IVPA-US and histology. Both modalities showed significantly greater lipid in MetS vs. lean swine, but only IVPA-US localized the lipid as perivascular. To investigate late-stage atherosclerosis, we performed ex vivo IVPA-US imaging of a human coronary artery with comparison to NIRS-IVUS and histology. Two advanced fibroatheromas were identified, with agreement between IVPA-measured lipid area and NIRS-derived lipid content. As confirmed histologically, IVPA-US has sensitivity to detect lipid content similar to NIRS-IVUS and provides additional depth resolution, enabling quantification and localization of lipid cores within plaques.
Collapse
Affiliation(s)
- Ayeeshik Kole
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, MS 385, Indianapolis, IN, 46202, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Yingchun Cao
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Jie Hui
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, 47907, USA
| | - Islam A Bolad
- Roudebush VA Medical Center and Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Mouhamad Alloosh
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, MS 385, Indianapolis, IN, 46202, USA
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Photonics Center, Boston University, Boston, MA, 02215, USA
| | - Michael Sturek
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, MS 385, Indianapolis, IN, 46202, USA.
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA.
| |
Collapse
|
30
|
Karlsson S, Anesäter E, Fransson K, Andell P, Persson J, Erlinge D. Intracoronary near-infrared spectroscopy and the risk of future cardiovascular events. Open Heart 2019; 6:e000917. [PMID: 30997122 PMCID: PMC6443121 DOI: 10.1136/openhrt-2018-000917] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 01/23/2023] Open
Abstract
Objectives The objectives of this study were to investigate if findings by intracoronary near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) are associated with future cardiovascular events and if NIRS can differentiate culprit from non-culprit segments in patients with coronary artery disease. Methods The study included 144 patients with coronary artery disease undergoing percutaneous coronary intervention and combined NIRS-IVUS imaging at two Swedish hospitals. The NIRS-derived lipid core burden index (LCBI), the 4 mm segment with maximum LCBI (MaxLCBI4mm) and the IVUS-derived maximum plaque burden (MaxPB) were analysed within the culprit segment and continuous 10 mm non-culprit segments of the index culprit vessels. The association with future major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, acute coronary syndrome requiring revascularisation and cerebrovascular events during follow-up was evaluated using multivariable Cox regressions. A receiver operating characteristic (ROC) analysis was performed to test the ability of NIRS to discriminate culprit against non-culprit segments. Results A non-culprit maxLCBI4mm ≥400 (HR: 3.67, 95% CI 1.46 to 9.23, p=0.006) and a non-culprit LCBI ≥ median (HR: 3.08, 95% CI 1.11 to 8.56, p=0.031) were both significantly associated with MACCE, whereas a non-culprit MaxPB ≥70% (HR: 0.61, 95% CI 0.08 to 4.59, p=0.63) was not. The culprit segments had larger lipid cores compared with non-culprit segments (MaxLCBI4mm 425 vs 74, p<0.001), and the ROC analysis showed that NIRS can differentiate culprit against non-culprit segments (c-statistics: 0.85, 95% CI 0.81 to 0.89). Conclusion A maxLCBI4mm ≥400 and LCBI ≥ median, assessed by NIRS in non-culprit segments of a culprit artery, were significantly associated with patient-level MACCE. NIRS furthermore adequately discriminated culprit against non-culprit segments in patients with coronary disease.
Collapse
Affiliation(s)
- Sofia Karlsson
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Anesäter
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Klara Fransson
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
31
|
Golovynskyi S, Golovynska I, Stepanova LI, Datsenko OI, Liu L, Qu J, Ohulchanskyy TY. Optical windows for head tissues in near-infrared and short-wave infrared regions: Approaching transcranial light applications. JOURNAL OF BIOPHOTONICS 2018; 11:e201800141. [PMID: 30098115 DOI: 10.1002/jbio.201800141] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/09/2018] [Indexed: 05/02/2023]
Abstract
Optical properties of the rat head tissues (brain cortex, cranial bone and scalp skin) are assessed, aiming at transcranial light applications such as optical imaging and phototherapy. The spectral measurements are carried out over the wide spectral range of 350 to 2800 nm, involving visible, near-infrared (NIR) and short-wave infrared (SWIR) regions. Four tissue transparency windows are considered: ~700 to 1000 nm (NIR-I), ~1000 to 1350 nm (NIR-II), ~1550 to 1870 nm (NIR-III or SWIR) and ~2100 to 2300 nm (SWIR-II). The values of attenuation coefficient and total attenuation length are determined for all windows and tissue types. The spectra indicate transmittance peaks in NIR, NIR-II and SWIR-II, with maximum tissue permeability for SWIR light. The use of SWIR-II window for the transcranial light applications is substantiated. Furthermore, absorbance of the head tissues is investigated in details, by defining and describing the characteristic absorption peaks in NIR-SWIR.
Collapse
Affiliation(s)
- Sergii Golovynskyi
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Iuliia Golovynska
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Ludmila I Stepanova
- Institute of Biology and Medicine, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | | | - Liwei Liu
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Junle Qu
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Tymish Y Ohulchanskyy
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| |
Collapse
|