1
|
Homorodean C, Leucuta DC, Ober M, Homorodean R, Spinu M, Olinic M, Tataru D, Olinic DM. Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13671. [PMID: 34411283 DOI: 10.1111/eci.13671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients. METHODS A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models. RESULTS Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina. CONCLUSION Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non-culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.
Collapse
Affiliation(s)
- Calin Homorodean
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Ober
- Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | | | - Mihail Spinu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan Tataru
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| |
Collapse
|
2
|
Gatto L, Alfonso F, Paoletti G, Burzotta F, La Manna A, Budassi S, Biccirè FG, Fineschi M, Marco V, Fabbiocchi F, Vergallo R, Boi A, Ruscica G, Versaci F, Taglieri N, Calligaris G, Albertucci M, Romagnoli E, Ramazzotti V, Tamburino C, Crea F, Ozaki Y, Arbustini E, Prati F. Relationship betweeen the amount and location of macrophages and clinical outcome: subanalysis of the CLIMA-study. Int J Cardiol 2022; 346:8-12. [PMID: 34798205 DOI: 10.1016/j.ijcard.2021.11.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/30/2021] [Accepted: 11/15/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The ability of optical coherence tomography (OCT) to recognize intraplaque macrophage infiltration is now well acknowledged. This post-hoc analysis of the CLIMA study aimed to address the clinical impact of the circumferential extension of OCT-defined macrophages and their location at one year follow-up. METHODS The multicentre CLIMA study enrolled 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending (LAD) coronary artery. Measurements of circumferential extension of macrophages and measurements of the distance from intima-lumen contour to macrophages string were performed at the plaque cross-section judged as containing the greatest amount of macrophages. The main study endpoint was a composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR). RESULTS Patients with large macrophage arc (p = 0.001) and superficial macrophage arc (p < 0.001) showed a higher one-year incidence of the main one-year composite endpoint. Consistently hypertension (p = 0.018), family history of CAD (p = 0.046), diabetes mellitus (p = 0.036), lower ejection fraction (p = 0.009) and chronic kidney disease (p = 0.019) were more frequently found in patients experiencing the main composite endpoint. At multivariate Cox regression analysis, fibrous cap thickness < 75 μm (HR 2.51, 95% 1.46-4.32), presence of large (HR 1.97, 95%CI 1.16-3.35, p = 0.012) and superficial (HR 1.72, 95%CI 1.02-2.90; p = 0.040) macrophage arc remained independent predictors of the main composite endpoint. Large macrophage arc was associated with target LAD related MI. CONCLUSION The present post-hoc analysis of the CLIMA showed that the circumferential extension of macrophages and their location are related to a composite endpoint of cardiac death, MI and/or TVR.
Collapse
Affiliation(s)
- Laura Gatto
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Giulia Paoletti
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alessio La Manna
- Cardio-Thoracic Vascular Department, Azienda ospedaliero-Universitaria "Policlinico Vittorio-Emanuele", University of Catania, Catania, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Flavio Giuseppe Biccirè
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - Massimo Fineschi
- Department of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | | | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alberto Boi
- Interventional Cardiology Unit, Ospedale Brotzu, Cagliari, Italy
| | - Giovanni Ruscica
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | | | - Nevio Taglieri
- Cardio-Thoracic Vascular Department, University Hospital of Bologna, Bologna, Italy
| | | | - Mario Albertucci
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vito Ramazzotti
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Corrado Tamburino
- Cardio-Thoracic Vascular Department, Azienda ospedaliero-Universitaria "Policlinico Vittorio-Emanuele", University of Catania, Catania, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Prati
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy.
| |
Collapse
|
3
|
Drakopoulou M, Moldovan C, Toutouzas K, Tousoulis D. The role of microwave radiometry in carotid artery disease. Diagnostic and clinical prospective. Curr Opin Pharmacol 2018; 39:99-104. [PMID: 29631128 DOI: 10.1016/j.coph.2018.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/01/2018] [Accepted: 02/22/2018] [Indexed: 12/24/2022]
Abstract
Atherosclerosis of the internal carotid artery is an important cause of disabling ischemic stroke and therefore constitutes a major medical, social, and economic issue. Although advances in vascular imaging modalities during the last decades allow to risk stratify patients not solely on the degree of carotid artery stenosis but also based on 'high risk' features, there still remains a controversy over patient selection for carotid artery revascularization. Among other features of plaque vulnerability, there is an increasing body of evidence that inflammation is a key factor in the initiation, progression and destabilization of atherosclerotic plaques. Microwave radiometry (MWR) is a new imaging method that is based on the ability to detect noninvasively, with high accuracy, the relative changes of temperature in human tissues reflecting inflammatory activation. This review article aims to: (1) give an overview of current clinical experience with MWR in carotid arteries and (2) present its potential role for risk stratification.
Collapse
Affiliation(s)
- Maria Drakopoulou
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, UK; National and Kapodistrian Athens University, First Department of Cardiology, Hippokration Hospital, Athens, Greece.
| | - Carmen Moldovan
- National and Kapodistrian Athens University, First Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- National and Kapodistrian Athens University, First Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Dimitris Tousoulis
- National and Kapodistrian Athens University, First Department of Cardiology, Hippokration Hospital, Athens, Greece
| |
Collapse
|
4
|
|
5
|
Oshakbayev K, Dukenbayeva B, Togizbayeva G, Gazaliyeva M, Syzdykova A, Daurenbekov K, Issa P. Accumulated substancies and calorific capacity in adipose tissue: Physical and chemical clinical trial. BBA CLINICAL 2017. [PMID: 28626640 PMCID: PMC5466547 DOI: 10.1016/j.bbacli.2017.05.002] [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] [Indexed: 12/02/2022]
Abstract
Aim To study physical and chemical structures and properties including calorific value of human adipose tissue in different anatomical location in autopsy-assigned clinical trial. Methods A pilot physical and chemical descriptive randomized autopsy-assigned trial. Adipose tissue 252 sampled from 36 individuals at autopsy who between 36 and 63 years old died from road accidents. Interventions: Chemical functional groups and calorific value were studied using infrared and atomic adsorptive spectrometries, elemental chemical analysis and differential scanning calorimetry. Adipose tissue was sampled from the 7 various anatomical locations. Results The highest levels of the analysed chemical substancies were found in dense atherosclerotic plaque. Dense atherosclerotic plaque contains the most of metabolic products, organic and inorganic elements. Dense atherosclerotic plaque has the most of calorific value. The lowest calorific capacity has a pararenal fat. Conclusions Human body lipids serve as a harbor for various organic substances, they may absorb different metabolic products, and they have different calorific capacity depending on their location and forms. Atherosclerotic plaque contains the most of organic and inorganic elements, and brings the highest energy potential. The body adipose tissue is heterogeneous in content and in property. Atherosclerosis plaque contains the largest amount of organic/inorganic functional groups. Atherosclerosis plaque is a harbor for various organic substances. Adipose tissue has different calorific capacity depending on its locations and forms. Plaques bring the highest of energy potential in compare to other fats.
Collapse
Affiliation(s)
| | | | | | | | - Alma Syzdykova
- Nazarbayev University Medical Center, Astana, Kazakhstan
| | | | - Pernekul Issa
- Kazakh University for technology and business, Astana, Kazakhstan
| |
Collapse
|
6
|
Szilágyi SM, Popovici MM, Szilágyi L. Review. Automatic Segmentation Techniques of the Coronary Artery Using CT Images in Acute Coronary Syndromes. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Coronary artery disease represents one of the leading reasons of death worldwide, and acute coronary syndromes are their most devastating consequences. It is extremely important to identify the patients at risk for developing an acute myocardial infarction, and this goal can be achieved using noninvasive imaging techniques. Coronary computed tomography angiography (CCTA) is currently one of the most reliable methods used for assessing the coronary arteries; however, its use in emergency settings is sometimes limited due to time constraints. This paper presents the main characteristics of plaque vulnerability, the role of CCTA in the assessment of vulnerable plaques, and automatic segmentation techniques of the coronary artery tree based on CT angiography images. A detailed inventory of existing methods is given, representing the state-of-the-art of computational methods applied in vascular system segmentation, focusing on the current applications in acute coronary syndromes.
Collapse
Affiliation(s)
| | - Monica Marton Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, 21601, 76th Ave W, Edmonds, Washington , 98026, USA
| | - László Szilágyi
- Department of Electrical Engineering, Sapientia University, Tîrgu Mureș , Romania
| |
Collapse
|
7
|
Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017; 6:JAHA.117.005543. [PMID: 28314799 PMCID: PMC5524044 DOI: 10.1161/jaha.117.005543] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Dimitrios Tsiachris
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| | - Panagiota Pietri
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| |
Collapse
|
8
|
Toutouzas K, Karanasos A, Tousoulis D. Optical Coherence Tomography For the Detection of the Vulnerable Plaque. Eur Cardiol 2016; 11:90-95. [PMID: 30310454 DOI: 10.15420/ecr.2016:29:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Morphological characteristics of the atheromatous plaque have been associated with the development of plaque rupture and the pathogenesis of acute coronary syndromes (ACS). Plaques with a specific morphological phenotype that are at high risk of causing ACS are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that enables detailed visualization of atheromatous plaques. Consequently, OCT is a valuable research tool for examining the role of morphological characteristics of atheromatous plaques in the progression of coronary artery disease and plaque destabilisation, which leads to the clinical manifestation of ACS. This article summarises the pathophysiological insights obtained by OCT imaging in the formation and rupture of the vulnerable plaque.
Collapse
|
9
|
Saxena V, Gacchina Johnson C, Negussie AH, Sharma KV, Dreher MR, Wood BJ. Temperature-sensitive liposome-mediated delivery of thrombolytic agents. Int J Hyperthermia 2015; 31:67-73. [PMID: 25766387 DOI: 10.3109/02656736.2014.991428] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical efficacy of thrombolytic drugs is limited by lack of specific delivery and requires large therapeutic doses which increase toxicity. Encapsulating these drugs in temperature-sensitive liposomes and applying hyperthermia to deliver thrombolytic agents locally to thrombus might theoretically favourably alter the therapeutic window. The objectives of this study were to formulate liposomes encapsulating thrombolytics and assess thrombolytic activity following hyperthermia. METHODS Three liposome formulations were investigated: temperature-sensitive liposome (TSL, DPPC:DSPE-PEG2000 (mol% 95:5)), low temperature-sensitive liposome (LTSL, DPPC:MSPC:DSPE-PEG2000 (mol% 85.3:9.7:5)), and traditional temperature-sensitive liposome (TTSL, DPPC:HSPC:Chol:DSPE-PEG2000 (mol% 55:25:15:5)). To characterise temperature-dependent release of high molecular weight cargo from each formulation, fluorescein-conjugated dextrans (70 kDa) were loaded and release was quantified via spectrophotometry. Staphylokinase (SAK), urokinase, and tissue-type plasminogen activator were also loaded individually into each liposome formulation. Leakage at 37 °C and release at 38-44 °C were quantified via chromogenic enzymatic activity assay. Clot lysis was evaluated by measuring mass of blood clots before and after thrombolytic liposome treatment. RESULTS The LTSL formulation had optimal release characteristics with maximum release at 41.3 °C. Release of dextrans from LTSLs was observed to be 11.5 ± 1.5%, 79.7 ± 1.6%, and 93.6 ± 3.7% after 15 min in plasma at 37°, 39°, and 41.3 °C, respectively. The SAK LTSL had the highest release/leakage ratio and demonstrated greater clot lysis. CONCLUSIONS The SAK LTSL achieves significant clot lysis in vitro. When combined with local hyperthermia, the SAK LTSL potentially produces sufficient thrombolysis while minimising systemic side effects.
Collapse
Affiliation(s)
- Vishal Saxena
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Centre, National Cancer Institute, National Institutes of Health, Bethesda , Maryland , USA
| | | | | | | | | | | |
Collapse
|
10
|
Lazaros G, Toutouzas K, Drakopoulou M, Boudoulas H, Stefanadis C, Rajamannan N. Aortic sclerosis and mitral annulus calcification: a window to vascular atherosclerosis? Expert Rev Cardiovasc Ther 2014; 11:863-77. [DOI: 10.1586/14779072.2013.811978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Toutouzas K, Synetos A, Nikolaou C, Stathogiannis K, Tsiamis E, Stefanadis C. Microwave radiometry: a new non-invasive method for the detection of vulnerable plaque. Cardiovasc Diagn Ther 2013; 2:290-7. [PMID: 24282729 DOI: 10.3978/j.issn.2223-3652.2012.10.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/31/2012] [Indexed: 01/06/2023]
Abstract
Atherosclerosis and its consequences are the most rapidly growing vascular pathology, with myocardial infarction and ischemic cerebrovascular accident to remain a major cause of premature morbidity and death. In order to detect the morphological and functional characteristics of the vulnerable plaques, new imaging modalities have been developed. Intravascular thermography (IVT) is an invasive method, which provides information on the identification of the high-risk atheromatic plaques in coronary arteries. However, the invasive character of IVT excludes the method from primary prevention. Microwave radiometry (MR) is a new non-invasive method, which detects with high accuracy relative changes of temperature in human tissues whereas this thermal heterogeneity is indicative of inflammatory atherosclerotic plaque. Both experimental and clinical studies have proved the effectiveness of MR in detecting vulnerable plaque whereas recent studies have also revealed its association with plaque neoangiogenesis as assessed by contrast enhanced carotid ultrasound (CEUS).
Collapse
Affiliation(s)
- Konstantinos Toutouzas
- First Department of Cardiology, University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
12
|
Toutouzas K, Stathogiannis K, Synetos A, Karanasos A, Stefanadis C. Vulnerable Atherosclerotic Plaque: From the Basic Research Laboratory to the Clinic. Cardiology 2012; 123:248-53. [DOI: 10.1159/000345291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/01/2012] [Indexed: 11/19/2022]
|
13
|
Vancraeynest D, Pasquet A, Roelants V, Gerber BL, Vanoverschelde JLJ. Imaging the vulnerable plaque. J Am Coll Cardiol 2011; 57:1961-79. [PMID: 21565634 DOI: 10.1016/j.jacc.2011.02.018] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 12/27/2022]
Abstract
Cardiovascular diseases are still the primary causes of mortality in the United States and in Western Europe. Arterial thrombosis is triggered by a ruptured atherosclerotic plaque and precipitates an acute vascular event, which is responsible for the high mortality rate. These rupture-prone plaques are called "vulnerable plaques." During the past decades, much effort has been put toward accurately detecting the presence of vulnerable plaques with different imaging techniques. In this review, we provide an overview of the currently available invasive and noninvasive imaging modalities used to detect vulnerable plaques. We will discuss the upcoming challenges in translating these techniques into clinical practice and in assigning them their exact place in the decision-making process.
Collapse
Affiliation(s)
- David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Cliniques, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | | |
Collapse
|
14
|
Suh WM, Seto AH, Margey RJP, Cruz-Gonzalez I, Jang IK. Intravascular detection of the vulnerable plaque. Circ Cardiovasc Imaging 2011; 4:169-78. [PMID: 21406663 DOI: 10.1161/circimaging.110.958777] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- William M Suh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | | | | | | | | |
Collapse
|
15
|
Chatzizisis YS, Giannoglou GD. Shear stress and inflammation: are we getting closer to the prediction of vulnerable plaque? Expert Rev Cardiovasc Ther 2011; 8:1351-3. [PMID: 20936918 DOI: 10.1586/erc.10.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Toutouzas K, Grassos H, Synetos A, Drakopoulou M, Tsiamis E, Moldovan C, Agrogiannis G, Patsouris E, Siores E, Stefanadis C. A new non-invasive method for detection of local inflammation in atherosclerotic plaques: experimental application of microwave radiometry. Atherosclerosis 2010; 215:82-9. [PMID: 21256490 DOI: 10.1016/j.atherosclerosis.2010.12.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/09/2010] [Accepted: 12/14/2010] [Indexed: 11/16/2022]
Affiliation(s)
- K Toutouzas
- First Department of Cardiology, Hippokration Hospital, and Department of Pathology, Athens Medical School, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Toutouzas K, Drakopoulou M, Synetos A, Stefanadis C. Intravascular Thermography for Assessing Vulnerable Plaques. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Finch CE, Morgan TE, Longo VD, de Magalhaes JP. Cell resilience in species life spans: a link to inflammation? Aging Cell 2010; 9:519-26. [PMID: 20415721 DOI: 10.1111/j.1474-9726.2010.00578.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Species differences in life span have been attributed to cellular survival during various stressors, designated here as 'cell resilience'. In primary fibroblast cultures, cell resilience during exposure to free radicals, hypoglycemia, hyperthermia, and various toxins has shown generally consistent correlations with the species characteristic life spans of birds and mammals. However, the mechanistic links of cell resilience in fibroblast cultures to different species life spans are poorly understood. We propose that certain experimental stressors are relevant to somatic damage in vivo during inflammatory responses of innate immunity, particularly, resistance to reactive oxygen species (ROS), low glucose, and hyperthermia. According to this hypothesis, somatic cell resilience determines species differences in longevity during repeated infections and traumatic injuries in the natural environment. Infections and injury expose local fibroblasts and other cells to ROS generated by macrophages and to local temperature elevations. Systemically, acute phase immune reactions cause hypoglycemia and hyperthermia. We propose that cell resilience to somatic stressors incurred in inflammation is important in the evolution of longevity and that longer-lived species are specifically more resistant to immune-related stressors. This hypothesis further specifies Kirkwood's disposable soma theory. We suggest expanding the battery of stressors and markers used for comparative studies to additional cell types and additional parameters relevant to host defense and to their ecological specificities.
Collapse
Affiliation(s)
- Caleb E Finch
- University of Southern California, Los Angeles, CA 90089-0191, USA.
| | | | | | | |
Collapse
|
19
|
Larsen PJ, Waxman S. Intracoronary thermography: Utility to detect vulnerable and culprit plaques in patients with coronary artery disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0035-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Cuisset T, Beauloye C, Melikian N, Hamilos M, Sarma J, Sarno G, Naslund M, Smith L, Van de Vosse F, Pijls NHJ, De Bruyne B. In vitro and in vivo studies on thermistor-based intracoronary temperature measurements: Effect of pressure and flow. Catheter Cardiovasc Interv 2009; 73:224-30. [DOI: 10.1002/ccd.21780] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
21
|
|
22
|
Abstract
In a large proportion of previously asymptomatic individuals, sudden coronary death or acute myocardial infarction occurs as the first manifestation of coronary atherosclerosis. Imaging of coronary atheromatous plaques has traditionally centered on assessing the degree of luminal stenosis. The angiographic techniques that are routinely used to identify stenotic atherosclerotic lesions are unable to identify high-risk plaques; plaques prone to rupture and cause a cardiovascular event. This is partly due to the fact that the majority of culprit lesions that produce acute cardiovascular syndromes are not severely stenotic, possibly due to significant positive remodeling and reduced protective collateral circulation as well as because the risk of plaque rupture is more closely related to plaque content than plaque size. Recently, the focus of new imaging techniques is to identify the high risk plaques; the "vulnerable plaques." In this review, we will refer to the noninvasive and invasive techniques that can detect the vulnerable plaque.
Collapse
|
23
|
Jaffe AS. Key Issues in the Developing Synergism between Cardiovascular Imaging and Biomarkers. Clin Chem 2008; 54:1432-42. [DOI: 10.1373/clinchem.2008.106138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Background: Sophisticated methods of cardiac imaging have the potential to revolutionize the care of patients with cardiovascular disease. The benefits of these state-of-the art imaging techniques can be enhanced by their use in combination with new cardiac biomarkers. This review addresses potentially useful interactions between imaging and biomarkers.
Content: Areas were defined in which the combined use of novel imaging techniques and biomarkers would be most beneficial. This review addresses multiple cardiovascular conditions for which the useful aspects of imaging and biomarkers are likely to be positively synergistic, including acute and chronic ischemic heart disease, heart failure, myocarditis, hypertension, and atherosclerosis.
Conclusions: The synergistic use of imaging techniques and biomarkers will enhance the investigation of many key issues and questions and will be an important resource in the future.
Collapse
|
24
|
Imaging of the unstable plaque. Int J Cardiol 2008; 127:157-65. [DOI: 10.1016/j.ijcard.2007.11.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 08/14/2007] [Accepted: 11/02/2007] [Indexed: 11/18/2022]
|
25
|
Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK. In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 2008; 29:1721-8. [PMID: 18577556 DOI: 10.1093/eurheartj/ehn286] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Positive coronary arterial remodelling has been shown to be associated with unstable coronary syndromes and ex vivo histological characteristics of plaque vulnerability such as a large lipid core and high macrophage content. The aim of this study is to evaluate the in vivo association between coronary artery remodelling and underlying plaque characteristics identified by optical coherence tomography (OCT). OCT is a unique imaging modality capable of characterizing these important morphological features of vulnerable plaque. METHODS AND RESULTS OCT and intravascular ultrasound imaging was performed at corresponding sites in patients undergoing catheterization. OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (two or more quadrants) with fibrous cap thickness <65 microm. Remodelling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area. A total of 54 lesions from 48 patients were imaged. Positive remodelling compared with absent or negative remodelling was more commonly associated with lipid-rich plaque (100 vs. 60 vs. 47.4%, P = 0.01), a thin fibrous cap (median 40.2 vs. 51.6 vs. 87 microm, P = 0.003) and the presence of TCFA (80 vs. 38.5 vs. 5.6%, P < 0.001). Fibrous cap macrophage density was also higher in plaques with positive remodelling showing a positive linear correlation with the RI (r = 0.60, P < 0.001). CONCLUSION Coronary plaques with positive remodelling exhibit characteristic features of vulnerable plaque. This may explain the link between positive remodelling and unstable clinical presentations.
Collapse
Affiliation(s)
- Owen Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Schoenhagen P. Plaque temperature, arterial remodeling, and inflammation: understanding "hot-spots" in the coronary arteries. J Am Coll Cardiol 2007; 49:2272-3. [PMID: 17560292 DOI: 10.1016/j.jacc.2007.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|