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Gui Z, Shao C, Zhan Y, Wang Z, Li L. Vascular calcification: High incidence sites, distribution, and detection. Cardiovasc Pathol 2024; 72:107667. [PMID: 38866090 DOI: 10.1016/j.carpath.2024.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
Vascular calcification is an important pathological change in a variety of disease states such as atherosclerosis (AS), diabetes, chronic kidney disease (CKD), hypertension, and is a strong predictor of cardiovascular events. The distribution and location of calcification in different vessels may have different clinical effects and prognosis. Therefore, the study of high-risk sites of vascular calcification will help us to better understand the prevention, diagnosis, and treatment of related diseases, as well as to evaluate the efficacy and prognosis. So far, although there are some studies on the sites with high incidence of vascular calcification, there is a lack of systematic sorting out the distribution and location of vascular calcification in humans. Based on this, relevant databases were searched, literatures were retrieved, analyzed, and summarized, and the locations of high incidence of vascular calcification and their distribution characteristics, the relationship between high incidence of vascular calcification and hemodynamics, and the common detection methods of high incidence of vascular calcification were systematically described, hoping to provide help for clinical and research.
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Affiliation(s)
- Zebin Gui
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuanzi Zhan
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China.
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Zhang X, Zhu M, Zeng P, Guan M, Zhang H, Duan S, Huang H, Liu Y, Cong H, Chen Y. Identification of circulating microRNA-126-3p as a new biomarker for coronary artery calcification. SAGE Open Med 2024; 12:20503121241272646. [PMID: 39161400 PMCID: PMC11331480 DOI: 10.1177/20503121241272646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024] Open
Abstract
Objective Several circulating microRNAs, including microRNA-126-3p, have been identified as diagnostic and prognostic biomarker of cardiovascular disease. However, whether microRNA-126-3p is an independent risk predictor for coronary artery calcification is unclear. Methods In this prospective single-center study, we collected blood samples from coronary artery atherosclerosis patients (n = 54), patients with coronary artery calcification (n = 33) and controls (n = 56). Total RNA was extracted from plasma and blood cells with TRIzol reagents. The microRNA-126-3p level was determined via quantitative real-time polymerase chain reaction (RT-PCR). Results MicroRNA-126-3p levels were significantly increased in patients with coronary artery calcification than in coronary artery atherosclerosis patients or controls. The highest expression of microRNA-126-3p was observed in patients with moderate calcification who were diagnosed with Grade 2 calcification by coronary angiography. Age, microRNA-126-3p expression in veins, hypertension and diabetes significantly influence the occurrence of coronary artery calcification, among which diabetes and venous microRNA-126-3p expression were found to be independent risk factors for coronary artery calcification. Conclusions Taken together, the data in this study suggest that circulating microRNA-126-3p may be a novel noninvasive biomarker for coronary artery calcification. Regulating microRNA-126-3p expression may be an effective and promising strategy for the diagnosis and treatment of cardiovascular diseases, especially coronary artery calcification.
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Affiliation(s)
- Xia Zhang
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Mengmeng Zhu
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Peng Zeng
- College of Life Sciences, Nankai University, Tianjin, China
| | - Mingxiu Guan
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Hongyu Zhang
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Shaohua Duan
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Heli Huang
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Yulian Liu
- Tianjin Xiu Peng Biotechnology Development Co., Ltd., Tianjin, China
| | - Hongliang Cong
- Department of Cardiovascular Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Yuanli Chen
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
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3
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Schäfer S, Gogiraju R, Rösch M, Kerstan Y, Beck L, Garbisch J, Saliba AE, Gisterå A, Hermanns HM, Boon L, Kastenmüller W, Schäfer K, Cochain C, Zernecke A. CD8 + T Cells Drive Plaque Smooth Muscle Cell Dedifferentiation in Experimental Atherosclerosis. Arterioscler Thromb Vasc Biol 2024; 44:1852-1872. [PMID: 38868941 DOI: 10.1161/atvbaha.123.320084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Atherosclerosis is driven by the infiltration of the arterial intima by diverse immune cells and smooth muscle cells (SMCs). CD8+ T cells promote lesion growth during atherosclerotic lesion development, but their role in advanced atherosclerosis is less clear. Here, we studied the role of CD8+ T cells and their effects on SMCs in established atherosclerosis. METHODS CD8+ T cells were depleted in (SMC reporter) low-density lipoprotein receptor-deficient (Ldlr-/-) mice with established atherosclerotic lesions. Atherosclerotic lesion formation was examined, and single-cell RNA sequencing of aortic SMCs and their progeny was performed. Additionally, coculture experiments with primary aortic SMCs and CD8+ T cells were conducted. RESULTS Although we could not detect differences in atherosclerotic lesion size, an increased plaque SMC content was noted in mice after CD8+ T-cell depletion. Single-cell RNA sequencing of aortic lineage-traced SMCs revealed contractile SMCs and a modulated SMC cluster, expressing macrophage- and osteoblast-related genes. CD8+ T-cell depletion was associated with an increased contractile but decreased macrophage and osteoblast-like gene signature in this modulated aortic SMC cluster. Conversely, exposure of isolated aortic SMCs to activated CD8+ T cells decreased the expression of genes indicative of a contractile SMC phenotype and induced a macrophage and osteoblast-like cell state. Notably, CD8+ T cells triggered calcium deposits in SMCs under osteogenic conditions. Mechanistically, we identified transcription factors highly expressed in modulated SMCs, including Runx1, to be induced by CD8+ T cells in cultured SMCs in an IFNγ (interferon-γ)-dependent manner. CONCLUSIONS We here uncovered CD8+ T cells to control the SMC phenotype in atherosclerosis. CD8+ T cells promote SMC dedifferentiation and drive SMCs to adopt features of macrophage-like and osteoblast-like, procalcifying cell phenotypes. Given the critical role of SMCs in atherosclerotic plaque stability, CD8+ T cells could thus be explored as therapeutic target cells during lesion progression.
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MESH Headings
- Animals
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Myocytes, Smooth Muscle/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/immunology
- Cell Dedifferentiation
- Plaque, Atherosclerotic
- Mice
- Disease Models, Animal
- Atherosclerosis/pathology
- Atherosclerosis/metabolism
- Atherosclerosis/genetics
- Atherosclerosis/immunology
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/immunology
- Mice, Inbred C57BL
- Mice, Knockout
- Cells, Cultured
- Male
- Receptors, LDL/genetics
- Receptors, LDL/deficiency
- Phenotype
- Core Binding Factor Alpha 2 Subunit/genetics
- Core Binding Factor Alpha 2 Subunit/metabolism
- Aorta/pathology
- Aorta/immunology
- Aorta/metabolism
- Coculture Techniques
- Aortic Diseases/pathology
- Aortic Diseases/genetics
- Aortic Diseases/immunology
- Aortic Diseases/metabolism
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Affiliation(s)
- Sarah Schäfer
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
| | - Rajinikanth Gogiraju
- Department of Cardiology, Cardiology I, University Medicine Mainz, Germany (R.G., K.S.)
| | - Melanie Rösch
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
| | - Yvonne Kerstan
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
| | - Lina Beck
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
| | - Janine Garbisch
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
| | - Antoine-Emmanuel Saliba
- Institute of Molecular Infection Biology Faculty of Medicine, University of Würzburg, Germany (A.-E.S.)
| | - Anton Gisterå
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (A.G.)
| | - Heike M Hermanns
- Medical Clinic II, Division of Hepatology (H.M.H.), University Hospital of Würzburg, Germany
| | | | | | - Katrin Schäfer
- Department of Cardiology, Cardiology I, University Medicine Mainz, Germany (R.G., K.S.)
| | - Clément Cochain
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine (S.S., M.R., Y.K., L. Beck, J.G., C.C., A.Z.), University Hospital of Würzburg, Germany
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Onea HL, Olinic M, Lazar FL, Homorodean C, Ober MC, Spinu M, Achim A, Tataru DA, Olinic DM. A Review Paper on Optical Coherence Tomography Evaluation of Coronary Calcification Pattern: Is It Relevant Today? J Cardiovasc Dev Dis 2024; 11:231. [PMID: 39195139 DOI: 10.3390/jcdd11080231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
The process of coronary calcification represents one of the numerous pathophysiological mechanisms involved in the atherosclerosis continuum. Optical coherence tomography (OCT) represents an ideal imaging modality to assess plaque components, especially calcium. Different calcification patterns have been contemporarily described in both early stages and advanced atherosclerosis. Microcalcifications and spotty calcifications correlate positively with macrophage burden and inflammatory markers and are more frequently found in the superficial layers of ruptured plaques in acute coronary syndrome patients. More compact, extensive calcification may reflect a later stage of the disease and was traditionally associated with plaque stability. Nevertheless, a small number of culprit coronary lesions demonstrates the presence of dense calcified plaques. The purpose of the current paper is to review the most recent OCT data on coronary calcification and the interrelation between calcification pattern and plaque vulnerability. How different calcified plaques influence treatment strategies and associated prognostic implications is of great interest.
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Affiliation(s)
- Horea-Laurentiu Onea
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- County Clinical Emergency Hospital Sibiu, 550024 Sibiu, Romania
| | - Maria Olinic
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Second Cardiology Department, County Clinical Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- County Clinical Emergency Hospital Sibiu, 550024 Sibiu, Romania
| | - Calin Homorodean
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Second Cardiology Department, County Clinical Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Mihai Claudiu Ober
- Second Cardiology Department, County Clinical Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Mihail Spinu
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Second Cardiology Department, County Clinical Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Alexandru Achim
- Niculae Stancioiu Heart Institute Cluj-Napoca, 400001 Cluj-Napoca, Romania
| | - Dan Alexandru Tataru
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Second Cardiology Department, County Clinical Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Dan Mircea Olinic
- Department of Internal Medicine, Medical Clinic Number 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Second Cardiology Department, County Clinical Emergency Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
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5
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Kawai K, Kawakami R, Finn AV, Virmani R. Differences in Stable and Unstable Atherosclerotic Plaque. Arterioscler Thromb Vasc Biol 2024; 44:1474-1484. [PMID: 38924440 DOI: 10.1161/atvbaha.124.319396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
- Kenji Kawai
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
| | - Rika Kawakami
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
| | - Aloke V Finn
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
- University of Maryland School of Medicine, Baltimore (A.V.F.)
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD (K.K., R.K., A.V.F., R.V.)
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6
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Zhao J, Wu T, Tan J, Chen Y, Xu X, Guo Y, Jin C, Xiu L, Zhao R, Sun S, Peng C, Li S, Yu H, Liu Y, Wei G, Li L, Wang Y, Hou J, Dai J, Fang C, Yu B. Pancoronary plaque characteristics in STEMI patients with rapid plaque progression: An optical coherence tomography study. Int J Cardiol 2024; 400:131821. [PMID: 38301829 DOI: 10.1016/j.ijcard.2024.131821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Non-culprit plaque progression is associated with recurrent cardiac ischemic events and worse clinical outcomes. Given that atherosclerosis is a systemic disease, the pancoronary characteristics of patients with rapid plaque progression are unknown. This study aims to identify pancoronary plaque features in patients with ST-segment elevation myocardial infarction (STEMI) with and without rapid plaque progression, focused on the patient level. METHODS AND RESULTS From January 2017 to July 2019, 291 patients underwent 3-vessel optical coherence tomography imaging at the time of the primary procedure and a follow-up angiography interval of 12 months. The final analysis included 237 patients. Overall, 308 non-culprit lesions were found in 78 STEMI patients with rapid plaque progression, and 465 non-culprit plaques were found in 159 STEMI patients without rapid plaque progression. These patients had a higher pancoronary vulnerability (CLIMA-defined high-risk plaque: 47.4% vs. 33.3%; non-culprit plaque rupture: 25.6% vs. 14.5%) and a significantly higher prevalence of other vulnerable plaque characteristics (i.e., lipid-rich plaque, cholesterol crystal, microchannels, calcification, spotty calcification, and thrombus) at baseline versus those without rapid plaque progression. Lesions with rapid progression were highly distributed at the LAD, tending to be near the bifurcation. In multivariate analysis, age ≥ 65 years was an independent predictor of subsequent rapid lesion progression at the patient level, whereas microchannel, spotty calcification, and cholesterol crystal were independent predictors for STEMI patients ≥65 years old. CONCLUSIONS STEMI patients with subsequent rapid plaque progression had higher pancoronary vulnerability and commonly presented vulnerable plaque morphology. Aging was the only predictor of subsequent rapid plaque progression.
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Affiliation(s)
- Jiawei Zhao
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Tianyu Wu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Jinfeng Tan
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yuzhu Chen
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Xueming Xu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yibo Guo
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Chengmei Jin
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Lili Xiu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Rui Zhao
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Sibo Sun
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Cong Peng
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Shuang Li
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Huai Yu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yanchao Liu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Guo Wei
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Lulu Li
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yini Wang
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Jingbo Hou
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Jiannan Dai
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Chao Fang
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China.
| | - Bo Yu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China.
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7
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Ma S, Xie X, Yuan R, Xin Q, Miao Y, Leng SX, Chen K, Cong W. Vascular Aging and Atherosclerosis: A Perspective on Aging. Aging Dis 2024:AD.2024.0201-1. [PMID: 38502584 DOI: 10.14336/ad.2024.0201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024] Open
Abstract
Vascular aging (VA) is recognized as a pivotal factor in the development and progression of atherosclerosis (AS). Although various epidemiological and clinical research has demonstrated an intimate connection between aging and AS, the candidate mechanisms still require thorough examination. This review adopts an aging-centric perspective to deepen the comprehension of the intricate relationship between biological aging, vascular cell senescence, and AS. Various aging-related physiological factors influence the physical system's reactions, including oxygen radicals, inflammation, lipids, angiotensin II, mechanical forces, glucose levels, and insulin resistance. These factors cause endothelial dysfunction, barrier damage, sclerosis, and inflammation for VA and promote AS via distinct or shared pathways. Furthermore, the increase of senescent cells inside the vascular tissues, caused by genetic damage, dysregulation, secretome changes, and epigenetic modifications, might be the primary cause of VA.
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Affiliation(s)
- Shudong Ma
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, China
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuena Xie
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Pharmacy, Macau University of Science and Technology, Macau, China
| | - Rong Yuan
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiqi Xin
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Miao
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Sean Xiao Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Keji Chen
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, China
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weihong Cong
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Pharmacy, Macau University of Science and Technology, Macau, China
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8
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Rahoual G, Zeitouni M, Charpentier E, Ritvo PG, Rouanet S, Procopi N, Boukhelifa S, Charleux P, Guedeney P, Kerneis M, Barthélémy O, Silvain J, Montalescot G, Redheuil A, Collet JP. Phenotyping coronary plaque by computed tomography in premature coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:257-266. [PMID: 37597177 DOI: 10.1093/ehjci/jead212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/06/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
AIMS Premature coronary artery disease (CAD) is an aggressive disease with multiple recurrences mostly related to new coronary lesions. This study aimed to compare coronary plaque characteristics of individuals with premature CAD with those of incidental plaques found in matched individuals free of overt cardiovascular disease, using coronary computed tomography angiography (CCTA). METHODS AND RESULTS Of 1552 consecutive individuals who underwent CCTA, 106 individuals with history of acute or stable obstructive CAD ≤45 years were matched by age, sex, smoking status, cardiovascular heredity, and dyslipidaemia with 106 controls. CCTA were analysed for Coronary Artery Disease Reporting and Data System score, plaque composition, and high-risk plaque (HRP) features, including spotty calcification, positive remodelling, low attenuation, and napkin-ring sign. The characteristics of 348 premature CAD plaques were compared with those of 167 incidental coronary plaques of matched controls. The prevalence of non-calcified plaques was higher among individuals with premature CAD (65.1 vs. 30.2%, P < 0.001), as well as spotty calcification (42.5 vs. 17.9%, P < 0.001), positive remodelling (41.5 vs. 9.4%, P < 0.001), low attenuation (24.5 vs. 3.8%, P < 0.001), and napkin-ring sign (1.9 vs. 0.0%). They exhibited an average of 2.2 (2.7) HRP, while the control group displayed 0.4 (0.8) HRP (P < 0.001). Within a median follow-up of 24 (16, 34) months, individuals with premature CAD and ischaemic recurrence (n = 24) had more HRP [4.3 (3.9)] than those without ischaemic recurrence [1.5 (1.9)], mostly non-calcified with low attenuation and positive remodelling. CONCLUSION Coronary atherosclerosis in individuals with premature CAD is characterized by a high and predominant burden of non-calcified plaque and unusual high prevalence of HRP, contributing to disease progression with multiple recurrences. A comprehensive qualitative CCTA assessment of plaque characteristics may further risk stratify our patients, beyond cardiovascular risk factors.
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Affiliation(s)
- Ghilas Rahoual
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Michel Zeitouni
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Etienne Charpentier
- INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France
| | - Paul-Gydeon Ritvo
- INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Niki Procopi
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Sena Boukhelifa
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Pierre Charleux
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Mathieu Kerneis
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Olivier Barthélémy
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Johanne Silvain
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Alban Redheuil
- INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France
| | - Jean-Philippe Collet
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
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9
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Sarwar M, Adedokun S, Narayanan MA. Role of intravascular ultrasound and optical coherence tomography in intracoronary imaging for coronary artery disease: a systematic review. J Geriatr Cardiol 2024; 21:104-129. [PMID: 38440344 PMCID: PMC10908578 DOI: 10.26599/1671-5411.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Coronary angiography has long been the standard for coronary imaging, but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention (PCI). Intracoronary imaging techniques like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can overcome these limitations. IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution. These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI. Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone. While IVUS demonstrates consistent clinical outcome benefits, OCT evidence is less robust. IVUS has progressed from early motion detection to high-resolution systems, with smaller compatible catheters. OCT utilizes near infrared light to achieve unparalleled resolutions, but requires temporary blood clearance for optimal imaging. Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease, improving outcomes. IVUS and recent advancements in zero- and low-contrast OCT techniques can reduce nephrotoxic contrast exposure, thus helping to minimize PCI complications in these high-risk patient groups. IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone. Both have comparable clinical outcomes, emphasizing the need for tailored imaging choices based on clinical scenarios. Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes. This systematic review aims to delve into the nuances of IVUS and OCT, highlighting their strengths and limitations as PCI adjuncts.
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Affiliation(s)
- Maruf Sarwar
- Department of Cardiovascular Sciences, White River Health, Batesville, AR, USA
| | - Stephen Adedokun
- Division of Cardiology, University of Tennessee at Memphis, TN, USA
| | - Mahesh Anantha Narayanan
- Department of Cardiovascular Sciences, White River Health, Batesville, AR, USA
- University of Arkansas Medical Sciences, Little Rock, AR, USA
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10
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Onnis C, Virmani R, Kawai K, Nardi V, Lerman A, Cademartiri F, Scicolone R, Boi A, Congiu T, Faa G, Libby P, Saba L. Coronary Artery Calcification: Current Concepts and Clinical Implications. Circulation 2024; 149:251-266. [PMID: 38227718 PMCID: PMC10794033 DOI: 10.1161/circulationaha.123.065657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.
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Affiliation(s)
- Carlotta Onnis
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Kenji Kawai
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Roberta Scicolone
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Alberto Boi
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari Italy
| | - Terenzio Congiu
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
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11
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Yurdagul A, Aikawa E. Discovering a Rare Smooth Muscle Cell Population Specific to Men in Ascending Aortic Aneurysm Using Spatial Transcriptomics. Arterioscler Thromb Vasc Biol 2023; 43:2298-2300. [PMID: 37916413 PMCID: PMC10842258 DOI: 10.1161/atvbaha.123.320235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Arif Yurdagul
- Department of Molecular and Cellular Physiology, LSU Health Sciences Center in Shreveport, Shreveport, LA, 71130
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Li R, Liu M, Li J, Jiao X, Guo X. Intracranial Spotty Calcium Predicts Recurrent Stroke in Patients with Symptomatic Intracranial Atherosclerotic Stenosis : A Prospective Cohort Study. Clin Neuroradiol 2023; 33:985-992. [PMID: 37284877 PMCID: PMC10654160 DOI: 10.1007/s00062-023-01299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Accumulating evidence highlights the association of calcium characteristics and cardiovascular events, but its role in cerebrovascular stenosis has not been well studied. We aimed to investigate the contribution of calcium patterns and density to recurrent ischemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). METHODS In this prospective study, 155 patients with symptomatic ICAS in the anterior circulation were included, and all subjects underwent computed tomography angiography. The median follow-up for all patients was 22 months and recurrent ischemic stroke were recorded. Cox regression analysis was performed to examine whether calcium patterns and density were associated with recurrent ischemic stroke. RESULTS During the follow-up, 29 patients who experienced recurrent ischemic stroke were older than those without recurrent ischemic stroke (62.93 ± 8.10 years vs. 57.00 ± 12.07 years, p = 0.027). A significantly higher prevalence of intracranial spotty calcium (86.2% vs. 40.5%, p < 0.001) and very low-density intracranial calcium (72.4% vs. 37.3%, p = 0.001) were observed in patients with recurrent ischemic stroke. Multivariable Cox regression analysis showed that intracranial spotty calcium, rather than very low-density intracranial calcium, remained an independent predictor of recurrent ischemic stroke (adjusted hazard ratio 5.35, 95% confidence interval 1.32-21.69, p = 0.019). CONCLUSION In patients with symptomatic ICAS, intracranial spotty calcium is an independent predictor of recurrent ischemic stroke, which will further facilitate risk stratification and suggest that more aggressive treatment should be considered for these patients.
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Affiliation(s)
- Rui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Moqi Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Jialu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Xueqiao Jiao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China.
- National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China.
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13
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Nagayama Y, Emoto T, Kato Y, Kidoh M, Oda S, Sakabe D, Funama Y, Nakaura T, Hayashi H, Takada S, Uchimura R, Hatemura M, Tsujita K, Hirai T. Improving image quality with super-resolution deep-learning-based reconstruction in coronary CT angiography. Eur Radiol 2023; 33:8488-8500. [PMID: 37432405 DOI: 10.1007/s00330-023-09888-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/22/2023] [Accepted: 04/23/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To evaluate the effect of super-resolution deep-learning-based reconstruction (SR-DLR) on the image quality of coronary CT angiography (CCTA). METHODS Forty-one patients who underwent CCTA using a 320-row scanner were retrospectively included. Images were reconstructed with hybrid (HIR), model-based iterative reconstruction (MBIR), normal-resolution deep-learning-based reconstruction (NR-DLR), and SR-DLR algorithms. For each image series, image noise, and contrast-to-noise ratio (CNR) at the left main trunk, right coronary artery, left anterior descending artery, and left circumflex artery were quantified. Blooming artifacts from calcified plaques were measured. Image sharpness, noise magnitude, noise texture, edge smoothness, overall quality, and delineation of the coronary wall, calcified and noncalcified plaques, cardiac muscle, and valves were subjectively ranked on a 4-point scale (1, worst; 4, best). The quantitative parameters and subjective scores were compared among the four reconstructions. Task-based image quality was assessed with a physical evaluation phantom. The detectability index for the objects simulating the coronary lumen, calcified plaques, and noncalcified plaques was calculated from the noise power spectrum (NPS) and task-based transfer function (TTF). RESULTS SR-DLR yielded significantly lower image noise and blooming artifacts with higher CNR than HIR, MBIR, and NR-DLR (all p < 0.001). The best subjective scores for all the evaluation criteria were attained with SR-DLR, with significant differences from all other reconstructions (p < 0.001). In the phantom study, SR-DLR provided the highest NPS average frequency, TTF50%, and detectability for all task objects. CONCLUSION SR-DLR considerably improved the subjective and objective image qualities and object detectability of CCTA relative to HIR, MBIR, and NR-DLR algorithms. CLINICAL RELEVANCE STATEMENT The novel SR-DLR algorithm has the potential to facilitate accurate assessment of coronary artery disease on CCTA by providing excellent image quality in terms of spatial resolution, noise characteristics, and object detectability. KEY POINTS • SR-DLR designed for CCTA improved image sharpness, noise property, and delineation of cardiac structures with reduced blooming artifacts from calcified plaques relative to HIR, MBIR, and NR-DLR. • In the task-based image-quality assessments, SR-DLR yielded better spatial resolution, noise property, and detectability for objects simulating the coronary lumen, coronary calcifications, and noncalcified plaques than other reconstruction techniques. • The image reconstruction times of SR-DLR were shorter than those of MBIR, potentially serving as a novel standard-of-care reconstruction technique for CCTA performed on a 320-row CT scanner.
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Affiliation(s)
- Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Takafumi Emoto
- Department of Central Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yuki Kato
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sakabe
- Department of Central Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Sentaro Takada
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Ryutaro Uchimura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masahiro Hatemura
- Department of Central Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
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14
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Qin Z, Yu L, Zhang Y, Xu Q, Li C, Zhao S, Xi X, Tian Y, Wang Z, Tian J, Yu B. Coronary artery calcification and plaque stability: an optical coherence tomography study. Heliyon 2023; 9:e23191. [PMID: 38149191 PMCID: PMC10750051 DOI: 10.1016/j.heliyon.2023.e23191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 10/12/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Background Coronary artery calcification (CAC), a surrogate of atherosclerosis, is related to stent underexpansion and adverse cardiac events. However, the effect of CAC on plaque stability is still controversial and the morphological significance of CAC has yet to be elucidated. Methods A retrospective series of 419 patients with acute coronary syndrome (ACS) who underwent optical coherence tomography (OCT) were enrolled. Patients were classified into three groups based on the calcification size in culprit plaques and the features of the culprit and non-culprit plaques among these groups were compared. Logistic regression was used to analyze independent risk factors for culprit plaque rupture and the nonlinear relationship between calcification parameters and culprit plaque rupture. Furthermore, we compared the detailed calcification parameters of different kinds of plaques. Results A total of 419 culprit plaques and 364 non-culprit plaques were identified. The incidence of calcification was 53.9 % in culprit plaques and 50.3 % in non-culprit plaques. Compared with culprit plaques without calcification, plaque rupture, macrophages and cholesterol crystals were more frequently observed in the spotty calcification group, and the lipid length was longer; the incidence of macrophages and cholesterol crystals was higher in the macrocalcification group. Calcification tended to be smaller in ruptured plaques than in non-ruptured plaques. Moreover, the arc and length of calcification were greater in culprit plaques than in non-culprit plaques. Conclusions Vulnerable features were more frequently observed in culprit plaques with spotty calcification, whereas the presence of macrocalcification calcifications did not significantly increase plaque vulnerability. Calcification tends to be larger in culprit plaques than in non-culprit plaques.
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Affiliation(s)
- Zhifeng Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Li Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Yanwen Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Qinglu Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Chao Li
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Suhong Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Xiangwen Xi
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Yanan Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Zhao Wang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
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15
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Nelles G, Abdelwahed YS, Alyaqoob A, Seppelt C, Stähli BE, Meteva D, Kränkel N, Haghikia A, Skurk C, Dreger H, Knebel F, Trippel TD, Krisper M, Sieronski L, Gerhardt T, Zanders L, Klotsche J, Landmesser U, Joner M, Leistner DM. Spotty calcium deposits within acute coronary syndrome (ACS)-causing culprit lesions impact inflammatory vessel-wall interactions and are associated with higher cardiovascular event rates at one year follow-up: Results from the prospective translational OPTICO-ACS study program. Atherosclerosis 2023; 385:117284. [PMID: 37871405 DOI: 10.1016/j.atherosclerosis.2023.117284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND AIMS Spotty calcium deposits (SCD) represent a vulnerable plaque feature which seems to result - as based on recent invitro studies - from inflammatory vessel-wall interactions. SCD can be reliably assessed by optical coherence tomography (OCT). Their prognostic impact is yet unknown. Therefore, the aims of this translational study were to comprehensively characterize different plaque calcification patterns, to analyze the associated inflammatory mechanisms in the microenvironment of acute coronary syndrome (ACS)-causing culprit lesions (CL) and to investigate the prognostic significance of SCD in a large cohort of ACS-patients. METHODS CL of the first 155 consecutive ACS-patients from the translational OPTICO-ACS-study program were investigated by OCT-characterization of the calcium phenotype at ACS-causing culprit lesions. Simultaneous immunophenotyping by flow-cytometric analysis and cytokine bead array technique across the CL gradient (ratio local/systemic levels) was performed and incidental major adverse cardiovascular events plus (MACE+) at 12 months after ACS were assessed. RESULTS SCD were observed within 45.2% of all analyzed ACS-causing culprit lesions (CL). Culprits containing spotty calcium were characterized by an increased culprit ratio of innate effector cytokines interleukin (IL)-8 [2.04 (1.24) vs. 1.37 (1.10) p < 0.05], as well as TNF (tumor necrosis factor)-α [1.17 (0.93) vs. 1.06 (0.89); p < 0.05)] and an increased ratio of circulating neutrophils [0.96 (0.85) vs. 0.91 (0.77); p < 0.05] as compared to culprit plaques without SCD. Total monocyte levels did not differ between the two groups (p = n.s.). However, SCD-containing CLs were characterized by an increased culprit ratio of intermediate monocytes [(1.15 (0.81) vs. 0.96 (0.84); p < 0.05)] with an enhanced surface expression of the integrin receptor CD49d as compared to intermediate monocytes derived from SCD-free CLs [(1.06 (0.94) vs. 0.97 (0.91)] p < 0.05. Finally, 12 months rates of MACE+ were higher in patients with, as compared to patients without SCD at CL (16.4% vs. 5.3%; p < 0.05). CONCLUSIONS This study for the first time identified a specific inflammatory profile of CL with SCD, with a predominance of neutrophils, intermediate monocytes and their corresponding effector molecules. Hence, this study advances our understanding of ACS-causing CL and provides the basis for future personalized anti-inflammatory, therapeutic approaches to ACS.
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Affiliation(s)
- Gregor Nelles
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Aseel Alyaqoob
- Department of Cardiology and ISAR Research Centre, German Heart Centre, 80636, Munich, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Munch, 80636, Munich, Germany
| | - Claudio Seppelt
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany
| | - Barbara E Stähli
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology, Universitäres Herzzentrum, Universitätsspital Zürich, Zurich, Switzerland
| | - Denitsa Meteva
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology Charité University Medicine Berlin, Campus Mitte, 10117, Germany
| | - Fabian Knebel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology Charité University Medicine Berlin, Campus Mitte, 10117, Germany; Department of Cardiology, Sana Clinic Lichtenberg, 10365, Berlin, Germany
| | - Tobias D Trippel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Cardiology, Charité University Medicine, Campus Virchow, 13353, Berlin, Germany
| | - Maximilian Krisper
- Department of Cardiology, Charité University Medicine, Campus Virchow, 13353, Berlin, Germany
| | - Lara Sieronski
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Teresa Gerhardt
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Berlin Institute of Health (BIH), 10117, Berlin, Germany; Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, USA
| | - Lukas Zanders
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Mitte, 10117, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Berlin Institute of Health (BIH), 10117, Berlin, Germany
| | - Michael Joner
- Department of Cardiology and ISAR Research Centre, German Heart Centre, 80636, Munich, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Munch, 80636, Munich, Germany
| | - David M Leistner
- Department of Cardiology Charité University Medicine Berlin, Campus Benjamin-Franklin, 12203, Berlin, Germany; DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, 12203, Berlin, Germany; Department of Medicine, Cardiology/Angiology, Goethe University Hospital, Frankfurt, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Frankfurt Rhine-Main, Frankfurt, Germany; Berlin Institute of Health (BIH), 10117, Berlin, Germany.
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16
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Hutton M, Frazer M, Lin A, Patel S, Misra A. New Targets in Atherosclerosis: Vascular Smooth Muscle Cell Plasticity and Macrophage Polarity. Clin Ther 2023; 45:1047-1054. [PMID: 37709601 DOI: 10.1016/j.clinthera.2023.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Despite an increase in treatment options, and substantial reductions in cardiovascular mortality over the past half-century, atherosclerosis remains the most prevalent cause of premature mortality worldwide. The development of innovative new therapies is crucial to further minimize atherosclerosis-related deaths. The diverse array of cell phenotypes derived from vascular smooth muscle cells (SMCs) and macrophages within atherosclerotic plaques are increasingly becoming recognized for their beneficial and detrimental roles in plaque stability and disease burden. This review explores how contemporary transcriptomics and fate-mapping studies have revealed vascular cell plasticity as a relatively unexplored target for therapeutic intervention. METHODS Recent literature for this narrative review was obtained by searching electronic databases (ie, Google Scholar, PubMed). Additional studies were sourced from reference lists and the authors' personal databases. FINDINGS The lipid-rich and inflammatory plaque milieu induces SMC phenotypic switching to both beneficial and detrimental phenotypes. Likewise, macrophage heterogeneity increases with disease burden to a variety of pro-inflammatory and anti-inflammatory activation states. These vascular cell phenotypes are determinants of plaque structure stability, and it is therefore highly likely that they influence clinical outcomes. Development of clinical treatments targeting deleterious phenotypes or promoting pro-healing phenotypes remains in its infancy. However, existing treatments (statins) have shown beneficial effects toward macrophage polarization, providing a rationale for more targeted approaches. In contrast, beneficial SMC phenotypic modulation with these pharmacologic agents has yet to be achieved. The range of modulated vascular cell phenotypes provides a multitude of novel targets and the potential to reduce future adverse events. IMPLICATIONS Vascular cell phenotypic heterogeneity must continue to be explored to lower cardiovascular events in the future. The rapidly increasing weight of evidence surrounding the role of SMC plasticity and macrophage polarity in plaque vulnerability provides a strong foundation upon which development of new therapeutics must follow. This approach may prove to be crucial in reducing cardiovascular events and improving patient benefit in the future.
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Affiliation(s)
- Michael Hutton
- Atherosclerosis and Vascular Remodeling Group, Heart Research Institute, Sydney, New South Wales, Australia
| | - Madeleine Frazer
- Atherosclerosis and Vascular Remodeling Group, Heart Research Institute, Sydney, New South Wales, Australia
| | - Alexander Lin
- Atherosclerosis and Vascular Remodeling Group, Heart Research Institute, Sydney, New South Wales, Australia; School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Patel
- Heart Research Institute, The University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashish Misra
- Atherosclerosis and Vascular Remodeling Group, Heart Research Institute, Sydney, New South Wales, Australia; Heart Research Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
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17
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Kataoka Y, Kitahara S, Funabashi S, Makino H, Matsubara M, Matsuo M, Omura-Ohata Y, Koezuka R, Tochiya M, Tamanaha T, Tomita T, Honda-Kohmo K, Noguchi M, Maruki M, Kanai E, Murai K, Iwai T, Sawada K, Matama H, Honda S, Fujino M, Yoneda S, Takagi K, Otsuka F, Asaumi Y, Hosoda K, Nicholls SJ, Yasuda S, Noguchi T. The effect of continuous glucose monitoring-guided glycemic control on progression of coronary atherosclerosis in type 2 diabetic patients with coronary artery disease: The OPTIMAL randomized clinical trial. J Diabetes Complications 2023; 37:108592. [PMID: 37741088 DOI: 10.1016/j.jdiacomp.2023.108592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/20/2023] [Accepted: 08/19/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) improves glycemic fluctuation and reduces hypoglycemic risk. Whether CGM-guided glycemic control favorably modulates coronary atherosclerosis in patients with type 2 diabetes (T2DM) remains unknown. METHODS The OPTIMAL trial was a prospective, randomized, single-center trial in which 94 T2DM patients with CAD were randomized to CGM- or HbA1c-guided glycemic control for 48 weeks (jRCT1052180152). The primary endpoint was the nominal change in total atheroma volume (TAV) measured by serial IVUS. The secondary efficacy measure was the nominal change in maxLCBI4mm on near-infrared spectroscopy imaging. RESULTS Among the 94 randomized patients, 82 had evaluable images at 48 weeks. Compared to HbA1c-guided glycemic control, CGM-guided control achieved a greater reduction in %coefficient of variation [-0.1 % (-1.8 to 1.6) vs. -3.3 % (-5.1 to -1.5), p = 0.01] and a greater increase in the duration with glucose between 70 and 180 mg/dL [-1.5 % (-6.0 to 2.9) vs. 6.7 % (1.9 to 11.5), p = 0.02]. TAV increased by 0.11 ± 1.9 mm3 in the HbA1c-guided group and decreased by -3.29 ± 2.00 mm3 in the CGM-guided group [difference = -3.4 mm3 (95%CI: -8.9 to 2.0 mm3), p = 0.22]. MaxLCBI4mm, increased by 90.1 ± 25.6 in the HbA1c-guided group and by 50.6 ± 25.6 in the CGM-guided group (difference = -45.6 (95%CI: -118.1 to 26.7) p = 0.21]. A post-hoc exploratory analysis showed a greater regression of maxLCBI4mm in the CGM-guided group [difference = 20.4 % (95%CI:1.3 to 39.5 %), p = 0.03]. CONCLUSIONS CGM-guided control for 48 weeks did not slow disease progression in T2DM patients with CAD. A greater regression of lipidic plaque under CGM-guided glycemic control in the post-hoc analysis requires further investigation.
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Affiliation(s)
- Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan.
| | - Satoshi Kitahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Kashiwa Kousei General Hospital, Kashiwa, Japan
| | - Sayaka Funabashi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Hisashi Makino
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Miki Matsuo
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Omura-Ohata
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Ryo Koezuka
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Mayu Tochiya
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Tamiko Tamanaha
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Tsutomu Tomita
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kyoko Honda-Kohmo
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Michio Noguchi
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Maki Maruki
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Emi Kanai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Syuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Centre, Suita, Osaka, Japan
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18
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Kitahara S, Kataoka Y, Miura H, Nishii T, Nishimura K, Murai K, Iwai T, Matama H, Honda S, Fujino M, Yoneda S, Takagi K, Otsuka F, Asaumi Y, Fujino Y, Tsujita K, Puri R, Nicholls SJ, Noguchi T. Characterization of plaque phenotypes exhibiting an elevated pericoronary adipose tissue attenuation: insights from the REASSURE-NIRS registry. Int J Cardiovasc Imaging 2023; 39:1943-1952. [PMID: 37380905 PMCID: PMC10589176 DOI: 10.1007/s10554-023-02907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
Inflammation has been considered to promote atheroma instability. Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, plaque phenotypes exhibiting high PCAT attenuation remains to be fully elucidated. The current study aims to characterize coronary atheroma with a greater vascular inflammation. We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCATRCA) and NIRS/IVUS-derived plaque measures were compared in patients with PCATRCA attenuation ≥ and < -78.3 HU (median). Lesions with PCATRCA attenuation ≥ -78.3 HU exhibited a greater frequency of maxLCBI4mm ≥ 400 (66% vs. 26%, p < 0.01), plaque burden ≥ 70% (94% vs. 74%, p = 0.02) and spotty calcification (49% vs. 6%, p < 0.01). Whereas positive remodeling (63% vs. 41%, p = 0.07) did not differ between two groups. On multivariable analysis, maxLCBI4mm ≥ 400 (OR = 4.07; 95%CI 1.12-14.74, p = 0.03), plaque burden ≥ 70% (OR = 7.87; 95%CI 1.01-61.26, p = 0.04), and spotty calcification (OR = 14.33; 95%CI 2.37-86.73, p < 0.01) independently predicted high PCATRCA attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCATRCA attenuation (p = 0.22), lesions harboring two or more features were significantly associated with higher PCATRCA attenuation. More vulnerable plaque phenotypes were observed in patients with high PCATRCA attenuation. Our findings suggest PCATRCA attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.
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Affiliation(s)
- Satoshi Kitahara
- Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-0862, Japan
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Chuo-Ku, Honjo, Kumamoto, 860-8556, Japan
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tatsuya Nishii
- Department of Radiology, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kota Murai
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Chuo-Ku, Honjo, Kumamoto, 860-8556, Japan
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hideo Matama
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Chuo-Ku, Honjo, Kumamoto, 860-8556, Japan
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yusuke Fujino
- Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-0862, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, 631 Blackburn Rd, Clayton, VIC, 3168, Australia
| | - Teruo Noguchi
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Chuo-Ku, Honjo, Kumamoto, 860-8556, Japan
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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19
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Cao JJ, Shen L, Nguyen J, Rapelje K, Porter C, Shlofmitz E, Jeremias A, Cohen DJ, Ali ZA, Shlofmitz R. Accuracy and limitation of plaque detection by coronary CTA: a section-to-section comparison with optical coherence tomography. Sci Rep 2023; 13:11845. [PMID: 37481671 PMCID: PMC10363114 DOI: 10.1038/s41598-023-38675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
Plaques identified by Coronary CT angiography (CCTA) are important in clinical diagnosis and primary prevention. High-risk plaque features by CCTA have been extensively validated using optical coherence tomography (OCT). However, since their general diagnostic performance and limitations have not been fully investigated, we sought to compare CCTA with OCT among consecutive vessel sections. We retrospectively compared 188 consecutive plaques and 84 normal sections in 41 vessels from 40 consecutive patients referred for chest pain evaluation who had both CCTA and OCT with a median time lapse of 1 day. The distance to reference points were used to co-register between the modalities and the diagnostic performance of CCTA was evaluated against OCT. Plaque categories evaluated by CT were calcified, non-calcified and mixed. The diagnostic performance of CCTA was excellent for detecting any plaque identified by OCT with the sensitivity, specificity, negative and positive predictive values and accuracy of 92%, 98%, 99%, 84% and 93%, respectively. The lower than expected negative predictive value was due to failure of detecting sub-millimeter calcified (≤ 0.25 mm2) (N = 12) and non-calcified plaques (N = 4). Misclassification of plaque type accounted for majority of false negative findings (25/41, 61%) which was most prevalent among the mixed plaque (19/41, 46%). There was calcification within mixed plaques (N = 5) seen by CCTA but missed by OCT. Our findings suggest that CCTA is excellent at identifying coronary plaques except those sub-millimeter in size which likely represent very early atherosclerosis, although the clinical implication of very mild atherosclerosis is yet to be determined.
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Affiliation(s)
- J Jane Cao
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA.
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - James Nguyen
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Kathleen Rapelje
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Craig Porter
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - David J Cohen
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Blvd, Roslyn, NY, USA
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20
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Zambrano A, Tintut Y, Demer LL, Hsu JJ. Potential mechanisms linking high-volume exercise with coronary artery calcification. Heart 2023; 109:1139-1145. [PMID: 36702539 PMCID: PMC10356745 DOI: 10.1136/heartjnl-2022-321986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
Recent studies have found an association between high volumes of physical activity and increased levels of coronary artery calcification (CAC) among older male endurance athletes, yet the underlying mechanisms have remained largely elusive. Potential mechanisms include greater exposure to inflammatory cytokines, reactive oxygen species and oxidised low-density lipoproteins, as acute strenuous physical activity has been found to enhance their systemic release. Other possibilities include post-exercise elevations in circulating parathyroid hormone, which can modify the amount and morphology of calcific plaque, and long-term exposure to non-laminar blood flow within the coronary arteries during vigorous physical activity, particularly in individuals with pre-existing atherosclerosis. Further, although the association has only been identified in men, the role of testosterone in this process remains unclear. This brief review discusses the association between high-volume endurance exercise and CAC in older men, elaborates on the potential mechanisms underlying the increased calcification, and provides clinical implications and recommendations for those at risk.
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Affiliation(s)
- Angelica Zambrano
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Yin Tintut
- Medicine/Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Linda L Demer
- Medicine/Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jeffrey J Hsu
- Medicine/Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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21
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Zadi T, van Dam-Nolen DHK, Aizaz M, van der Kolk AG, Nederkoorn PJ, Hendrikse J, Kooi ME, van der Lugt A, Bos D. Changes in intra- and extracranial carotid plaque calcification: a 2-year follow-up study. Sci Rep 2023; 13:8384. [PMID: 37225731 DOI: 10.1038/s41598-023-34223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
Extra- and intracranial carotid plaque calcification might have plaque-stabilizing effects, yet information on changes in plaque calcification remains scarce. We evaluated changes in carotid plaque calcification over 2 years follow-up in patients with symptomatic carotid artery disease. This study is based on the PARISK-study, a multicenter cohort study, with TIA/minor stroke patients with ipsilateral mild-to-moderate carotid artery stenosis (< 70%). We included 79 patients (25% female, mean age 66 years) who underwent CTA imaging with 2 year interval. We assessed the volume of extra- and intracranial carotid artery calcification (ECAC and ICAC) and calculated the difference between baseline and follow-up ECAC and ICAC volume. We performed multivariable regression analyses to investigate the association between change of ECAC or ICAC with cardiovascular determinants. ECAC. We found increase (46.2%) and decrease (34%) in ECAC volume during 2 year follow-up, both significantly correlation with baseline ECAC volume (OR = 0.72, 95% CI 0.58-0.90 respectively OR = 2.24, 95% CI 1.60-3.13).We found significant correlation for change in ECAC volume with diabetes (β = 0.46, 95% CI 0.03-0.89) and baseline ECAC volume (β = 0.81, 95% CI 0.73-0.88). ICAC. We found increase (45.0%) and decrease (25.0%) in ICAC volume. The ICAC decrease was significantly correlated with baseline ICAC volume (OR = 2.17, 95% CI 1.48-3.16), age (OR = 2.00, 95% CI 1.19-3.38) and use of antihypertensive drugs (OR = 3.79, 95% CI 1.20-11.96]).The overall change of ICAC volume was also significantly correlated with diabetes (β = 0.92, 95% CI 1.59-7.02), use of oral hypoglycemic drugs (β = 0.86, 95% CI 0.12-1.59) and baseline ICAC volume (β = 0.71, 95% CI 0.55-0.87). We provide novel insights into the dynamics of carotid plaque calcification in symptomatic stroke patients.
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Affiliation(s)
- T Zadi
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - D H K van Dam-Nolen
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - M Aizaz
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A G van der Kolk
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - P J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Hendrikse
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M E Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - D Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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22
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Skenteris NT, Hemme E, Delfos L, Karadimou G, Karlöf E, Lengquist M, Kronqvist M, Zhang X, Maegdefessel L, Schurgers LJ, Arnardottir H, Biessen EAL, Bot I, Matic L. Mast cells participate in smooth muscle cell reprogramming and atherosclerotic plaque calcification. Vascul Pharmacol 2023; 150:107167. [PMID: 36958707 DOI: 10.1016/j.vph.2023.107167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Calcification, a key feature of advanced human atherosclerosis, is positively associated with vascular disease burden and adverse events. We showed that macrocalcification can be a stabilizing factor for carotid plaque molecular biology, due to inverse association with immune processes. Mast cells (MCs) are important contributors to plaque instability, but their relationship with macrocalcification is unexplored. With a hypothesis that MC activation negatively associates with carotid plaque macrocalcification, we aimed to investigate the link between MCs and carotid plaque vulnerability, and study MC role in plaque calcification via smooth muscle cells (SMCs). METHODS Pre-operative computed tomography angiographies of patients (n = 40) undergoing surgery for carotid stenosis were used to characterize plaque morphology. Plaque microarrays (n = 40 and n = 126) were used for bioinformatic deconvolution of immune cell populations. Tissue microarrays (n = 103) were used to histologically validate the contribution of activated and resting MCs in plaques. RESULTS Activated MCs and their typical markers were negatively correlated with macrocalcification. The ratio of activated vs. resting MCs was increased in low-calcified plaques from symptomatic patients. There was no modulating effect of medication on MC ratios. In vitro experiments showed that SMC calcification attenuated MC activation, while both active and resting MCs stimulated SMC calcification and induced dedifferentiation towards a pro-inflammatory-, osteochondrocyte-like phenotype, without modulating their migro-proliferative function. CONCLUSIONS Integrative analyses from human plaques showed that MC activation is inversely associated with macrocalcification and positively with parameters of plaque vulnerability. Mechanistically, MCs induce SMC osteogenic reprograming, while matrix calcification in turn attenuates MC activation, offering new therapeutic avenues for exploration.
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Affiliation(s)
- Nikolaos T Skenteris
- Cardiovascular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden; Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Esmeralda Hemme
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, the Netherlands
| | - Lucie Delfos
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, the Netherlands
| | - Glykeria Karadimou
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Eva Karlöf
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mariette Lengquist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Malin Kronqvist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Xiang Zhang
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Lars Maegdefessel
- Cardiovascular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Technical University Munich, Klinikum rechts der Isar, Department for Vascular and Endovascular Surgery, Germany
| | - Leon J Schurgers
- Department of Biochemistry and CARIM, School for Cardiovascular Diseases, Maastricht University, Netherlands; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Hildur Arnardottir
- Cardiovascular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Erik A L Biessen
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Ilze Bot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, the Netherlands
| | - Ljubica Matic
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
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Chen J, Tang Y, Shen Z, Wang W, Hou J, Li J, Chen B, Mei Y, Liu S, Zhang L, Lu S. Predicting and Analyzing Restenosis Risk after Endovascular Treatment in Lower Extremity Arterial Disease: Development and Assessment of a Predictive Nomogram. J Endovasc Ther 2023:15266028231158294. [PMID: 36891634 DOI: 10.1177/15266028231158294] [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: 03/10/2023]
Abstract
PURPOSE This study aimed to develop and internally validate nomograms for predicting restenosis after endovascular treatment of lower extremity arterial diseases. MATERIALS AND METHODS A total of 181 hospitalized patients with lower extremity arterial disease diagnosed for the first time between 2018 and 2019 were retrospectively collected. Patients were randomly divided into a primary cohort (n=127) and a validation cohort (n=54) at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression was used to optimize the feature selection of the prediction model. Combined with the best characteristics of LASSO regression, the prediction model was established by multivariate Cox regression analysis. The predictive models' identification, calibration, and clinical practicability were evaluated by the C index, calibration curve, and decision curve. The prognosis of patients with different grades was compared by survival analysis. Internal validation of the model used data from the validation cohort. RESULTS The predictive factors included in the nomogram were lesion site, use of antiplatelet drugs, application of drug coating technology, calibration, coronary heart disease, and international normalized ratio (INR). The prediction model demonstrated good calibration ability, and the C index was 0.762 (95% confidence interval: 0.691-0.823). The C index of the validation cohort was 0.864 (95% confidence interval: 0.801-0.927), which also showed good calibration ability. The decision curve shows that when the threshold probability of the prediction model is more significant than 2.5%, the patients benefit significantly from our prediction model, and the maximum net benefit rate is 30.9%. Patients were graded according to the nomogram. Survival analysis found that there was a significant difference in the postoperative primary patency rate between patients of different classifications (log-rank p<0.001) in both the primary cohort and the validation cohort. CONCLUSION We developed a nomogram to predict the risk of target vessel restenosis after endovascular treatment by considering information on lesion site, postoperative antiplatelet drugs, calcification, coronary heart disease, drug coating technology, and INR. CLINICAL IMPACT Clinicians can grade patients after endovascular procedure according to the scores of the nomograms and apply intervention measures of different intensities for people at different risk levels. During the follow-up process, an individualized follow-up plan can be further formulated according to the risk classification. Identifying and analyzing risk factors is essential for making appropriate clinical decisions to prevent restenosis.
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Affiliation(s)
- Jinxing Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Yanan Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Zekun Shen
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Weiyi Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Jiaxuan Hou
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Jiayan Li
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Bingyi Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Yifan Mei
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Shuang Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Liwei Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
| | - Shaoying Lu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi, P. R. China
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24
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Zhao Y, Malik S, Criqui MH, Allison MA, Budoff MJ, Sandfort V, Wong ND. Coronary calcium density in relation to coronary heart disease and cardiovascular disease in adults with diabetes or metabolic syndrome: the Multi-ethnic Study of Atherosclerosis (MESA). BMC Cardiovasc Disord 2022; 22:536. [PMID: 36494811 PMCID: PMC9733236 DOI: 10.1186/s12872-022-02956-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronary artery calcium (CAC) density is inversely associated with coronary heart disease (CHD) and cardiovascular disease (CVD) risk. We examined this relation in those with diabetes mellitus (DM) or metabolic syndrome (MetS). METHODS We studied 3,818 participants with non-zero CAC scores from the Multiethnic Study of Atherosclerosis and classified them as DM, MetS (without DM) or neither DM/MetS. Risk factor-adjusted CAC density was calculated and examined in relation to incident CHD and CVD events over a median follow-up of 15 years among these three disease groups. RESULTS Adjusted CAC density was 2.54, 2.61 and 2.69 among those with DM, MetS or neither DM/MetS. Hazard ratios (HRs) for CHD per 1 SD increase of CAC density was 0.91 (95% CI: 0.72-1.16), 0.70 (95% CI: 0.56-0.87) and 0.79 (95% CI: 0.66-0.95) for those with DM, MetS or neither DM/MetS groups and were 0.77 (95% CI: 0.64-0.94), 0.83 (95% CI: 0.70-0.99) and 0.82 (95% CI: 0.71-0.95) for CVD, respectively. Adjustment for CAC density increased the HRs of CAC volume for CHD/CVD events. Compared to prediction models with or without single CAC measures, c-statistics of models with CAC volume and density were the highest ranging 0.67-0.72. CONCLUSION CAC density is lower among patients with DM or MetS than those with neither DM/MetS and is inversely associated with future CHD/CVD risk among them. Including CAC density in risk assessment among those with MetS may improve prediction of CHD and CVD.
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Affiliation(s)
- Yanglu Zhao
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, University of California Los Angeles, Los Angeles, USA ,grid.266093.80000 0001 0668 7243Heart Disease Prevention Program, University of California Irvine, Irvine, USA
| | - Shaista Malik
- grid.266093.80000 0001 0668 7243Heart Disease Prevention Program, University of California Irvine, Irvine, USA
| | - Michael H. Criqui
- grid.266100.30000 0001 2107 4242Division of Preventive Medicine, University of California San Diego, San Diego, USA
| | - Matthew A. Allison
- grid.266100.30000 0001 2107 4242Division of Preventive Medicine, University of California San Diego, San Diego, USA
| | - Matthew J. Budoff
- grid.239844.00000 0001 0157 6501Lindquist Institute, Harbor-UCLA Medical Center, Los Angeles, USA
| | - Veit Sandfort
- grid.94365.3d0000 0001 2297 5165Radiology & Imaging Sciences, National Institutes of Health, Bethesda, USA
| | - Nathan D. Wong
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, University of California Los Angeles, Los Angeles, USA ,grid.266093.80000 0001 0668 7243Heart Disease Prevention Program, University of California Irvine, Irvine, USA
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Ban X, Li Z, Duan Y, Xu K, Xiong J, Tu Y. Advanced Imaging Modalities Provide New Insights into Coronary Artery Calcification. Eur J Radiol 2022; 157:110601. [DOI: 10.1016/j.ejrad.2022.110601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/07/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
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26
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Li X, Wu M, Li J, Guo Q, Zhao Y, Zhang X. Advanced targeted nanomedicines for vulnerable atherosclerosis plaque imaging and their potential clinical implications. Front Pharmacol 2022; 13:906512. [PMID: 36313319 PMCID: PMC9606597 DOI: 10.3389/fphar.2022.906512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Atherosclerosis plaques caused by cerebrovascular and coronary artery disease have been the leading cause of death and morbidity worldwide. Precise assessment of the degree of atherosclerotic plaque is critical for predicting the risk of atherosclerosis plaques and monitoring postinterventional outcomes. However, traditional imaging techniques to predict cardiocerebrovascular events mainly depend on quantifying the percentage reduction in luminal diameter, which would immensely underestimate non-stenotic high-risk plaque. Identifying the degree of atherosclerosis plaques still remains highly limited. vNanomedicine-based imaging techniques present unique advantages over conventional techniques due to the superior properties intrinsic to nanoscope, which possess enormous potential for characterization and detection of the features of atherosclerosis plaque vulnerability. Here, we review recent advancements in the development of targeted nanomedicine-based approaches and their applications to atherosclerosis plaque imaging and risk stratification. Finally, the challenges and opportunities regarding the future development and clinical translation of the targeted nanomedicine in related fields are discussed.
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27
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Emfietzoglou M, Mavrogiannis MC, Samaras A, Rampidis GP, Giannakoulas G, Kampaktsis PN. The role of cardiac computed tomography in predicting adverse coronary events. Front Cardiovasc Med 2022; 9:920119. [PMID: 35911522 PMCID: PMC9334665 DOI: 10.3389/fcvm.2022.920119] [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] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac computed tomography (CCT) is now considered a first-line diagnostic test for suspected coronary artery disease (CAD) providing a non-invasive, qualitative, and quantitative assessment of the coronary arteries and pericoronary regions. CCT assesses vascular calcification and coronary lumen narrowing, measures total plaque burden, identifies plaque composition and high-risk plaque features and can even assist with hemodynamic evaluation of coronary lesions. Recent research focuses on computing coronary endothelial shear stress, a potent modulator in the development and progression of atherosclerosis, as well as differentiating an inflammatory from a non-inflammatory pericoronary artery environment using the simple measurement of pericoronary fat attenuation index. In the present review, we discuss the role of the above in the diagnosis of coronary atherosclerosis and the prediction of adverse cardiovascular events. Additionally, we review the current limitations of cardiac computed tomography as an imaging modality and highlight how rapid technological advancements can boost its capacity in predicting cardiovascular risk and guiding clinical decision-making.
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Affiliation(s)
- Maria Emfietzoglou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Michail C. Mavrogiannis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | | | - Polydoros N. Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Polydoros N. Kampaktsis
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28
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Shishikura D, Octavia Y, Hayat U, Thondapu V, Barlis P. Atherogenesis and Inflammation. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kataoka Y, Nicholls SJ, Andrews J, Uno K, Kapadia SR, Tuzcu EM, Nissen SE, Puri R. Plaque microstructures during metformin therapy in type 2 diabetic subjects with coronary artery disease: optical coherence tomography analysis. Cardiovasc Diagn Ther 2022; 12:77-87. [PMID: 35282660 PMCID: PMC8898697 DOI: 10.21037/cdt-21-346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/29/2021] [Indexed: 07/28/2023]
Abstract
BACKGROUND While metformin is recommended as a first-line cardioprotective therapy for type 2 diabetic patients, whether it exerts direct effects on atherosclerotic plaque remains uncertain. The current study characterized coronary plaque microstructures in type 2 diabetic patients who received metformin. METHODS We retrospectively analyzed 409 non-culprit lipid plaques in 313 type 2 diabetic patients with coronary artery disease (CAD) by using frequency-domain optical coherence tomography (FD-OCT) imaging. FD-OCT derived plaque microstructures were compared in patients stratified according to metformin use. RESULTS A proportion of 38.6% of study subjects received metformin. Patients receiving metformin more likely exhibited a history of hypertension (79.3% vs. 67.1%, P=0.03) and metabolic syndrome (52.8% vs. 36.4%, P=0.01). On FD-OCT imaging, the prevalence of lipid plaque was lower in the metformin group (66.2% vs. 77.9%, P=0.03). Furthermore, the metformin group demonstrated plaques with a smaller lipid arc (median: 168.7° vs. 208.5°, P=0.008), shorter longitudinal length (media: 5.1 vs. 9.1 mm, P=0.04), and a lower frequency of cholesterol crystal (3.9% vs. 18.2%, P=0.01) and spotty calcification (3.9% vs. 34.8%, P=0.008). These differences remained significant after adjusting for clinical characteristics and glycemic control. However, in patients who received insulin, the favourable effect of metformin on lipid arc was not observed (insulin user: P=0.87; insulin non-user: P=0.009; P value for interaction between two groups, P=0.02). CONCLUSIONS Metformin use was associated with a lower prevalence of vulnerable plaque features in type 2 diabetic patients with CAD, especially insulin non-user. These findings suggest the potential of metformin to exert direct plaque stabilization effects in type 2 diabetic subjects.
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Affiliation(s)
- Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Australia
| | - Jordan Andrews
- South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Kiyoko Uno
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven E. Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio, USA
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30
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Kawashima H, Serruys PW, Hara H, Ono M, Gao C, Wang R, Garg S, Sharif F, de Winter RJ, Mack MJ, Holmes DR, Morice MC, Kappetein AP, Thuijs DJFM, Milojevic M, Noack T, Mohr FW, Davierwala PM, Onuma Y. 10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification. JACC Cardiovasc Interv 2022; 15:193-204. [PMID: 34973904 DOI: 10.1016/j.jcin.2021.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). BACKGROUND Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization. METHODS This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial. Patients with HCLs were further stratified according to disease type (3-vessel disease or left main disease) and assigned treatment (PCI or CABG). RESULTS The 532 patients with ≥1 HCL had a higher crude mortality rate at 10 years than those without (36.4% vs 22.3%; HR: 1.79; 95% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an independent predictor of 10-year mortality (HR: 1.36; 95% CI: 1.09-1.69; P = 0.006). There was a significant interaction in mortality between treatment effect (PCI and CABG) and the presence or absence of HCLs (Pinteraction = 0.005). In patients without HCLs, mortality was significantly higher after PCI than after CABG (26.0% vs 18.8%; HR: 1.44; 95% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P = 0.264). CONCLUSIONS At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, Massy, France
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | | | - Piroze M Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
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Bellinge JW, Francis RJ, Lee SC, Bondonno NP, Sim M, Lewis JR, Watts GF, Schultz CJ. The effect of vitamin K1 on arterial calcification activity in subjects with diabetes mellitus: a post hoc analysis of a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2022; 115:45-52. [PMID: 34637494 DOI: 10.1093/ajcn/nqab306] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary and aortic artery calcifications are generally slow to develop, and their burden predicts cardiovascular disease events. In patients with diabetes mellitus, arterial calcification is accelerated and calcification activity can be detected using 18F-sodium fluoride positron emission tomography (18F-NaF PET). OBJECTIVES We aimed to determine whether vitamin K1 supplementation inhibits arterial calcification activity in individuals with diabetes mellitus. METHODS This was a post hoc analysis of the ViKCoVaC (effect of Vitamin-K1 and Colchicine on Vascular Calcification activity in subjects with Diabetes Mellitus) double-blind randomized controlled trial conducted in Perth, Western Australia. Individuals with diabetes mellitus and established coronary calcification (coronary calcium score > 10), but without clinical coronary artery disease, underwent baseline 18F-NaF PET imaging, followed by oral vitamin K1 supplementation (10 mg/d) or placebo for 3 mo, after which 18F-NaF PET imaging was repeated. We tested whether individuals randomly assigned to vitamin K1 supplementation had reduced development of new 18F-NaF PET positive lesions within the coronary arteries and aorta. RESULTS In total, 149 individuals completed baseline and follow-up imaging studies. Vitamin K1 supplementation independently decreased the odds of developing new 18F-NaF PET positive lesions in the coronary arteries (OR: 0.35; 95% CI: 0.16, 0.78; P = 0.010), aorta (OR: 0.27; 95% CI: 0.08, 0.94; P = 0.040), and in both aortic and coronary arteries (OR: 0.28; 95% CI: 0.13, 0.63; P = 0.002). CONCLUSIONS In individuals with diabetes mellitus, supplementation with 10 mg vitamin K1/d may prevent the development of newly calcifying lesions within the aorta and the coronary arteries as detected using 18F-NaF PET. Further long-term studies are needed to test this hypothesis.This trial was registered at anzctr.org.au as ACTRN12616000024448.
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Affiliation(s)
- Jamie W Bellinge
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sing C Lee
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicola P Bondonno
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marc Sim
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,Centre for Kidney Research, Children's Hospital Westmead, School of Public Health, University of Sydney, Westmead, New South Wales, Australia
| | - Gerald F Watts
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Yang H, Liu B, Yin Q, Zhang S, Shen Y, Ji C, Wang H, Dong Y, Lin L, Wang X. Comparison of symptomatic vertebrobasilar plaques between patients with and without Diabetes Mellitus using computed tomographic angiography and vessel wall magnetic resonance imaging. Diab Vasc Dis Res 2022; 19:14791641211073944. [PMID: 35199586 PMCID: PMC8883388 DOI: 10.1177/14791641211073944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Diabetes mellitus is significantly associated with posterior circulation ischemic stroke. We aimed to compare the characteristics of vertebrobasilar plaques in symptomatic patients with and without diabetes using high-resolution vessel wall magnetic resonance imaging and computed tomographic angiography. METHODS From April 2017 to May 2021, cases from patients with transient ischemic attack or stroke in the posterior circulation territory who underwent high-resolution vessel wall magnetic resonance imaging and computed tomographic angiography were reviewed. Characteristics of culprit vertebrobasilar plaques were compared between patients with and without diabetes. Multivariate regression analysis was performed to assess the correlation between culprit plaque characteristics and diabetes. RESULTS A total of 148 patients were included and 75 patients were diagnosed with diabetes mellitus. Patients with diabetes had more intraplaque hemorrhage, calcification, spotty calcification presence, and higher calcification volume (all p < 0.05) compared with those without diabetes. Multivariate analysis demonstrated differences in the presence of intraplaque hemorrhage (p = 0.045) and number of spotty calcifications (p = 0.047) were statistically significant after adjusting for baseline characteristics. CONCLUSIONS Symptomatic patients with diabetes have a higher incidence of intraplaque hemorrhage and larger calcification burden than those without diabetes, indicating the association of diabetes with more advanced plaque features in the posterior circulation.
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Affiliation(s)
- Huan Yang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bo Liu
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingqing Yin
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuai Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yelong Shen
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Congshan Ji
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haipeng Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yin Dong
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Liangjie Lin
- MSC Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Ximing Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Ximing Wang, Shandong Provincial Hospital, Jinan, China.
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Imaging Inflammation in Patients and Animals: Focus on PET Imaging the Vulnerable Plaque. Cells 2021; 10:cells10102573. [PMID: 34685553 PMCID: PMC8533866 DOI: 10.3390/cells10102573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023] Open
Abstract
Acute coronary syndrome (ACS) describes a range of conditions associated with the rupture of high-risk or vulnerable plaque. Vulnerable atherosclerotic plaque is associated with many changes in its microenvironment which could potentially cause rapid plaque progression. Present-day PET imaging presents a plethora of radiopharmaceuticals designed to image different characteristics throughout plaque progression. Improved knowledge of atherosclerotic disease pathways has facilitated a growing number of pathophysiological targets for more innovative radiotracer design aimed at identifying at-risk vulnerable plaque and earlier intervention opportunity. This paper reviews the efficacy of PET imaging radiotracers 18F-FDG, 18F-NaF, 68Ga-DOTATATE, 64Cu-DOTATATE and 68Ga-pentixafor in plaque characterisation and risk assessment, as well as the translational potential of novel radiotracers in animal studies. Finally, we discuss our murine PET imaging experience and the challenges encountered.
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Rodrigues IG, Pinho CPS, Sobral Filho D, Leão APD, Oliveira MCM, Barbosa GP, Siqueira AAD, Bandeira F. The impact of visceral fat and levels of vitamin D on coronary artery calcification. Rev Assoc Med Bras (1992) 2021; 67:88-93. [PMID: 34161468 DOI: 10.1590/1806-9282.67.01.20200388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/20/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluated calcification of the coronary arteries and its association with visceral fat and 25-hydroxyvitamin D (25(OH)D) serum levels. METHODS A cross sectional study involving 140 individuals without any previous diagnosis of cardiovascular disease. A biochemical analysis of vitamin D serum levels was carried out, as well as computed tomography to measure coronary artery calcium score and visceral adipose tissue. RESULTS The mean age of the individuals was 55.9 (±12.4). Coronary artery calcium was observed in 40.7% of the population. Vitamin D presented median serum levels of 30.4 ng/ml (IQ24.5-39.1), with 14,1 and 33.7% of the individuals presenting deficiency and insufficiency, respectively. In the univariate analysis, the calcium score was more prevalent in aged patients (p<0.01), in hypertensive individuals (p<0.01), in diabetics (p=0.02), and in those with a higher concentration of VAT (p=0.02). In the adjusted analysis, it was found that the highest concentration of VAT (OR: 4.0; 95%CI 1.4-11.7), hypertension (OR: 4.8; 95%CI 1.5-15.3), and age (OR: 10.4; 95%CI 3.9-27.6) were predictors of subclinical atherosclerosis, regardless of body mass index, diabetes, and 25OHD. CONCLUSIONS Excess visceral fat was associated with subclinical atherosclerosis, regardless of other risk factors for cardiovascular disease. Serum levels of 25OHD were not associated with CAD in its early stages.
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Affiliation(s)
- Isa Galvão Rodrigues
- Universidade de Pernambuco, Pronto Socorro Cardiológico Universitário de Pernambuco - Recife (PE), Brasil
| | - Claudia Porto Sabino Pinho
- Universidade de Pernambuco, Pronto Socorro Cardiológico Universitário de Pernambuco - Recife (PE), Brasil
| | - Dário Sobral Filho
- Universidade de Pernambuco, Pronto Socorro Cardiológico Universitário de Pernambuco - Recife (PE), Brasil.,Universidade de Pernambuco, Faculdade de Ciências Médicas - Recife (PE), Brasil
| | - Ana Paula Dornelas Leão
- Universidade de Pernambuco, Pronto Socorro Cardiológico Universitário de Pernambuco - Recife (PE), Brasil
| | | | | | | | - Francisco Bandeira
- Universidade de Pernambuco, Faculdade de Ciências Médicas - Recife (PE), Brasil
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Kocyigit D, Scanameo A, Xu B. Multimodality imaging for the prevention of cardiovascular events: Coronary artery calcium and beyond. Cardiovasc Diagn Ther 2021; 11:840-858. [PMID: 34295709 PMCID: PMC8261752 DOI: 10.21037/cdt-19-654] [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: 11/29/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has been the leading cause of death worldwide for more than a decade. Prevention is of utmost importance to reduce related mortality. The innovations in cardiovascular imaging technology, in addition to our improved understanding of coronary atherosclerosis pathogenesis, have resulted in cardiovascular imaging becoming one of the most influential tools for diagnosis and risk stratification in ASCVD. Although numerous publications have emerged on this topic, data that guide routine cardiology clinical practice currently focus on the utility of a limited number of such modalities, namely arterial ultrasonography and computed tomography. Herein, current evidence with respect to the role of multimodality cardiovascular imaging on ASCVD prevention will be reviewed.
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Affiliation(s)
- Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Predictive value of spiral shape in coronary plaque progression: an intraindividual comparative study. Coron Artery Dis 2021; 31:e37-e43. [PMID: 34010187 DOI: 10.1097/mca.0000000000001060] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted a pilot study to explore the value of spiral-shaped sign of plaque from coronary computed tomographic angiography (CCTA) in predicting plaque progression by intraindividual comparison. METHODS A total of 30 patients with a total of 60 plaques who received serial CCTA were retrospectively included and intraindividual compared. The spiral shape was defined as plaques coursing along the long axis of a coronary artery and encircling it at an angle of ≥ 180 degrees. The high-risk and other plaque signs were recorded. RESULTS On baseline CCTA, the spiral shape (P < 0.01) and length (P < 0.05) of plaques were more frequently seen in the progression group than in the nonprogression group; however, there was no difference between two groups in terms of high-risk plaque signs. In the progression group, plaque length, volume, and napkin-ring sign on follow-up CCTA were significantly greater than at baseline (P < 0.05). In the nonprogression group, there were fewer low-attenuation and positive remodeling plaques on follow-up CCTA than at baseline (P < 0.05). The spiral shape (standardized β = -4.55; P < 0.01) was an independent risk factor for plaque progression. There were 24 spiral plaques in the progression group, of which 16 (66.7%) had progression below the twist point of the spiral shape. CONCLUSIONS The baseline spiral shape is more frequently found in those lesions that progress than in those that do not in patients with multiple coronary lesions, and the spiral shape is an independent predictor of which plaques will progress.
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The Impact of Coronary Artery Calcification on Long-Term Cardiovascular Outcomes. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Decades of research and experimental studies have investigated various strategies to prevent acute coronary events. However, significantly efficient preventive methods have not been developed and still remains a challenge to determine if a coronary atherosclerotic plaque will become vulnerable and unstable. This review aims to assess the significance of plaque vulnerability markers, more precisely the role of spotty calcifications in the development of major cardiac events, given that coronary calcification is a hallmark of atherosclerosis. Recent studies have suggested that microcalcifications, spotty calcifications, and the presence of the napkin-ring sign are predictive vulnerable plaque features, and their presence may cause plaque instability.
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38
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Gu C, Wang N, Ren P, Wu X, Pang B, Zhang S, Hou X, Xu D, Yuan Y, Liu G. Association between postprandial lipoprotein subclasses and Framingham cardiovascular disease risk stratification. Clin Biochem 2020; 89:51-57. [PMID: 33359967 DOI: 10.1016/j.clinbiochem.2020.12.009] [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: 05/13/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the ability of postprandial lipoprotein subclass concentrations to stratify patients with respect to their risk for cardiovascular disease (CVD). METHODS Using the Framingham cardiovascular disease risk score (FRS) algorithm, a total of 112 consecutive patients referred for community health screening were stratified into two groups: (a) low-risk (FRS < 10%) and (b) intermediate/high-risk (FRS ≥ 10%). Serum lipoprotein subclass concentrations were determined by Vertical Auto Profile (VAP-II). RESULTS Fasting and postprandial levels of LDL4, HDL2, VLDL1 + 2, VLDL3, and RLP, as well as fasting levels of ApoB and postprandial levels of LDL3 and IDL1, were significantly different in the intermediate/high risk FRS group vs. the low-risk group (P < 0.05). Correlations between Framingham CVD risk and LDL3, LDL4, IDL1, VLDL1 + 2, VLDL3, RLP, and ApoB were positive while negative for HDL2 in both the fasting and postprandial states. Intermediate/high risk for CVD was shown to be significantly associated with both fasting and postprandial levels of VLDL1 + 2 and RLP, as well as with postprandial LDL4 and VLDL3, as determined using forward conditional logistic regression analysis. Postprandial levels of VLDL1 + 2 were better at identifying patients in the intermediate/high-risk FRS group than fasting levels, although the differences were not significant due to overlapping reference intervals. In addition, the association between RLP and VLDL subclasses relative to Framingham CVD risk increased significantly in the postprandial state (ΔR2 = 0.023; ΔF = 7.178; ΔP = 0.025) but not in the fasting state. CONCLUSIONS The use of postprandial lipoprotein subclass concentrations is not inferior to the use of fasting levels in identifying intermediate/high-risk FRS individuals. In addition, changes in RLP and VLDL subclass concentrations in fasting vs. postprandial states may reveal lipid metabolic mechanisms associated with CVD.
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Affiliation(s)
- Chun Gu
- Department of Laboratory, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Na Wang
- Department of Laboratory, Southern District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Peng Ren
- Department of Laboratory, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Xuemei Wu
- Department of Laboratory, Southern District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Bo Pang
- Department of Laboratory, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Shuying Zhang
- Department of Laboratory, Southern District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Xueyun Hou
- Department of Laboratory, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Dan Xu
- Department of Laboratory, Southern District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Yuliang Yuan
- Department of Laboratory, Southern District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China.
| | - Guijian Liu
- Department of Laboratory, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China.
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Lee R, Seok JW. An Update on [ 18F]Fluoride PET Imaging for Atherosclerotic Disease. J Lipid Atheroscler 2020; 9:349-361. [PMID: 33024730 PMCID: PMC7521973 DOI: 10.12997/jla.2020.9.3.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis is the leading cause of life-threatening morbidity and mortality, as the rupture of atherosclerotic plaques leads to critical atherothrombotic events such as myocardial infarction and ischemic stroke, which are the 2 most common causes of death worldwide. Vascular calcification is a complicated pathological process involved in atherosclerosis, and microcalcifications are presumed to increase the likelihood of plaque rupture. Despite many efforts to develop novel non-invasive diagnostic modalities, diagnostic techniques are still limited, especially before symptomatic presentation. From this point of view, vulnerable plaques are a direct target of atherosclerosis imaging. Anatomic imaging modalities have the limitation of only visualizing macroscopic structural changes, which occurs in later stages of disease, while molecular imaging modalities are able to detect microscopic processes and microcalcifications, which occur early in the disease process. Na[18F]-fluoride positron emission tomography/computed tomography could allow the early detection of plaque instability, which is deemed to be a primary goal in the prevention of cardiac or brain ischemic events, by quantifying the microcalcifications within vulnerable plaques and evaluating the atherosclerotic disease burden.
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Affiliation(s)
- Reeree Lee
- Department of Nuclear Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ju Won Seok
- Department of Nuclear Medicine, Chung-Ang University Hospital, Seoul, Korea
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40
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Shi X, Han Y, Li M, Yin Q, Liu R, Wang F, Xu X, Xiong Y, Ye R, Liu X. Superficial Calcification With Rotund Shape Is Associated With Carotid Plaque Rupture: An Optical Coherence Tomography Study. Front Neurol 2020; 11:563334. [PMID: 33071946 PMCID: PMC7530839 DOI: 10.3389/fneur.2020.563334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Plaque rupture is an important etiology for symptomatic carotid stenosis. The role of calcification in the plaque vulnerability has been controversial. We aimed to detect the geometric features of calcifications in carotid plaque and to examine its association with plaque rupture. Methods: Optical coherence tomography assessment of carotid plaque was performed in 88 patients. Calcification shape was evaluated through quantitative measurements of the long and short axis, area size, circumference, calcification arc, and longitudinal length. Calcification location was analyzed through the distance to the lumen. Furthermore, we developed idealized fluid-structure interaction models to investigate the association of calcification shape and plaque stress. Results: A total of 33 ruptured plaques and 30 non-ruptured plaques were recognized. Ruptured plaques had more multiple calcifications and protruded calcifications. The calcifications in the ruptured plaques displayed a remarkably lower long-axis/short-axis (L/S) ratio than in the non-ruptured plaques (p = 0.001). We classified calcification shape into crescentic calcification (L/S > 2.5) and rotund calcification (L/S ≤ 2.5). Rotund-shaped calcifications were more common in ruptured plaques than in non-ruptured plaques (p = 0.02). Superficial calcifications with minimal distance to the lumen ≤ 50 μm accounted for 79.4% of all calcifications in the ruptured plaques, and only 7.7% in the non-ruptured plaques (p < 0.001). Biomechanical analysis showed that the plaque with rotund-shaped calcification developed 7.91-fold higher von Mises stress than the plaque with crescentic calcification. Conclusions: Superficial calcifications and rotund-shaped calcifications are associated with carotid plaque rupture, suggesting that calcification location and shape may play a key role in plaque vulnerability.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Li
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qin Yin
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaohui Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunyun Xiong
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruidong Ye
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Pugliese L, Spiritigliozzi L, Di Tosto F, Ricci F, Cavallo AU, Di Donna C, De Stasio V, Presicce M, Benelli L, D'Errico F, Pasqualetto M, Floris R, Chiocchi M. Association of plaque calcification pattern and attenuation with instability features and coronary stenosis and calcification grade. Atherosclerosis 2020; 311:150-157. [PMID: 32771265 DOI: 10.1016/j.atherosclerosis.2020.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/10/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Coronary computed tomography (CT) allows calculating coronary artery calcium score (CACS). However, other CT features might be more strongly related to plaque vulnerability and risk of future coronary events. This study investigated the association of plaque calcification pattern and attenuation with plaque instability features, coronary artery disease (CAD) grade and CACS. METHODS One-hundred patients with coronary stenosis associated with calcified plaques were considered for this analysis. CACS, CAD grade, calcification pattern and attenuation, features of plaque instability, and epicardial adipose tissue (EAT) thickness and attenuation were assessed with non-contrast and contrast-enhanced CT angiography. RESULTS Of 373 calcified plaques, 131 were responsible for the highest degree of coronary stenosis (1.31 ± 0.53 per patient). Participants were stratified according to the features of the highest-grade lesion(s) into patients with large (35%), spotty (52%) or mixed (13%) calcification pattern and tertiles of plaque calcification attenuation (using the mean value for multiple lesions). Patients with large calcification pattern or higher plaque calcification attenuation had higher stenosis and CACS grade (and EAT attenuation), but lower plaque instability score, whereas those with spotty calcification pattern or lower plaque calcification attenuation had lower stenosis and CACS grade (and EAT attenuation), but higher plaque instability score. Among the instability features, low attenuation and napkin-ring sign, but not positive remodeling, were associated with a spotty pattern and a lower calcification attenuation. CONCLUSIONS Both the pattern and attenuation of calcification should be considered, in addition to CACS, for risk stratification of heavily calcified high-risk patients with non-critical coronary stenosis.
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Affiliation(s)
- Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Federica Di Tosto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Armando U Cavallo
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Matteo Presicce
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Francesca D'Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Monia Pasqualetto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Tor Vergata University of Rome and Unit of Diagnostic Imaging, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
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Jinnouchi H, Sato Y, Sakamoto A, Cornelissen A, Mori M, Kawakami R, Gadhoke NV, Kolodgie FD, Virmani R, Finn AV. Calcium deposition within coronary atherosclerotic lesion: Implications for plaque stability. Atherosclerosis 2020; 306:85-95. [PMID: 32654790 DOI: 10.1016/j.atherosclerosis.2020.05.017] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
Atherosclerotic lesion progression is associated with intimal calcification. The earliest lesion that shows calcification is pathologic intimal thickening in which calcifications appear as microcalcifications that vary in size from <0.5 to 15 μm. The calcifications become larger as plaques progress, becoming punctate (>15 μm to 1 mm in diameter), fragmented (>1 mm), and eventually sheet-like calcification (>3 mm). When stratified by plaque type, maximum calcifications are observed in fibrocalcific plaques, followed by healed plaque ruptures. Lesions of acute thrombi, i.e., plaque rupture and erosions, which are the most frequent causes of acute coronary syndromes, show much less calcification than stable fibrocalcific plaques. Conversely, a calcified nodule, the least common lesion of acute thrombosis, occurs in highly calcified lesions. Pro-inflammatory cytokines observed in unstable plaques may provoke an early phase of osteogenic differentiation of smooth muscle cells (SMCs), a release of calcifying extracellular matrix vesicles, and/or induce apoptosis of macrophages and SMCs, which also calcify. Recent pathologic and imaging based studies indicate that lesions with dense calcifications are more likely to be stable plaques (fibrocalcific plaques), while micro, punctate, or fragmented calcifications are associated with either early stage plaques or unstable lesions (plaque rupture or erosion). Clinical non-invasive computed tomography (CT) studies show that the greater the calcium score, the higher the likelihood of patients developing future acute coronary events. This appears contradictory with the findings from pathologic autopsy studies. However, CT analysis of calcium subtypes is limited by resolution and blooming artifacts. Thus, areas of heavy calcification may not be the cause of future events as pathologic studies suggest. Rather, calcium may be an overall marker for the extent of disease. These types of discrepancies can perhaps be resolved by invasive or non-invasive high resolution imaging studies carried out at intervals in patients who present with acute coronary syndromes versus stable angina patients. Coronary calcium burden is greater in stable plaques than unstable plaques and there is a negative correlation between necrotic core area and area of calcification. Recent clinical studies have demonstrated that statins can reduce plaque burden by demonstrating a reduction in percent and total atheroma volume. However, calcification volume increases. In summary, pathologic studies show that sheet calcification is highly prevalent in stable plaques, while microcalcifications, punctate, and fragmented calcifications are more frequent in unstable lesions. Both pathologic and detailed analysis of imaging studies in living patients can resolve some of the controversies in our understanding of coronary calcification.
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Affiliation(s)
| | - Yu Sato
- CVPath Institute, Gaithersburg, MD, USA
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Finck T, Stojanovic A, Will A, Hendrich E, Martinoff S, Hausleiter J, Hadamitzky M. Long-term prognostic value of morphological plaque features on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2020; 21:237-248. [PMID: 31578556 DOI: 10.1093/ehjci/jez238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/03/2019] [Accepted: 08/31/2019] [Indexed: 01/24/2023] Open
Abstract
AIMS To investigate the incremental prognostic value of morphological plaque features beyond clinical risk and coronary stenosis levels. Although associated with the degree of coronary stenosis, most cardiac events occur on the basis of ruptured non-obstructive plaques and consecutive vessel thrombosis. As such, identification of vulnerable plaques is paramount for cardiovascular risk prediction and treatment decisions. METHODS AND RESULTS A total of 1615 patients with suspected but not previously diagnosed coronary artery disease (CAD) were examined by coronary computed tomography angiography and morphological plaque features were assessed. Mean follow-up was 10.5 (interquartile range 9.2-11.4) years. Cox proportional hazards analysis was used for the composite endpoint of cardiac death and non-fatal myocardial infarction. The study endpoint was reached in 51 patients (36 cardiac deaths, 15 non-fatal myocardial infarctions). In addition to quantitative parameters (presence of any calcified/non-calcified plaque or elevated plaque load), morphologic plaque features such as a spotty or gross calcification pattern and napkin-ring sign (NRS) were predictive for events. However, only spotty calcified plaques and NRS could confer additive prognostic value beyond clinical risk and coronary stenosis level. In a stepwise approach, endpoint prediction beyond clinical risk (Morise score) could be improved by inclusion of CAD severity (χ2 of 27.5, P < 0.001) and further discrimination for spotty calcified plaques (χ2 of 3.89, P = 0.049). CONCLUSION Improved cardiovascular risk prediction beyond clinical risk and coronary stenosis levels can be made by discriminating for the presence of spotty calcified plaques. Thus, an intensified prophylactic anti-atherosclerotic treatment appears to be warranted in patients with coronary plaques that show spotty calcifications.
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Affiliation(s)
- Tom Finck
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Antonija Stojanovic
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Albrecht Will
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Eva Hendrich
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Stefan Martinoff
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Heart Alliance at DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung E.V.), Munich, Germany
| | - Martin Hadamitzky
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
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44
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Shi X, Gao J, Lv Q, Cai H, Wang F, Ye R, Liu X. Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe? Front Physiol 2020; 11:56. [PMID: 32116766 PMCID: PMC7013039 DOI: 10.3389/fphys.2020.00056] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Calcification is a clinical marker of atherosclerosis. This review focuses on recent findings on the association between calcification and plaque vulnerability. Calcified plaques have traditionally been regarded as stable atheromas, those causing stenosis may be more stable than non-calcified plaques. With the advances in intravascular imaging technology, the detection of the calcification and its surrounding plaque components have evolved. Microcalcifications and spotty calcifications represent an active stage of vascular calcification correlated with inflammation, whereas the degree of plaque calcification is strongly inversely related to macrophage infiltration. Asymptomatic patients have a higher content of plaque calcification than that in symptomatic patients. The effect of calcification might be biphasic. Plaque rupture has been shown to correlate positively with the number of spotty calcifications, and inversely with the number of large calcifications. There may be certain stages of calcium deposition that may be more atherogenic. Moreover, superficial calcifications are independently associated with plaque rupture and intraplaque hemorrhage, which may be due to the concentrated and asymmetrical distribution of biological stress in plaques. Conclusively, calcification of differential amounts, sizes, shapes, and positions may play differential roles in plaque homeostasis. The surrounding environments around the calcification within plaques also have impacts on plaque homeostasis. The interactive effects of these important factors of calcifications and plaques still await further study.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Southeast University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
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45
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Iwai T, Kataoka Y, Otsuka F, Asaumi Y, Nicholls SJ, Noguchi T, Yasuda S. Chronic kidney disease and coronary atherosclerosis: evidences from intravascular imaging. Expert Rev Cardiovasc Ther 2019; 17:707-716. [DOI: 10.1080/14779072.2019.1676150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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46
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Abstract
Vascular calcification (VC) is strongly associated with all-cause mortality and is an independent predictor of cardiovascular events. Resulting from its complex, multifaceted nature, targeted treatments for VC have not yet been developed. Lipoproteins are well characterized in the pathogenesis of atherosclerotic plaques, leading to the development of plaque regressing therapeutics. Although their roles in plaque progression are well documented, their roles in VC, and calcification of a plaque, are not well understood. In this review, early in vitro data and clinical correlations suggest an inhibitory role for HDL (high-density lipoproteins) in VC, a stimulatory role for LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein) and a potentially causal role for Lp(a) (lipoprotein [a]). Additionally, after treatment with a statin or PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, plaque calcification is observed to increase. With the notion that differing morphologies of plaque calcification associate with either a more stable or unstable plaque phenotype, uncovering the mechanisms of lipoprotein-artery wall interactions could produce targeted therapeutic options for VC.
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Affiliation(s)
- Emma J. Akers
- From the South Australian Health and Medical Research Institute, Adelaide, Australia (E.J.A.)
- The University of Adelaide, Australia (E.J.A.)
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia (S.J.N.)
| | - Belinda A. Di Bartolo
- The Kolling Institute of Medical Research, The University of Sydney, Australia (B.A.D.B.)
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47
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Culprit lesion morphology in young patients with ST-segment elevated myocardial infarction: A clinical, angiographic and optical coherence tomography study. Atherosclerosis 2019; 289:94-100. [DOI: 10.1016/j.atherosclerosis.2019.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 01/24/2023]
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48
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Vancheri F, Longo G, Vancheri S, Danial JSH, Henein MY. Coronary Artery Microcalcification: Imaging and Clinical Implications. Diagnostics (Basel) 2019; 9:E125. [PMID: 31547506 PMCID: PMC6963848 DOI: 10.3390/diagnostics9040125] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification.
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Affiliation(s)
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy.
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy.
| | - John S H Danial
- Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK.
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, 901 87 Umea, Sweden.
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK.
- Molecular and Clinical Sciences Research Institute, St George's University, London UB8 3PH, UK.
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49
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Should CT replace IVUS for evaluation of CAD in large-scale clinical trials: Effects of medical therapy on atherosclerotic plaque. J Cardiovasc Comput Tomogr 2019; 13:248-253. [PMID: 31351840 DOI: 10.1016/j.jcct.2019.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/15/2019] [Accepted: 06/23/2019] [Indexed: 11/22/2022]
Abstract
Clinical trials assessing the effect of medical therapies on atherosclerotic plaques have hitherto employed invasive imaging techniques such as intravascular ultrasound (IVUS). This has limited the study population to high-risk patients in whom invasive coronary angiography is indicated; moreover, IVUS typically is performed utilizing a target lesion-based analysis. Recently, comprehensive quantitative analysis of all atherosclerotic plaques in the complete coronary artery network has become possible through the use of coronary computed tomography angiography (CCTA). Excellent inter-observer and inter-scan reproducibility of CCTA has been reported. Several studies have already tested the applicability of CCTA-measured plaque volume changes as an imaging surrogate endpoint in clinical trials and have found positive results. Further, substantial evidence supports the use of CCTA as a novel imaging surrogate that can accurately assess the changes in plaque characteristics according to medical treatment. In this review, we summarize current evidences that support the use of CCTA as a novel imaging surrogate that can replace IVUS in evaluating the results of treatment. We also attempt to determine whether the technological advances in CCTA will extend its application beyond use as a diagnostic method in clinical practice to use in large-scale clinical trials.
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50
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Kutkienė S, Petrulionienė Ž, Laucevičius A, Čerkauskienė R, Kasiulevičius V, Samuilis A, Augaitienė V, Gedminaitė A, Bieliauskienė G, Šaulytė-Mikulskienė A, Staigytė J, Petrulionytė E, Gargalskaitė U, Skiauterytė E, Matuzevičienė G, Kovaitė M, Nedzelskienė I. Is the coronary artery calcium score the first-line tool for investigating patients with severe hypercholesterolemia? Lipids Health Dis 2019; 18:149. [PMID: 31279347 PMCID: PMC6612412 DOI: 10.1186/s12944-019-1090-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background Coronary artery calcium (CAC) is known as a reliable tool for estimating risk of myocardial infarction, coronary death, all-cause mortality and is even used to evaluate suitable asymptomatic patients. We therefore aimed to evaluate whether CAC scoring can be applied in the algorithm for clinical examination of patients with severe hypercholesterolemia (SH). Methods During the period of 2016–2017 a total of 213 asymptomatic adults, underwent computed tomography angiography to evaluate their CAC scoring. The sample consisted of 110 patients with SH and 103 age and sex matched controls without dyslipidemia and established cardiovascular disease. Results In total there were 79 (37.2%) subjects with elevated (≥25th) CAC percentiles. Out of them 47 (59.5%) had SH and 32 (40.5%) did not. CAC score did not differ between groups (SH (+) 140.30 ± 185.72 vs SH (−) 87.84 ± 140.65, p = 0.146), however there was a comparable difference in how the participants of these groups distributed among different percentile groups (p = 0.044). Gender, blood pressure, tabaco use, physical activity, family history of coronary artery disease and diabetes mellitus were not associated with CAC score (p > 0.05). There were no significant correlations between biochemical parameters and CAC percentiles except for increase in lipoprotein(a) (p = 0.038). Achilles tendon pathology, visceral obesity, body mass index and increased waist-hip ratio were not associated with CAC percentiles either (p > 0.05). Conclusions CAC score is not associated with presence of SH. CAC score is not an appropriate diagnostic tool in the algorithm for clinical examination of patients with SH. Further larger studies are needed to support our findings.
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Affiliation(s)
- Sandra Kutkienė
- Faculty of Medicine Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Žaneta Petrulionienė
- Faculty of Medicine Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Aleksandras Laucevičius
- Faculty of Medicine Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Rimantė Čerkauskienė
- Vilnius University Hospital Santaros Klinikos, Children's hospital, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vytautas Kasiulevičius
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania.,Faculty of Medicine Clinic of Internal Diseases Family Medicine and Oncology, Vilnius University, Vilnius, Vilnius, Lithuania
| | - Artūras Samuilis
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania.,Department of Radiology Nuclear Medicine and Medical Physics, Vilnius University Institute of Biomechanical Sciences, Vilnius, Lithuania
| | - Virginija Augaitienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania.,Department of Radiology Nuclear Medicine and Medical Physics, Vilnius University Institute of Biomechanical Sciences, Vilnius, Lithuania
| | - Aurelija Gedminaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania.,Department of Radiology Nuclear Medicine and Medical Physics, Vilnius University Institute of Biomechanical Sciences, Vilnius, Lithuania
| | - Gintarė Bieliauskienė
- Faculty of Medicine Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Akvilė Šaulytė-Mikulskienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania. .,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania.
| | - Justina Staigytė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | | | - Urtė Gargalskaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Eglė Skiauterytė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Gabija Matuzevičienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Milda Kovaitė
- Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Irena Nedzelskienė
- Vilnius University Hospital Santaros Klinikos, Children's hospital, Vilnius, Lithuania
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