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Trimarchi G, Pizzino F, Paradossi U, Gueli IA, Palazzini M, Gentile P, Di Spigno F, Ammirati E, Garascia A, Tedeschi A, Aschieri D. Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention. J Cardiovasc Dev Dis 2024; 11:245. [PMID: 39195153 DOI: 10.3390/jcdd11080245] [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: 07/11/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/29/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered around lifestyle changes, risk factors management, and medication. However, the integration of imaging methods offers a novel dimension in early disease detection, risk assessment, and ongoing monitoring of at-risk individuals. Imaging techniques such as supra-aortic trunks ultrasound, echocardiography, cardiac magnetic resonance, and coronary computed tomography angiography have broadened our understanding of the anatomical and functional aspects of cardiovascular health. These techniques enable personalized prevention strategies by providing detailed insights into the cardiac and vascular states, significantly enhancing our ability to combat the progression of CVDs. This review focuses on amalgamating current findings, technological innovations, and the impact of integrating advanced imaging modalities into cardiovascular risk prevention, aiming to offer a comprehensive perspective on their potential to transform preventive cardiology.
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Affiliation(s)
- Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98124 Messina, Italy
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Fausto Pizzino
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio-Regione Toscana, 54100 Massa, Italy
| | - Umberto Paradossi
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio-Regione Toscana, 54100 Massa, Italy
| | - Ignazio Alessio Gueli
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio-Regione Toscana, 54100 Massa, Italy
| | - Matteo Palazzini
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Piero Gentile
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Francesco Di Spigno
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Andrea Garascia
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Andrea Tedeschi
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Daniela Aschieri
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
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Dimitriadis K, Pyrpyris N, Theofilis P, Mantzouranis E, Beneki E, Kostakis P, Koutsopoulos G, Aznaouridis K, Aggeli K, Tsioufis K. Computed Tomography Angiography Identified High-Risk Coronary Plaques: From Diagnosis to Prognosis and Future Management. Diagnostics (Basel) 2024; 14:1671. [PMID: 39125547 PMCID: PMC11311283 DOI: 10.3390/diagnostics14151671] [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: 07/07/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
CT angiography has become, in recent years, a main evaluating modality for patients with coronary artery disease (CAD). Recent advancements in the field have allowed us to identity not only the presence of obstructive disease but also the characteristics of identified lesions. High-risk coronary atherosclerotic plaques are identified in CT angiographies via a number of specific characteristics and may provide prognostic and therapeutic implications, aiming to prevent future ischemic events via optimizing medical treatment or providing coronary interventions. In light of new evidence evaluating the safety and efficacy of intervening in high-risk plaques, even in non-flow-limiting disease, we aim to provide a comprehensive review of the diagnostic algorithms and implications of plaque vulnerability in CT angiography, identify any differences with invasive imaging, analyze prognostic factors and potential future therapeutic options in such patients, as well as discuss new frontiers, including intervening in non-flow-limiting stenoses and the role of CT angiography in patient stratification.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.P.); (P.T.); (E.M.); (E.B.); (P.K.); (G.K.); (K.A.); (K.A.); (K.T.)
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Wang D, Shang ZY, Cui Y, Yang BQ, Ntaios G, Chen HS. Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion. Stroke Vasc Neurol 2023; 8:387-398. [PMID: 36914215 PMCID: PMC10648047 DOI: 10.1136/svn-2022-002071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI). METHODS We retrospectively enrolled eligible patients from January 2015 to July 2021. The multidimensional parameters of plaque such as remodelling index (RI), plaque burden (PB), percentage lipid-rich necrotic core (%LRNC), presence of discontinuity of plaque surface (DPS), fibrous cap rupture, intraplaque haemorrhage and complicated plaque were evaluated by HR-MRI. RESULTS Among 279 stroke patients, intracranial plaque proximal to LVO was more prevalent in the ipsilateral versus contralateral side to stroke (75.6% vs 58.8%, p<0.001). The larger PB (p<0.001), RI (p<0.001) and %LRNC (p=0.001), the higher prevalence of DPS (61.1% vs 50.6%, p=0.041) and complicated plaque (63.0% vs 50.6%, p=0.016) were observed in the plaque ipsilateral versus contralateral to stroke. Logistic analysis showed that RI and PB were positively associated with an ischaemic stroke (RI: crude OR: 1.303, 95% CI 1.072 to 1.584, p=0.008; PB: crude OR: 1.677, 95% CI 1.381 to 2.037, p<0.001). In subgroup with <50% stenotic plaque, the greater PB, RI, %LRNC and the presence of complicated plaque were more closely related to stroke, which was not evident in subgroup with ≥50% stenotic plaque. CONCLUSION This is the first study to report the characteristics of intracranial plaque proximal to LVO in non-cardioembolic stroke. It provides potential evidence to support different aetiological roles of <50% stenotic vs ≥50% stenotic intracranial plaque in this population.
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Affiliation(s)
- Dan Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Zi-Yang Shang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Ben-Qiang Yang
- Radiology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
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Racz AO, Racz I, Szabo GT, Uveges A, Koszegi Z, Penczu B, Kolozsvari R. The Effects of Percutaneous Coronary Intervention on the Flow in Acute Coronary Syndrome Patients-Geometry in Focus. J Pers Med 2022; 12:jpm12081264. [PMID: 36013213 PMCID: PMC9410387 DOI: 10.3390/jpm12081264] [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: 05/24/2022] [Revised: 07/02/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Evaluation of the effect of three dimensional (3D) coronary plaque characteristics derived from two dimensional (2D) invasive angiography images (ICA) on coronary flow determined by TIMI frame count (TFC) in acute coronary syndrome (ACS) has not been thoroughly investigated. A total of 71 patients with STEMI, and 73 with NSTEMI were enrolled after primary angioplasty. Pre- and post-PCI TFCs were obtained. From 2D images, 3D reconstruction was performed of the culprit vessel, and multiple plaque parameters were measured. In STEMI, the average post-PCI frame count decreased significantly, resulting in better flow. With regards to 2/3D parameters, no differences were found between the STEMI and NSTEMI groups. The 3D parameters in the subgroup with an increase with at least three frames resulting in worsening post-PCI flow were compared to parameters of the patients with improved or significantly not change flow (delta frame count < 3), and greater minimal luminal diameter and area was found in the worsening (increased) frame group. In STEMI 2/3D, parameters showed no correlation with worsening flow, whereas in NSTEMI, greater minimal luminal diameter and area correlated with decreased flow. We can conclude that certain 2/3D parameters can predict slower flow in ACS, resulting in the use of GP IIb/IIIa receptor blocker.
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Affiliation(s)
- Agnes Orsolya Racz
- Department of Cardiology and Heart Surgery, University of Debrecen Faculty of Medicine, Moricz Zs. Krt 22, Debrecen 4032, Hungary; (A.O.R.); (I.R.); (G.T.S.); (A.U.); (Z.K.)
| | - Ildiko Racz
- Department of Cardiology and Heart Surgery, University of Debrecen Faculty of Medicine, Moricz Zs. Krt 22, Debrecen 4032, Hungary; (A.O.R.); (I.R.); (G.T.S.); (A.U.); (Z.K.)
| | - Gabor Tamas Szabo
- Department of Cardiology and Heart Surgery, University of Debrecen Faculty of Medicine, Moricz Zs. Krt 22, Debrecen 4032, Hungary; (A.O.R.); (I.R.); (G.T.S.); (A.U.); (Z.K.)
| | - Aron Uveges
- Department of Cardiology and Heart Surgery, University of Debrecen Faculty of Medicine, Moricz Zs. Krt 22, Debrecen 4032, Hungary; (A.O.R.); (I.R.); (G.T.S.); (A.U.); (Z.K.)
| | - Zsolt Koszegi
- Department of Cardiology and Heart Surgery, University of Debrecen Faculty of Medicine, Moricz Zs. Krt 22, Debrecen 4032, Hungary; (A.O.R.); (I.R.); (G.T.S.); (A.U.); (Z.K.)
- 3rd Department of Internal Medicine, Szabolcs-Szatmar-Bereg County Hospital, Nyíregyháza 4400, Hungary
| | - Bence Penczu
- Department of Cardiology, Borsod-Abaúj-Zemplén County Hospital, Miskolc 3526, Hungary;
| | - Rudolf Kolozsvari
- Department of Cardiology and Heart Surgery, University of Debrecen Faculty of Medicine, Moricz Zs. Krt 22, Debrecen 4032, Hungary; (A.O.R.); (I.R.); (G.T.S.); (A.U.); (Z.K.)
- Correspondence: ; Tel.: +36-30-66-383-66
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Dual-energy CT plaque characteristics of post mortem thin-cap fibroatheroma in comparison to infarct-related culprit lesions. Heart Vessels 2021; 37:400-410. [PMID: 34608510 DOI: 10.1007/s00380-021-01942-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Improvement of non-invasive identification of high-risk plaque may increase the preventive options of acute coronary syndrome. To describe the characteristics of thin-cap fibroatheroma (TCFA) in a post mortem model in comparison to characteristics of culprit lesions in patients with non-ST-elevation-myocardial-infarction (NSTEMI) using the dual energy computed tomography (DECT). Three post mortem hearts were prepared with iodine-contrast, inserted in a Kyoto phantom and scanned by DECT. Six TCFA were identified using histopathological analysis (cap thickness < 65 μm and necrotic core > 10% of the plaque area). In the NSTEMI group, 29 patients were scheduled to DECT prior to coronary angiography and invasive treatment. Culprit lesions were identified blinded for the patient history by two independent invasive cardiologists using the coronary angiography. The DECT analysis of TCFA and culprit lesions was performed retrospectively with determination of effective atomic number (Effective-Z), Hounsfield Unit (HU), plaque type (non-calcified, predominantly non-calcified, predominantly calcified or calcified), spotty calcification,, plaque length, plaque volume and plaque burden and the remodeling index. The Effective-Z, HU and plaqueburden were significantly different between TCFA and culprit lesions (P < 0.05).The TCFA plaques were more calcified in comparison to culprit lesions (P < 0.05). No significant difference in the other plaque characteristics was observed. The use of DECT demonstrated different Effective-Z values and different characteristics of post mortem TCFA in comparison to in vivo culprit lesions. This finding may highlight, that not all TCFA should be considered as vulnerable.
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Stojan G, Li J, Budoff M, Arbab-Zadeh A, Petri MA. High-risk coronary plaque in SLE: low-attenuation non-calcified coronary plaque and positive remodelling index. Lupus Sci Med 2021; 7:7/1/e000409. [PMID: 32723810 PMCID: PMC7388871 DOI: 10.1136/lupus-2020-000409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/13/2020] [Accepted: 06/25/2020] [Indexed: 01/06/2023]
Abstract
Background Positive remodelling index and presence of low-attenuation non-calcified plaque (LANCP) are characteristic vessel changes in unstable coronary plaques. We sought to characterise these high-risk plaque features in patients with systemic lupus erythematosus (SLE) and to compare them with controls. Methods A total of 72 patients who satisfied the SLICC classification criteria for SLE had coronary CT angiography (CCTA) studies, 30 of which had follow-up CCTA, as screening for occult coronary atherosclerotic disease in asymptomatic individuals. A total of 100 consecutive controls with no known history of lupus, heart disease or revascularisation who had two coronary CT angiograms at least 1 year apart were included in the study. These were asymptomatic patients referred by their primary physicians for screening of coronary artery disease and the screening interval was decided by the primary physicians. The methodology for image acquisition was identical. Results LANCP burden at baseline was significantly greater in patients with SLE compared with controls. LANCP volume was significantly greater in patients over 60 years of age (p<0.05) and in those with current prednisone dose >10 mg/day. LANCP burden remained stable over follow-up. There were no significant differences in remodelling index compared with controls. Conclusion This is the first study describing high-risk CCTA features of coronary plaque in patients with SLE. Both LANCP and positive remodelling are common in SLE. These characteristic vessel changes may identify patients with SLE at increased risk of cardiovascular events and those in need for more frequent cardiac monitoring.
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Affiliation(s)
- George Stojan
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jessica Li
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew Budoff
- Cardiology, David Geffen School of Medicine, Los Angeles, California, USA.,Cardiology, UCLA, Los Angeles, California, USA
| | | | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Carpenter HJ, Gholipour A, Ghayesh MH, Zander AC, Psaltis PJ. In Vivo Based Fluid-Structure Interaction Biomechanics of the Left Anterior Descending Coronary Artery. J Biomech Eng 2021; 143:081001. [PMID: 33729476 DOI: 10.1115/1.4050540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Indexed: 12/25/2022]
Abstract
A fluid-structure interaction-based biomechanical model of the entire left anterior descending coronary artery is developed from in vivo imaging via the finite element method in this paper. Included in this investigation is ventricle contraction, three-dimensional motion, all angiographically visible side branches, hyper/viscoelastic artery layers, non-Newtonian and pulsatile blood flow, and the out-of-phase nature of blood velocity and pressure. The fluid-structure interaction model is based on in vivo angiography of an elite athlete's entire left anterior descending coronary artery where the influence of including all alternating side branches and the dynamical contraction of the ventricle is investigated for the first time. Results show the omission of side branches result in a 350% increase in peak wall shear stress and a 54% decrease in von Mises stress. Peak von Mises stress is underestimated by up to 80% when excluding ventricle contraction and further alterations in oscillatory shear indices are seen, which provide an indication of flow reversal and has been linked to atherosclerosis localization. Animations of key results are also provided within a video abstract. We anticipate that this model and results can be used as a basis for our understanding of the interaction between coronary and myocardium biomechanics. It is hoped that further investigations could include the passive and active components of the myocardium to further replicate in vivo mechanics and lead to an understanding of the influence of cardiac abnormalities, such as arrythmia, on coronary biomechanical responses.
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Affiliation(s)
- Harry J Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Alireza Gholipour
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mergen H Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Anthony C Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia
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Senoner T, Plank F, Langer C, Beyer C, Steinkohl F, Barbieri F, Adukauskaite A, Widmann G, Friedrich G, Dichtl W, Feuchtner GM. Smoking and obesity predict high-risk plaque by coronary CTA in low coronary artery calcium score (CACS). J Cardiovasc Comput Tomogr 2021; 15:499-505. [PMID: 33933380 DOI: 10.1016/j.jcct.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The AHA recommends statins in patients with CACS>100 AU. However in patients with low CACS (1-99 AU), no clear statement is provided, leaving the clinician in a grey-zone. High-risk plaque (HRP) criteria by coronary CTA are novel imaging biomarkers indicating a higher a-priori cardiovascular (CV) risk, which could help for decision-making. Therefore the objective of our study was to identify which CV-risk factors predict HRP in patients with low CACS 1-99. METHODS 1003 symptomatic patients with low-to-intermediate risk, a clinical indication for coronary computed tomography angiography (CCTA) and who had a coronary artery calcium score (CACS) between 1 and 99 AU, were enrolled. CCTA analysis included: stenosis severity and HRP-criteria: low-attenuation plaque (LAP <30HU, <60HU and <90HU) napkin-ring-sign, spotty calcification and positive remodeling. Multivariate regression models were created for predicting HRP-criteria by the major 5 cardiovascular risk factors (CVRF) (smoking, arterial hypertension, positive family history, dyslipidemia, diabetes) and obesity (BMI>25 kg/m2). RESULTS 304 (33.5%) were smokers. 20.4% of smokers had HRP compared with only 14.9% of non-smokers (p = 0.045). Male gender was associated with HRP (p < 0.001). Smoking but not the other 5 CVRF had the most associations with HRP-criteria (LAP<60HU/≥2 criteria:OR 1.59; 95%CI:1.07-2.35), LAP<90HU (OR 1.57; 95%CI:1.01-2.43), Napkin-Ring-Sign (OR 1.78; 95%CI:1.02-3.1) and positive remodelling (OR 1.54; 95%CI:1.09-2.19). Smoking predicted fibrofatty LAP<90HU in males only. Obesity predicted LAP<60HU in both females and males. CONCLUSIONS In patients with low CACS 1-99AU, male gender, smoking and obesity, but not the other CVRF predict HRP. These patients would rather benefit from intensification of primary CV-prevention measures such as statins.
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Affiliation(s)
- Thomas Senoner
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Fabian Plank
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | | | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Austria
| | | | - Fabian Barbieri
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Agne Adukauskaite
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Austria
| | - Guy Friedrich
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
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Characteristics of culprit lesion in patients with non-ST-elevation myocardial infarction and improvement of diagnostic utility using dual energy cardiac CT. Int J Cardiovasc Imaging 2021; 37:1781-1788. [PMID: 33502653 DOI: 10.1007/s10554-020-02141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
AIMS The aim of the study was to identify the characteristics of the culprit lesions compared to non-culprit lesions in patients with non-ST-elevation-myocardial infarction using dual energy computed tomography (DECT). METHODS AND RESULTS In 29 patients, we identified 29 culprit lesions and 227 non-culprit lesions. Quantitative values such as the effective atomic number (effective-Z) and Hounsfield Units (HU) values were measured. Furthermore, all the lesions were characterised using characteristics such as composition (non-calcified, predominantly-non-calcified, predominantly-calcified, or calcified), presence of spotty calcification, remodelling index, and napkin ring sign. The mean effective-Z and HU values were significantly lower in culprit lesions than in non-culprit lesions (8.99 ± 1.21 vs 9.79 ± 1.52; p = 0.0066 and 87.41 ± 84.97 vs. 154.45 ± 176.13; p = 0.0447). The culprit lesions had a higher frequency of non-calcified plaques and predominantly non-calcified plaques, and were with a greater presence of napkin ring signs in comparison with non-culprit lesions. There were no differences in the presence of spotty calcification or remodelling index. By adding effective-Z to plaque characteristics such as non-calcified, positive remodelling, spotty calcification, and napkin rings we observed a significant increased sensitivity of detecting culprit lesions (65.5% vs.44.8%), but no significant changes in area under curve (AUC). CONCLUSION The use of DECT adds new information of the plaque composition expressed by the effective-Z, which differs significantly in culprit lesions in comparison with non-culprit lesions. The use of the effective-Z improves the diagnostic sensitivity in detection of culprit lesions.
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Ghasemi M, Nolan DR, Lally C. Assessment of mechanical indicators of carotid plaque vulnerability: Geometrical curvature metric, plaque stresses and damage in tissue fibres. J Mech Behav Biomed Mater 2020; 103:103573. [PMID: 32090902 DOI: 10.1016/j.jmbbm.2019.103573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/15/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
Stroke is a major cause of death worldwide. The rupture of atherosclerotic carotid plaques is the leading single cause of stroke. Currently there is no accepted clinical measure to quantitatively assess the risk of carotid plaque rupture. Structural analyses of vulnerable plaques, using finite element (FE) analysis, have retrospectively found that regions of high stress tend to be the site of plaque rupture. The current study proposes a new clinical measure, based on plaque geometry, to assess the risk of carotid plaque rupture. This measure, named the weighted curvature difference, is based on the curvature of both the lumen and intima-media boundary, and the local plaque thickness. A series of idealized and realistic, 2-D and 3-D geometries are used to systematically assess this novel geometrical metric. The areas predicted to be at high risk of rupture using this geometrical metric are compared with areas of high stress, obtained from both isotropic and anisotropic material models. These results are also compared with areas in diseased carotid arteries that are predicted to have high damage accumulation in collagen fibres using a continuum damage model. Results show the new geometrical metric consistently predicts the locations of high stress in all of the vessel geometries examined. The drawbacks of using lumen curvature only as a risk measure are highlighted; particularly in the case of outward remodelled vessels. Weighted curvature difference shows great potential to be used as a metric to efficiently distinguish the rupture prone areas in a diseased vessels in a way that is independent of material properties.
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Affiliation(s)
- Milad Ghasemi
- Dept. of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - David R Nolan
- Dept. of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Caitríona Lally
- Dept. of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Young CC, Bonow RH, Barros G, Mossa-Basha M, Kim LJ, Levitt MR. Magnetic resonance vessel wall imaging in cerebrovascular diseases. Neurosurg Focus 2019; 47:E4. [DOI: 10.3171/2019.9.focus19599] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebrovascular diseases manifest as abnormalities of and disruption to the intracranial vasculature and its capacity to carry blood to the brain. However, the pathogenesis of many cerebrovascular diseases begins in the vessel wall. Traditional luminal and perfusion imaging techniques do not provide adequate information regarding the differentiation, onset, or progression of disease. Intracranial high-resolution MR vessel wall imaging (VWI) has emerged as an invaluable technique for understanding and evaluating cerebrovascular diseases. The location and pattern of contrast enhancement in intracranial VWI provides new insight into the inflammatory etiology of cerebrovascular diseases and has potential to permit earlier diagnosis and treatment. In this report, technical considerations of VWI are discussed and current applications of VWI in vascular malformations, blunt cerebrovascular injury/dissection, and steno-occlusive cerebrovascular vasculopathies are reviewed.
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Affiliation(s)
| | | | | | | | - Louis J. Kim
- Departments of 1Neurological Surgery,
- 2Radiology, and
- 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Michael R. Levitt
- Departments of 1Neurological Surgery,
- 2Radiology, and
- 3Mechanical Engineering, and
- 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
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12
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Hao YM, Yuan HQ, Ren Z, Qu SL, Liu LS, Dang-HengWei, Yin K, Fu M, Jiang ZS. Endothelial to mesenchymal transition in atherosclerotic vascular remodeling. Clin Chim Acta 2018; 490:34-38. [PMID: 30571947 DOI: 10.1016/j.cca.2018.12.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022]
Abstract
Endothelial cells are the main components of the heart, blood vessels, and lymphatic vessels, which play an important role in regulating the physiological functions of the cardiovascular system. Endothelial dysfunction is involved in a variety of acute and chronic cardiovascular diseases. As a special type of epithelial-mesenchymal transition (EMT), endothelium to mesenchymal transition (EndMT) regulates the transformation of endothelial cells into mesenchymal cells accompanied by changes in the expression of various transcription factors and cytokines, which is closely related to vascular endothelial injury, vascular remodeling, myocardial fibrosis and valvar disease. Endothelial cells undergoing EndMT lose their endothelial characteristics and undergo a transition toward a more mesenchymal-like phenotype. However, the molecular mechanism of EndMT remains unclear. EndMT, as a type of endothelial dysfunction, can cause vascular remodeling which is a major determinant of atherosclerotic luminal area. Therefore, exploring the important signaling pathways in the process of EndMT may provide novel therapeutic strategies for treating atherosclerotic diseases.
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Affiliation(s)
- Ya-Meng Hao
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China
| | - Hou-Qin Yuan
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China
| | - Zhong Ren
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China
| | - Shun-Lin Qu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China
| | - Lu-Shan Liu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China
| | - Dang-HengWei
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China
| | - Kai Yin
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China; Research Lab of Translational Medicine, Medical School, University of South China, Hengyang 421001, PR China
| | - Mingui Fu
- Department of Biomedical Science, Shock/Trauma Research Center, School of Medicine, University of Missouri Kansas City, Kansas City, MO 64108, USA
| | - Zhi-Sheng Jiang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, University of South, Hengyang City, Hunan Province 421001, PR China.
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Guo R, Zhang X, Zhu X, Liu Z, Xie S. Morphologic characteristics of severe basilar artery atherosclerotic stenosis on 3D high-resolution MRI. BMC Neurol 2018; 18:206. [PMID: 30553271 PMCID: PMC6295022 DOI: 10.1186/s12883-018-1214-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background Two-dimensional high-resolution MRI (2D HRMRI) faces many technical challenges for fully assessing morphologic characteristics of inherent tortuous basilar arteries. Our aim was to investigate remodeling mechanisms and plaque distribution in symptomatic patients with basilar artery stenosis on three-dimensional (3D) HRMRI. Methods Forty-six consecutive patients with symptomatic basilar artery atherosclerotic stenosis on MRA (70–99%) were enrolled. The remodeling index (RI) was the ratio of vessel area at the maximal-lumen-narrowing (MLN) site to reference vessel area. RI ≥ 1.05 was defined as positive remodeling (PR), RI ≤ 0.95 as negative remodeling (NR), and 0.95 < RI < 1.05 as intermediate remodeling (IR). The remodeling patterns were divided into two groups (PR and non-PR [NR and IR]). The cross-sectional and longitudinal distribution of BA plaques were evaluated. Results Two patients were excluded because of poor-quality images. Images of 44 patients were available for measurements. PR was found in 23 (52.3%) patients, and non-PR in 21 (47.7%) patients. At the MLN sites, vessel area, wall area, plaque size and percentage of plaque burden of PR group were significantly greater than non-PR group (p < .001). Most plaques (90.9%) of the 44 patients were located at the dorsal, left and right walls. For the longitudinal distribution of plaque, 8 (18.2%) and 36 (81.8%) plaques were located in BA proximal and distal to AICA, respectively. Most plaques (68.2%) were eccentrically distributed. Conclusions 3D HRMRI with postprocessing multiple planar reconstruction is able to evaluate the remodeling pattern and plaque distribution of basilar artery atherosclerotic stenosis, which might be used to guide intracranial intervention.
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Affiliation(s)
- Runcai Guo
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing, China
| | - Xuebin Zhang
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing, China
| | - Xianjin Zhu
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing, China.
| | - Zunjing Liu
- Department of Neurology, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing, China.
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing, China
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14
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Comparison of plaque morphology between peripheral and coronary artery disease (from the CLARITY and ADAPT-DES IVUS substudies). Coron Artery Dis 2018; 28:369-375. [PMID: 28118185 DOI: 10.1097/mca.0000000000000469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to help understand the different outcomes when treating peripheral arterial disease (PAD) versus coronary artery disease (CAD). We compared plaque morphology between PAD and CAD using intravascular ultrasound. METHODS Complete Lesion Assessment with ffR and IVUS TechnologY (CLARITY) was a prospective, multicenter trial that enrolled 50 PAD patients with a lower extremity wound fed by a tibial or a peroneal artery with diameter stenosis more than 50%. Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents (ADAPT-DES) was a prospective, multicenter, registry that enrolled 8582 CAD patients. We compared preintervention intravascular ultrasound findings in 42 PAD lesions from CLARITY versus 79 matched CAD lesions from ADAPT-DES. RESULTS Compared with CAD lesions, PAD lesions had (i) smaller mean vessel, plaque, and lumen volumes; (ii) twice the lesion length; (iii) greater maximum superficial calcium arc and plaque eccentricity (i.e. there was more concentric plaque) measured at the minimum lumen area site; (iv) calcium arc and plaque eccentricity were positively correlated to plaque burden in both PAD and CAD lesions; and (v) calcium arc and the presence of concentric plaque were greater in PAD compared with CAD independent of the degree of plaque burden. CONCLUSION Compared with CAD lesions, PAD lesions in a tibial or a peroneal artery were longer; had more concentric, diffuse, and calcified plaque; and had smaller vessel volumes.
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15
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Leibundgut G, Kaspar M. Chronic Total Occlusions. Interv Cardiol 2017. [DOI: 10.5772/68067] [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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16
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Nyulas T, Chiţu M, Mester A, Jáni L, Condrea S, Opincariu D, Kovács I, Benedek I, Benedek T. Computed Tomography Biomarkers of Vulnerable Coronary Plaques. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography.
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Affiliation(s)
- Tiberiu Nyulas
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Monica Chiţu
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - András Mester
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Laura Jáni
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Sebastian Condrea
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Diana Opincariu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - István Kovács
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Imre Benedek
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
| | - Theodora Benedek
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tîrgu Mureș, Romania
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Feng C, Hua T, Xu Y, Liu XY, Huang J. Arterial remodeling of basilar atherosclerosis in isolated pontine infarction. Neurol Sci 2014; 36:547-51. [PMID: 25367406 DOI: 10.1007/s10072-014-1994-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Abstract
Isolated pontine infarctions are usually classified as paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI). Although they have different shapes and locations, some recent studies proved that they might both be associated with basilar artery atherosclerosis in pathogenesis. This study aimed to explore the difference of basilar artery remodeling between two subtypes of pontine infarctions. Patients with PPI or LPI were scanned by High-resolution MRI (HR-MRI). The MR images of patients with basilar artery atherosclerosis were further analyzed to measure the vessel, lumen and wall areas at different segments of basilar arteries. Stenosis rate and remodeling index were calculated according to which arterial remodeling was divided into positive, intermediate and negative remodeling. Vascular risk factors and remodeling-related features were compared between PPI and LPI, and also between patients with and without positive remodeling. 34 patients with PPI and 21 patients with LPI had basilar artery atherosclerosis identified by HR-MRI. Positive remodeling was dominant in LPI group while in PPI group, three subtypes of remodeling were equal. Patients with positive remodeling had higher levels of low-density lipoprotein and homocysteine. Positive remodeling of basilar artery might reflect the low stability of basilar atherosclerotic plaques, which was more closely associated with LPI than PPI.
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Affiliation(s)
- Chao Feng
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Middle Yanchang Rd. 301#, Zhabei District, Shanghai, China
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18
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Sun Z, Xu L. Computational fluid dynamics in coronary artery disease. Comput Med Imaging Graph 2014; 38:651-63. [PMID: 25262321 DOI: 10.1016/j.compmedimag.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 01/01/2023]
Abstract
Computational fluid dynamics (CFD) is a widely used method in mechanical engineering to solve complex problems by analysing fluid flow, heat transfer, and associated phenomena by using computer simulations. In recent years, CFD has been increasingly used in biomedical research of coronary artery disease because of its high performance hardware and software. CFD techniques have been applied to study cardiovascular haemodynamics through simulation tools to predict the behaviour of circulatory blood flow in the human body. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of coronary artery geometry, thus, identifying risk factors for development and progression of coronary artery disease. This review aims to provide an overview of the CFD applications in coronary artery disease, including biomechanics of atherosclerotic plaques, plaque progression and rupture; regional haemodynamics relative to plaque location and composition. A critical appraisal is given to a more recently developed application, fractional flow reserve based on CFD computation with regard to its diagnostic accuracy in the detection of haemodynamically significant coronary artery disease.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia 6845, Australia.
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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