1
|
Zhang G, Yang J, Xing H, Yin H, Gu G. Predicting Endothelium-Dependent Diastolic Function (FMD) and Its Correlation with the Degree of Coronary Artery Disease (CAD) and Plaque Vulnerability for Cardiovascular Events. Int J Gen Med 2024; 17:1117-1125. [PMID: 38532846 PMCID: PMC10964785 DOI: 10.2147/ijgm.s435417] [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: 08/27/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
Objective This study aims to investigate the correlation between vascular endothelium-dependent diastolic function (FMD) and the degree of coronary artery disease (CAD), plaque vulnerability, and its predictive value for cardiovascular events. Methods Initially, patients (n=100) who were admitted from January 2020 to January 2021 and intended to undergo percutaneous coronary intervention (PCI) were selected. Further, FMD in all patients was determined before the procedure and divided into a high-FMD group (≥4.2%) and a low-FMD group (<4.2%). Further, the data of two groups, including general information, coronary artery lesions, and plaque fibrous cap, were compared. Finally, the relationship between FMD and the degree of coronary artery lesions and plaque vulnerability was analyzed. Results No significant differences were observed concerning general information, number of coronary arteries-associated branches, lesion type, involvement of the left main stem (LM), the proportion of chronic occluded lesions (CTO), and lipid pool angle between the low-FMD group and the high-FMD group (P > 0.05). Nevertheless, the degree of stenosis of the lesions in the low-FMD group was significantly higher than in the high-FMD group (P < 0.05). In addition, the thickness of the fibrous cap was considerably lower than that in the high-FMD group (P < 0.05). Moreover, the incidence rate of TCFA was significantly higher than the high-FMD group (P < 0.05). The correlation analysis showed that FMD was significantly negatively correlated with the degree of coronary artery lesion stenosis and TCFA (P < 0.05) and positively correlated with the fibrous cap thickness (P < 0.05). Conclusion Overall, a negative correlation between FMD and the degree of coronary stenosis, plaque vulnerability, and a high predictive value for post-PCI cardiovascular events suggested that FMD could be a critical diagnostic marker for CAD.
Collapse
Affiliation(s)
- Guangming Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050004, People’s Republic of China
| | - Jing Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050004, People’s Republic of China
| | - Hanghang Xing
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050004, People’s Republic of China
| | - Hongning Yin
- Department of Heart ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050004, People's Republic of China
| | - Guoqing Gu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050004, People’s Republic of China
| |
Collapse
|
2
|
Li J, Chen R, Zhou J, Wang Y, Zhao X, Liu C, Zhou P, Chen Y, Song L, Yan S, Yan H, Zhao H. Lipid Content Distribution and its Clinical Implication in Patients with Acute Myocardial Infarction-Plaque Erosion: Results from the Prospective OCTAMI Study. J Atheroscler Thromb 2024; 31:23-35. [PMID: 37423723 PMCID: PMC10776303 DOI: 10.5551/jat.64144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
AIMS Plaque erosion (PE) is one of the main plaque phenotypes of acute coronary syndrome (ACS). However, the underlying plaque component and distribution have not been systematically analysed. This study aims to investigate the distribution of lipid and calcium content in culprit lesions assessed by optical coherence tomography (OCT) in patients with PE and explore its relationship with prognosis in a cohort of ST segment elevation myocardial infarction (STEMI) patients. METHODS A prospective cohort of 576 patients with STEMI was enrolled in our study. After exclusion, 152 PE patients with clear underlying plaque components were ultimately analysed. The culprit lesion was divided into the border zone, external erosion zone and erosion site in the longitudinal view. Each pullback of the culprit lesions was assessed by 3 independent investigators frame-by-frame, and the quantity and distribution of lipid and calcium components were recorded. RESULTS Of the 152 PE patients, lipid and calcium contents were more likely to exist in the external erosion zone than in the other regions. In particular, a high level of lipid content proximal to the erosion site was significantly associated with plaque vulnerability and a higher incidence of MACEs. CONCLUSION This study revealed that high level of lipid content in the proximal external erosion zone was related to high-risk plaque characteristics and poor prognosis, which provided a novel method for risk stratification and precise management in patients with plaque erosion.
Collapse
Affiliation(s)
- Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
3
|
Nafee T, Shah A, Forsberg M, Zheng J, Ou J. State-of-art review: intravascular imaging in percutaneous coronary interventions. CARDIOLOGY PLUS 2023; 8:227-246. [PMID: 38304487 PMCID: PMC10829907 DOI: 10.1097/cp9.0000000000000069] [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: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
The history of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) reflects the relentless pursuit of innovation in interventional cardiology. These intravascular imaging technologies have played a pivotal role in our understanding of coronary atherosclerosis, vascular pathology, and the interaction of coronary stents with the vessel wall. Two decades of clinical investigations demonstrating the clinical efficacy and safety of intravascular imaging modalities have established these technologies as staples in the contemporary cardiac catheterization lab's toolbox and earning their place in revascularization clinical practice guidelines. In this comprehensive review, we will delve into the historical evolution, mechanisms, and technical aspects of IVUS and OCT. We will discuss the expanding evidence supporting their use in complex percutaneous coronary interventions, emphasizing their crucial roles in optimizing patient outcomes and ensuring procedural success. Furthermore, we will explore the substantial advances that have propelled these imaging modalities to the forefront of contemporary interventional cardiology. Finally, we will survey the latest developments in the field and explore the promising future directions that have the potential to further revolutionize coronary interventions.
Collapse
Affiliation(s)
- Tarek Nafee
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Areeb Shah
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Michael Forsberg
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Jingsheng Zheng
- Department of Cardiology, AtlantiCare Regional Medical Center, Pomona, NJ 08240, USA
| | - Jiafu Ou
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
4
|
Biesenbach IIA, Heinsen LJ, Overgaard KS, Andersen TR, Auscher S, Egstrup K. The Effect of Clinically Indicated Liraglutide on Pericoronary Adipose Tissue in Type 2 Diabetic Patients. Cardiovasc Ther 2023; 2023:5126825. [PMID: 36714196 PMCID: PMC9867582 DOI: 10.1155/2023/5126825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
Vascular inflammation can be detected in the pericoronary adipose tissue (PCAT) by coronary computed tomography angiography (CCTA) attenuation. Treatment with liraglutide is associated with anti-inflammatory effects and reduces cardiovascular risk in diabetic patients. This study is aimed at examining the effect of clinically indicated liraglutide on PCAT attenuation. Asymptomatic patients with type 2 diabetes mellitus (T2DM) and without known ischemic heart disease underwent clinical examination, blood analysis, and CCTA. The main coronary arteries were outlined and PCAT attenuation was measured on the proximal 40 mm. Patients treated with liraglutide on a clinical indication were compared to patients not receiving liraglutide. The study included 190 patients; 53 (28%) received liraglutide (Lira+) and 137 (72%) did not (Lira-). There were no significant differences in PCAT attenuation between the two groups in either artery. However, PCAT attenuation measured around the left anterior descending artery (LAD) was lower in the Lira+ group after adjustment for age, sex, body mass index, and T2DM duration (b coefficient -2.4, p = 0.029). In a population of cardiac asymptomatic T2DM patients, treatment with clinically indicated liraglutide was not associated with differences in PCAT attenuation compared to nonliraglutide treatment in the unadjusted model. An association was seen in the adjusted model for the left anterior descending artery, possibly indicating an anti-inflammatory effect.
Collapse
Affiliation(s)
- Irmelin I. A. Biesenbach
- Faculty of Health Science, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Alle 15, 5700 Svendborg, Denmark
| | - Laurits J. Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Alle 15, 5700 Svendborg, Denmark
| | - Katrine S. Overgaard
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Alle 15, 5700 Svendborg, Denmark
| | - Thomas R. Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Alle 15, 5700 Svendborg, Denmark
| | - Søren Auscher
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Alle 15, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- Faculty of Health Science, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Alle 15, 5700 Svendborg, Denmark
| |
Collapse
|
5
|
Risk Score for Prediction of Acute Kidney Injury in Patients with Acute ST-Segment Elevation Myocardial Infarction. DISEASE MARKERS 2022; 2022:7493690. [PMID: 36583063 PMCID: PMC9794425 DOI: 10.1155/2022/7493690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Background Acute kidney injury (AKI) is an important comorbidity of ST-Segment Elevation Myocardial Infarction (STEMI) and worsens the prognosis. The purpose of this study was to investigate the relationship between clinical data, test results, surgical findings, and AKI in STEMI patients and to develop a simple, practical model for predicting the risk of AKI. Method Prognostic prediction research with clinical risk score development was conducted. The data used for model development was derived from the database of the Henan Province Cardiovascular Disease Clinical Data and Sample Resource Bank Engineering Research Center. The data used for external validation was derived from the China Chest Pain Center database. The study endpoint was defined as the occurrence of AKI. Logistic regression analysis was used to identify independent predictors of AKI. Logistic coefficients of each predictor were used for score weighting and transformation. The predictive performance of the newly derived risk scores was validated, respectively, by receiver operating characteristic (ROC) regression in the development population and the external validation population. Result A total of 364 patients, 57 (15.6%) with AKI and 307 (84.4%) without AKI, were included for score derivation. The validation crowd includes 88 STEMI patients in different institutions. A total of 11 potential predictors were explored under the multivariable logistic regression model. The new risk score was based on five final predictors which were age > 72 years, ejection fraction of no more than 40%, baseline serum creatinine > 102.7 mmol/L, red blood cell distribution width > 13.15, and culprit lesion located in the middistal segment. With only five predictor variables, the score predicted the risk of AKI with the effective discriminative ability (area under the receiver operating characteristic curve (AuROC): 0.721, 95% confidence interval (CI): 0.652-0.790). In the external validation, the newly developed score confirmed a similar discrimination as the crowd used for derivation (AuROC: 0.731, 95% CI: 0.624-0.838). Conclusion The newly developed score was proved to have good predictive performance and could be practically applied for risk stratification of AKI in STEMI patients.
Collapse
|
6
|
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
|
7
|
Physiologic and compositional coronary artery disease extension in patients with takotsubo syndrome assessed using artificial intelligence: an optical coherence tomography study. Coron Artery Dis 2022; 33:349-353. [PMID: 35383583 DOI: 10.1097/mca.0000000000001130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute and reversible ventricular motion abnormality without epicardial coronary obstruction. Optical flow ratio (OFR) is an approach to evaluate the coronary stenosis significance based on three-dimensional optical coherence tomography (3D-OCT). The aim of this study is to utilize OCT and an artificial intelligence plaque characterization model to show the prevalence and composition of atherosclerotic disease in coronary vessels of patients with TTS. METHODS This is a retrospective and observational study which enrolled patients with TTS who underwent coronary angiography and OCT examination. OCT images were analyzed for tissue characterization and OFR computation using a novel artificial intelligence algorithm. RESULTS A total of 37 patients and 49 vessels were studied. All patients were imaged in the left anterior descending coronary artery (LAD) and about two-thirds were also imaged in the left circumflex coronary artery (LCX). Most patients were women (n = 35), and apical was the most common takotsubo type. Tissue composition analysis yielded the following overall plaque types: fibrous (67.1%), lipid (15.5%), and calcium (3.77%). The mean OFR for LAD and LCX was 0.97 ± 0.04 and 0.98 ± 0.02, respectively. CONCLUSION Utilizing automatic plaque characterization on OCT images by artificial intelligence, we found that TTS patients have coronary artery disease (i.e. presence of lipid, calcified, or fibrous tissue). The advent of artificial intelligence methods may allow for large-scale studies of patients with TTS.
Collapse
|
8
|
OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1171-1179. [DOI: 10.1093/ehjci/jeac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Indexed: 11/13/2022] Open
|
9
|
Shlofmitz E, Mintz GS, Torguson R, Zhang C, Shea C, Shah P, Doros G, Ali ZA, Artis A, Singh V, Skinner W, Cate TT, Di Mario C, Garcia-Garcia HM, Waksman R. Longitudinal Distribution of Lipid-Rich Plaque in Nonculprit Lesions: A Lipid Rich Plaque Study Subanalysis. JACC Cardiovasc Imaging 2021; 15:168-170. [PMID: 34801454 DOI: 10.1016/j.jcmg.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
|
10
|
Sibbald M, Pinilla-Echeverri N, Alameer M, Chavarria J, Dutra G, Sheth T. Using Optical Coherence Tomography to Identify Lipid and Its Impact on Interventions and Clinical Events - A Scoping Review. Circ J 2021; 85:2053-2062. [PMID: 34305071 DOI: 10.1253/circj.cj-21-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optical coherence tomographic (OCT) imaging has enabled identification of lipid, with increasing interest in how it may affect coronary interventions and clinical outcomes. This review summarizes the available evidence around OCT identification of lipid and its effect on interventions, clinical events, and the natural history of coronary disease. METHODS AND RESULTS We conducted a scoping review using the Medline, HealthStar, and Embase databases for articles published between 1996 and 2021. We screened 1,194 articles and identified 51 for inclusion in this study, summarizing the key findings. The literature supports a common OCT definition of lipid as low-signal regions with diffuse borders, validated against histology and other imaging modalities with acceptable intra- and inter-rater reliability. There is evidence that OCT-identified lipid at the site of stent implantation increases the risk of edge dissection, incomplete stent apposition, in-stent tissue protrusion, decreased coronary flow after stenting, side branch occlusion, and post-procedural cardiac biomarker increases. In mostly retrospective studies, lipid indices measured at non-stented sites are associated with plaque progression and the development of recurrent ischemic events. CONCLUSIONS There is extensive literature supporting the ability of OCT to identify lipid and demonstrating a substantial impact of lipid on percutaneous coronary intervention outcomes. Future work to prospectively evaluate the effect of the characteristics of lipid-rich plaques on long-term clinical outcomes is needed.
Collapse
Affiliation(s)
| | | | | | | | | | - Tej Sheth
- Department of Medicine, McMaster University
- Population Health Research Institute, McMaster University
| |
Collapse
|
11
|
Leistner DM, Kränkel N, Meteva D, Abdelwahed YS, Seppelt C, Stähli BE, Rai H, Skurk C, Lauten A, Mochmann HC, Fröhlich G, Rauch-Kröhnert U, Flores E, Riedel M, Sieronski L, Kia S, Strässler E, Haghikia A, Dirks F, Steiner JK, Mueller DN, Volk HD, Klotsche J, Joner M, Libby P, Landmesser U. Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap: results from the prospective translational OPTICO-ACS study. Eur Heart J 2021; 41:3549-3560. [PMID: 33080003 DOI: 10.1093/eurheartj/ehaa703] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Acute coronary syndromes with intact fibrous cap (IFC-ACS), i.e. caused by coronary plaque erosion, account for approximately one-third of ACS. However, the underlying pathophysiological mechanisms as compared with ACS caused by plaque rupture (RFC-ACS) remain largely undefined. The prospective translational OPTICO-ACS study programme investigates for the first time the microenvironment of ACS-causing culprit lesions (CL) with intact fibrous cap by molecular high-resolution intracoronary imaging and simultaneous local immunological phenotyping. METHODS AND RESULTS The CL of 170 consecutive ACS patients were investigated by optical coherence tomography (OCT) and simultaneous immunophenotyping by flow cytometric analysis as well as by effector molecule concentration measurements across the culprit lesion gradient (ratio local/systemic levels). Within the study cohort, IFC caused 24.6% of ACS while RFC-ACS caused 75.4% as determined and validated by two independent OCT core laboratories. The IFC-CL were characterized by lower lipid content, less calcification, a thicker overlying fibrous cap, and largely localized near a coronary bifurcation as compared with RFC-CL. The microenvironment of IFC-ACS lesions demonstrated selective enrichment in both CD4+ and CD8+ T-lymphocytes (+8.1% and +11.2%, respectively, both P < 0.05) as compared with RFC-ACS lesions. T-cell-associated extracellular circulating microvesicles (MV) were more pronounced in IFC-ACS lesions and a significantly higher amount of CD8+ T-lymphocytes was detectable in thrombi aspirated from IFC-culprit sites. Furthermore, IFC-ACS lesions showed increased levels of the T-cell effector molecules granzyme A (+22.4%), perforin (+58.8%), and granulysin (+75.4%) as compared with RFC plaques (P < 0.005). Endothelial cells subjected to culture in disturbed laminar flow conditions, i.e. to simulate coronary flow near a bifurcation, demonstrated an enhanced adhesion of CD8+T cells. Finally, both CD8+T cells and their cytotoxic effector molecules caused endothelial cell death, a key potential pathophysiological mechanism in IFC-ACS. CONCLUSIONS The OPTICO-ACS study emphasizes a novel mechanism in the pathogenesis of IFC-ACS, favouring participation of the adaptive immune system, particularly CD4+ and CD8+ T-cells and their effector molecules. The different immune signatures identified in this study advance the understanding of coronary plaque progression and may provide a basis for future development of personalized therapeutic approaches to ACS with IFC. TRIAL REGISTRATION The study was registered at clinicalTrials.gov (NCT03129503).
Collapse
Affiliation(s)
- David M Leistner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Nicolle Kränkel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Denitsa Meteva
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Claudio Seppelt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Himanshu Rai
- DZHK (German Centre for Cardiovascular Research) Partner Site Munch, Munich, 80636, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Alexander Lauten
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Hans-Christian Mochmann
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany
| | - Georg Fröhlich
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Eduardo Flores
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany
| | - Matthias Riedel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Lara Sieronski
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Sylvia Kia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Elisabeth Strässler
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Arash Haghikia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Fabian Dirks
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Julia K Steiner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Dominik N Mueller
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany.,Experimental and Clinical Research Centre (ECRC), a cooperation of Charité University Medicine Berlin and Max Delbruck Centre for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany.,Max Delbruck Centre for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
| | - Hans-Dieter Volk
- Berlin Institute of Health (BIH), Berlin 10117, Germany.,Institute for Medical Immunology and BIH Centre for Regenerative Therapies (BCRT), and Berlin Centre for Advanced Therapies (BeCAT), Charité University Medicine Berlin, Berlin 13353, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, and Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Charité Mitte, Berlin 10117, Germany
| | - Michael Joner
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Munich, 80636, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Munch, Munich, 80636, Germany
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave Louis Pasteur, Boston, MA 02115, USA
| | - Ulf Landmesser
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| |
Collapse
|
12
|
Hougaard M, Hansen HS, Thayssen P, Maehara A, Antonsen L, Junker A, Mintz GS, Jensen LO. Influence of Ezetimibe on Plaque Morphology in Patients with ST Elevation Myocardial Infarction Assessed by Optical Coherence Tomography: An OCTIVUS Sub-Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1417-1424. [PMID: 31097383 DOI: 10.1016/j.carrev.2019.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
Abstract
AIMS The aim of the trial was to examine the influence of ezetimibe on plaque morphology in patients with ST-segment Elevation Myocardial Infarction (STEMI) with respect to fibrous cap thickness (FCT) and arcs of lipid plaque, calcific plaque, and macrophages using Optical Coherence Tomography (OCT). METHODS AND RESULTS In 87 statin naïve patients with STEMI treated with primary percutaneous intervention, a non-culprit study plaque in a non-infarct related coronary artery was assessed with OCT at baseline and after 12 months. Patients were treated with atorvastatin 80 mg and randomized (1:1) to ezetimibe 10 mg (n = 43) or placebo (n = 44). An increase in median FCT (ezetimibe 200 (140-260) μm to 240 (190-305) μm (p = 0.002) vs. placebo 205 (135-260) μm to 230 (180-270) μm (p < 0.001), between groups p = ns), a reduction in lipid arc (ezetimibe 1728.5 (1022.5-3904.7)° to 1164.5 (736.6-2580.1)° (p = 0.001) vs. placebo 1671.6 (978.3-2868.7)° to 1373.7 (791.2-2267.3)° (p = 0.019), between groups p = ns), and macrophage arc (ezetimibe 1730.3 (965.7-2984.4)° to 1324.8 (819.0-2819.7)° (p < 0.05) vs. placebo 1570.5 (794.7-3016.8)° to 1418.9 (584.1-2501.1)° (p < 0.01), between groups p = ns) were observed. CONCLUSION Aggressive LDL-lowering resulted in changes in OCT assessed plaque composition by increased FCT thickness and a reduction in lipid content and macrophage infiltration. Addition of ezetimibe 10 mg to atorvastatin 80 mg resulted in further LDL reduction, but no additional change in plaque composition was found.
Collapse
Affiliation(s)
- Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Akiko Maehara
- Cardiovascular Research Foundation, Columbia University Medical Center, United States of America
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Gary S Mintz
- Cardiovascular Research Foundation, Columbia University Medical Center, United States of America
| | | |
Collapse
|
13
|
Zhang TY, Zhao Q, Liu ZS, Zhang CY, Yang J, Meng K. Relationship between monocyte/lymphocyte ratio and non-culprit plaque vulnerability in patients with acute coronary syndrome: An optical coherence tomography study. Medicine (Baltimore) 2020; 99:e21562. [PMID: 33031255 PMCID: PMC7544167 DOI: 10.1097/md.0000000000021562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The importance of monocyte/lymphocyte ratio (MLR) has been indicated in the initiation and progression of coronary artery disease. However, few previous researches demonstrated the relationship between MLR and plaque vulnerability. We aimed to investigate coronary non-culprit plaque vulnerability in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT).A total of 72 ACS patients who underwent coronary angiography and OCT test in Beijing Anzhen Hospital were included in this retrospective study. The plaque vulnerability and plaque morphology were assessed by OCT.The non-culprit plaque in high MLR group exhibited more vulnerable features, characterizing as thinner thickness of fibrous cap (P = .013), greater maximum lipid core angle (P = .010) and longer lipid plaque length (P = .041). A prominently negative liner relation was found between MLR and thickness of fibrous cap (R = -0.225, P = .005). Meanwhile, the proportion of OCT-detected thin cap fibro-atheroma (TCFA) (P = .014) and plaque rupture (P = .017) were higher in high MLR group. Most importantly, multivariable logistic regression analysis showed MLR level was identified as an independent contributor to the presence of TCFA (OR:3.316, 95%: 1.448-7.593, P = .005). MLR could differentiate TCFA with a sensitivity of 60.0% and a specificity of 85.1%.Circulating MLR level has potential value in identifying the presence of vulnerable plaque in patients with ACS. MLR, as a non- invasive biomarker of inflammation, may be valuable in revealing plaque vulnerability.
Collapse
Affiliation(s)
- Ting-yu Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Qi Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Ze-sen Liu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University
| | - Chao-yi Zhang
- Department of Cardiology, Beijing Zhongguanchun Hospital, Beijing, China
| | - Jie Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Kang Meng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| |
Collapse
|
14
|
Comparison of plaque distribution and wire-free functional assessment in patients with stable angina and non-ST elevation myocardial infarction: an optical coherence tomography and quantitative flow ratio study. Coron Artery Dis 2020; 32:131-137. [PMID: 32826449 DOI: 10.1097/mca.0000000000000944] [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
BACKGROUND Data comparing plaque characteristics and wire-free physiological assessment in the target vessel in patients with stable angina versus acute coronary syndrome are sparse. Therefore, we investigated the difference in plaque distribution between stable angina and non-ST-elevation myocardial infarction (NSTEMI) and explored the relationship between target vessel vulnerability by optical coherence tomography (OCT) and wire-free functional assessment with quantitative flow ratio (QFR). METHODS Patients with stable angina (n = 25) and NSTEMI (n = 24) were in the final prospective study cohort from the DECODE study (ClinicalTrials.gov, NCT02335086). All 5480 OCT frames in the region of interest were analyzed to study plaque morphology in the target vessel. QFR was analyzed from baseline coronary angiography before percutaneous coronary intervention. Vulnerable vessel score (VVS) was calculated from each plaque, and vessel QFR was then compared. RESULTS Out of all frames, thin-cap fibroatheroma was common with NSTEMI compared to stable angina (10.9 versus 6.3%, P < 0.01), while fibrous plaque was more commonly seen with stable angina compared to NSTEMI (19.7 versus 14.4%, P < 0.01). Calcified plaque was similar in both clinical settings (approximately 6%). Regression analysis showed that segments with normal vessel walls were located significantly farther from the other plaque types. Longitudinal distances for plaque-type in NSTEMI were numerically greater than those for stable angina; however, the mean difference was less than 10 mm. The VVS had a significant inverse linear correlation with QFR (r = -0.34, P = 0.009). CONCLUSIONS The plaque distribution by OCT between stable angina and NSTEMI was similar. Target vessel vulnerability was greater in patients with lower QFR value.
Collapse
|
15
|
Li X, Kan J, She L, Shrestha R, Pan T, You W, Wu Z, Ge Z, Zhang JJ, Gogas BD, Ye F, Chen SL. Optical coherence tomography predictors of target vessel myocardial infarction after provisional stenting in patients with coronary bifurcation disease. Catheter Cardiovasc Interv 2020; 97:1331-1340. [PMID: 32659048 DOI: 10.1002/ccd.28980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Provisional side branch (SB) stenting is correlated with target vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the mechanisms underlying this association remain unknown. OBJECTIVES To determine the correlation between SB lesion length with vulnerable plaques and TVMI using optical coherence tomography (OCT). BACKGROUND The correlation between SB lesion length with vulnerable plaques and TVMI is unknown. METHODS A total of 405 patients with 405 bifurcation lesions who underwent preprocedure OCT imaging of both the main vessel (MV) and the SB were enrolled. Patients were divided into long SB lesion (SB lesion length ≥10 mm) and short SB lesion (SB lesion length <10 mm) groups according to quantitative coronary analysis; they were also stratified by the presence of vulnerable plaques identified by OCT. The primary endpoint was the occurrence of TVMI after provisional stenting at 1-year follow-up. RESULTS In total, 178 (43.9%) patients had long SB lesions. Vulnerable plaques were predominantly localized in the MV and were more frequently in the long SB lesion group (42.7%) than in the short SB lesion group (24.2%, p < .001). At 1-year follow-up after provisional stenting, there were 31 (7.7%) TVMIs, with 21 (11.8%) in the long SB lesion group and 10 (4.4%) in the short SB lesion group (p = .009). Multivariate regression analysis showed that long SB lesion length (p = .011), absence of vulnerable plaques in the polygon of confluence (p = .001), and true coronary bifurcation lesions (p = .004) were the three independent factors of TVMI. CONCLUSIONS The presence of long SB lesion with MV vulnerable plaques predicts the increased risk of TVMI after provisional stenting in patients with true coronary bifurcation lesions. Further studies are warranted to identify the best stenting techniques for coronary bifurcation lesions with long SB lesions.
Collapse
Affiliation(s)
- Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liping She
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Rajiv Shrestha
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Pan
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Wei You
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiming Wu
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Bill D Gogas
- Division of Cardiology, Emory University Hospital, Atlanta, Georgia, USA
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.,College of Pharmacy, Nanjing Medical University, Nanjing, China
| |
Collapse
|
16
|
Araki M, Soeda T, Kim HO, Thondapu V, Russo M, Kurihara O, Shinohara H, Minami Y, Higuma T, Lee H, Yonetsu T, Kakuta T, Jang IK. Spatial Distribution of Vulnerable Plaques: Comprehensive In Vivo Coronary Plaque Mapping. JACC Cardiovasc Imaging 2020; 13:1989-1999. [PMID: 32912472 DOI: 10.1016/j.jcmg.2020.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The authors performed a comprehensive analysis on the distribution of coronary plaques with different phenotypes from our 3-vessel optical coherence tomography (OCT) database. BACKGROUND Previous pathology studies demonstrated that thin-cap fibroatheroma (TCFA) is localized in specific segments of the epicardial coronary arteries. A detailed description of in vivo coronary plaques of various phenotypes has not been reported. METHODS OCT images of all 3 coronary arteries in 131 patients were analyzed every 1 mm to assess plaque phenotype and features of vulnerability. In addition, plaques were divided into tertiles according to percent area stenosis (%AS). RESULTS Among 534 plaques identified in 393 coronary arteries, 27.0% were fibrous plaques, 13.3% were fibrocalcific plaques, 40.8% were thick-cap fibroatheromas, and 18.9% were TCFAs. TCFAs showed clustering in the proximal segment, particularly in the left anterior descending artery. On the other hand, fibrous plaques were relatively evenly distributed throughout the entire length of the coronary arteries. In patients with acute coronary syndromes (ACS), TCFAs showed stronger proximal clustering in the left anterior descending, 2 clustering peaks in the right coronary artery, and 1 clustering peak in the circumflex artery. The pattern of TCFA distribution was less obvious in patients without ACS. The prevalence of TCFA was higher in the highest %AS tertile, compared with the lowest %AS tertile (30% vs. 9%; p < 0.001). CONCLUSIONS The present 3-vessel OCT study showed that TCFAs cluster at specific locations in the epicardial coronary arteries, especially in patients with ACS. TCFA was more prevalent in segments with tight stenosis. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
Collapse
Affiliation(s)
- Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan.
| | - Hyung Oh Kim
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vikas Thondapu
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michele Russo
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroki Shinohara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea.
| |
Collapse
|
17
|
Difference in plaque characteristics of coronary culprit lesions in a cohort of Egyptian patients presented with acute coronary syndrome and stable coronary artery disease: An optical coherence tomography study. Egypt Heart J 2018; 70:95-100. [PMID: 30166889 PMCID: PMC6112336 DOI: 10.1016/j.ehj.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022] Open
Abstract
Aims This study was designed to utilize frequency-domain optical coherence tomography (FD-OCT) for assessment of plaque characteristics and vulnerability in patients with acute coronary syndrome (ACS) compared to stable coronary artery disease (SCAD). Methods and results We enrolled 48 patients; divided into an ACS-group (27 patients) and SCAD-group (21 patients) according to their clinical presentation. Hypertension and diabetes mellitus were more prevalent in SCAD group. Patients with ACS showed higher frequency of lipid-rich plaques (96.3% vs. 66.7%, P = .015), lower frequency of calcium plaques (7.4% vs. 57.1%, P < .001), and fibrous plaques (14.8% vs. 81%, P < .001) when compared with SCAD patients. The TCFA (defined as lipid-rich plaque with cap thickness <65 μm) identified more frequently (33.3% vs. 14.3%, P = .185), with a trend towards thinner median fibrous cap thickness (70 (50–180) µm vs. 100 (50–220) µm, P = .064) in ACS group. Rupture plaque (52% vs. 14.3%, P = .014), plaque erosion (18.5% vs. 0%, P = .059) and intracoronary thrombus (92.6% vs. 14.3%, P < .001) were observed more frequently in ACS group, while cholesterol crystals were identified frequently in patients with SCAD (0.0% vs. 33.3%, P = .002). Conclusion The current FD-OCT study demonstrated the differences of plaque morphology and identified distinct lesion characteristics between patients with ACS and those with SCAD. These findings could explain the clinical presentation of patients in both groups.
Collapse
Key Words
- %AS, percent area stenosis
- ACS, acute coronary syndrome
- Clinical presentation
- ECG, electrocardiogram
- EF, ejection fraction
- FCT, fibrous cap thickness
- FD-OCT, frequency-domain optical coherence tomography
- Frequency-domain optical coherence tomography
- ICC, intra-class correlation
- IVUS, intravascular ultrasound virtual histologic
- LAD, left anterior descending coronary artery
- LCX, left circumflex coronary artery
- MFCT, minimum fibrous cap thickness
- MLCSA, minimum luminal cross sectional area
- NSTE-ACS, non-ST-elevation acute coronary syndrome
- Plaque characteristics
- RCA, right coronary artery
- SAP, stable angina pectoris
- SCAD, stable coronary artery disease
- STEMI, ST elevation myocardial infarction
- TCFAs, thin cap fibroatheromas
Collapse
|
18
|
Di Vito L, Imola F, Gatto L, Romagnoli E, Limbruno U, Marco V, Picchi A, Micari A, Albertucci M, Prati F. Limitations of OCT in identifying and quantifying lipid components: an in vivo comparison study with IVUS-NIRS. EUROINTERVENTION 2018; 13:303-311. [PMID: 27973332 DOI: 10.4244/eij-d-16-00317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to assess the agreement between IVUS-NIRS and OCT to assess lipid plaques in patients with acute coronary syndromes or stable angina. In addition, the impact of both macrophages and calcifications was investigated. METHODS AND RESULTS Forty-three patients undergoing both IVUS-NIRS and OCT assessment of the culprit and/or non-culprit coronary lesions were enrolled. Cross-sections from lipid plaques, calcified plaques and normal-appearing vessel tracts were identified and matched with the two imaging techniques. Lipid arc was measured by both IVUS-NIRS and OCT. Macrophage presence and calcifications were also investigated with OCT. OCT detected a lipid plaque in 90 cross-sections (48.9%), with a sensitivity of 85.5% and a specificity of 69.7% as compared with IVUS-NIRS. The percentage of OCT false positive was 20.1% and of false negative was 4.9% for lipid plaque detection. The Pearson correlation coefficient for lipid arc was 0.675, p=0.0001. Macrophages were detected in 73% of OCT false positive cross-sections. Conversely, calcifications were present in 66.7% of OCT false negative cross-sections. The variability of lipid arc was independently associated with macrophages (beta=0.295, p=0.013). CONCLUSIONS Agreement between IVUS-NIRS and OCT for lipid plaque detection is suboptimal. The presence of macrophages and superficial calcifications on OCT negatively affects lipid detection.
Collapse
Affiliation(s)
- Luca Di Vito
- Centro per la Lotta contro l'Infarto - CLI Foundation, Rome, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Correlation of Serum Uric Acid Levels with Nonculprit Plaque Instability in Patients with Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7919165. [PMID: 29568764 PMCID: PMC5820670 DOI: 10.1155/2018/7919165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022]
Abstract
Elevated serum uric acid (SUA) level is known to be a prognostic factor in patients with acute coronary syndrome (ACS). However, the correlation between SUA level and coronary plaque instability has not been fully evaluated. The aim of this study was to investigate the association between SUA level and plaque instability of nonculprit lesions in patients with ACS using optical coherence tomography. A total of 150 patients with ACS who underwent 3-vessel optical coherence tomography were selected. Patients were classified into 3 groups according to tertiles of SUA level. There was a trend towards a thinner fibrous cap (0.15 ± 0.06 versus 0.07 ± 0.01 versus 0.04 ± 0.01 mm2, p < 0.001) and a wider mean lipid arc (169.41 ± 33.16 versus 177.22 ± 37.76 versus 222.43 ± 47.65°, p < 0.001) with increasing SUA tertile. The plaques of the high and intermediate tertile groups had a smaller minimum lumen area than the low tertile group (6.02 ± 1.11 versus 5.38 ± 1.28 mm2, p < 0.001). In addition, thin-cap fibroatheromas, microvessels, macrophages, and cholesterol crystals were more frequent in the high tertile group than the low and intermediate groups. Multivariate analysis showed SUA level to be a predictor of plaque instability.
Collapse
|
20
|
Phipps JE, Hoyt T, Vela D, Wang T, Michalek JE, Buja LM, Jang IK, Milner TE, Feldman MD. Diagnosis of Thin-Capped Fibroatheromas in Intravascular Optical Coherence Tomography Images: Effects of Light Scattering. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003163. [PMID: 27406987 DOI: 10.1161/circinterventions.115.003163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 05/16/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intravascular optical coherence tomography (IVOCT) images are recorded by detecting light backscattered within coronary arteries. We hypothesize that non-thin-capped fibroatheroma (TCFA) causes may scatter light to create the false appearance of IVOCT TCFA. METHODS AND RESULTS Ten human cadaver hearts were imaged with IVOCT (n=14 coronary arteries). IVOCT and histological TCFA images were coregistered and compared. Of 21 IVOCT TCFAs (fibrous cap <65 μm, lipid arc >1 quadrant), only 8 were true histological TCFA. Foam cell infiltration was responsible for 70% of false IVOCT TCFA and caused both thick-capped fibroatheromas to appear as TCFA, and the appearance of TCFAs when no lipid core was present. Other false IVOCT TCFA causes included smooth muscle cell-rich fibrous tissue (12%) and loose connective tissue (9%). If the lipid arc >1 quadrant (obtuse) criterion was disregarded, 45 IVOCT TCFAs were identified, and sensitivity of IVOCT TCFA detection increased from 63% to 87%, and specificity remained high at 92%. CONCLUSIONS We demonstrate that IVOCT can exhibit 87% (95% CI, 75%-93%) sensitivity and 92% specificity (95% CI, 86%-96%) to detect all lipid arcs (both obtuse and acute, <1 quadrant) TCFA, and we also propose new mechanisms involving light scattering that explain why other plaque components can masquerade as TCFA and cause low positive predictive value of IVOCT for TCFA detection (47% for obtuse lipid arcs). Disregarding the lipid arc >1 quadrant requirement enhances the ability of IVOCT to detect TCFA.
Collapse
Affiliation(s)
- Jennifer E Phipps
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Taylor Hoyt
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Deborah Vela
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Tianyi Wang
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Joel E Michalek
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - L Maximilian Buja
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Ik-Kyung Jang
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Thomas E Milner
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.)
| | - Marc D Feldman
- From the Department of Medicine (J.E.P., T.H., M.D.F.) and Epidemiology and Biostatistics (J.E.M.), University of Texas Health Science Center San Antonio; Department of Cardiovascular Pathology, Texas Heart Institute, Houston (D.V., L.M.B.); Department of Biomedical Engineering, University of Texas at Austin (T.W., T.E.M.); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio (M.D.F.).
| |
Collapse
|
21
|
Near-infrared autofluorescence induced by intraplaque hemorrhage and heme degradation as marker for high-risk atherosclerotic plaques. Nat Commun 2017; 8:75. [PMID: 28706202 PMCID: PMC5509677 DOI: 10.1038/s41467-017-00138-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/02/2017] [Indexed: 12/19/2022] Open
Abstract
Atherosclerosis is a major cause of mortality and morbidity, which is mainly driven by complications such as myocardial infarction and stroke. These complications are caused by thrombotic arterial occlusion localized at the site of high-risk atherosclerotic plaques, of which early detection and therapeutic stabilization are urgently needed. Here we show that near-infrared autofluorescence is associated with the presence of intraplaque hemorrhage and heme degradation products, particularly bilirubin by using our recently created mouse model, which uniquely reflects plaque instability as seen in humans, and human carotid endarterectomy samples. Fluorescence emission computed tomography detecting near-infrared autofluorescence allows in vivo monitoring of intraplaque hemorrhage, establishing a preclinical technology to assess and monitor plaque instability and thereby test potential plaque-stabilizing drugs. We suggest that near-infrared autofluorescence imaging is a novel technology that allows identification of atherosclerotic plaques with intraplaque hemorrhage and ultimately holds promise for detection of high-risk plaques in patients. Atherosclerosis diagnosis relies primarily on imaging and early detection of high-risk atherosclerotic plaques is important for risk stratification of patients and stabilization therapies. Here Htun et al. demonstrate that vulnerable atherosclerotic plaques generate near-infrared autofluorescence that can be detected via emission computed tomography.
Collapse
|
22
|
Kataoka Y, Puri R, Hammadah M, Duggal B, Uno K, Kapadia SR, Tuzcu EM, Nissen SE, King P, Nicholls SJ. Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004506. [PMID: 27511975 DOI: 10.1161/circimaging.116.004506] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Numerous reports suggest sex-related differences in atherosclerosis. Frequency-domain optical coherence tomography has enabled visualization of plaque microstructures associated with disease instability. The prevalence of plaque microstructures between sexes has not been characterized. We investigated sex differences in plaque features in patients with coronary artery disease. METHODS AND RESULTS Nonculprit plaques on frequency-domain optical coherence tomography imaging were compared between men and women with either stable coronary artery disease (n=320) or acute coronary syndromes (n=115). A greater prevalence of cardiovascular risk factors was observed in women. Nonculprit plaques in women with stable coronary artery disease were more likely to exhibit plaque erosion (8.6% versus 0.3%; P=0.03) and a smaller lipid arc (163.1±71.4° versus 211.2±71.2°; P=0.03), and less likely to harbor cholesterol crystals (17.2% versus 27.5%; P=0.01) and calcification (15.4% versus 34.4%; P=0.008), whereas fibrous cap thickness (105.2±62.1 versus 96.1±40.4 µm; P=0.57), the prevalence of thin-cap fibroatheroma (26.5% versus 25.2%; P=0.85), and microchannels (19.2% versus 20.5%; P=0.95) were comparable. In women with acute coronary syndrome, a smaller lipid arc (171.6±53.2° versus 235.8±86.4°; P=0.03), a higher frequency of plaque erosion (11.4% versus 0.6%; P=0.04), and a lower prevalence of cholesterol crystal (28.6% versus 38.2%; P=0.03) and calcification (10.0% versus 23.7%; P=0.01) were observed. These differences persisted after adjusting clinical demographics. Although thin-cap fibroatheromas in men clustered within proximal arterial segments, thin-cap fibroatheromas were evenly distributed in women. CONCLUSIONS Despite more comorbid risk factors in women, their nonculprit plaques exhibited more plaque erosion, and less cholesterol and calcium content. This distinct phenotype suggests sex-related differences in the pathophysiology of atherosclerosis.
Collapse
Affiliation(s)
- Yu Kataoka
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Rishi Puri
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Muhammad Hammadah
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Bhanu Duggal
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Kiyoko Uno
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Samir R Kapadia
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - E Murat Tuzcu
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Steven E Nissen
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Peta King
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.)
| | - Stephen J Nicholls
- From the South Australian Health & Medical Research Institute, University of Adelaide, Australia (Y.K., P.K., S.J.N.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., M.H., B.D., K.U., S.R.K., E.M.T.); and Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P., K.U., S.E.N.).
| |
Collapse
|
23
|
Plaque composition and morphologic characteristics in significant left main bifurcation disease; virtual histology intravascular ultrasound study. Coron Artery Dis 2016; 27:623-628. [DOI: 10.1097/mca.0000000000000417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Sakellarios AI, Raber L, Bourantas CV, Exarchos TP, Athanasiou LS, Pelosi G, Koskinas KC, Parodi O, Naka KK, Michalis LK, Serruys PW, Garcia-Garcia HM, Windecker S, Fotiadis DI. Prediction of Atherosclerotic Plaque Development in an In Vivo Coronary Arterial Segment Based on a Multilevel Modeling Approach. IEEE Trans Biomed Eng 2016; 64:1721-1730. [PMID: 28113248 DOI: 10.1109/tbme.2016.2619489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to explore major mechanisms of atherosclerotic plaque growth, presenting a proof-of-concept numerical model. METHODS To this aim, a human reconstructed left circumflex coronary artery is utilized for a multilevel modeling approach. More specifically, the first level consists of the modeling of blood flow and endothelial shear stress (ESS) computation. The second level includes the modeling of low-density lipoprotein (LDL) and high-density lipoprotein and monocytes transport through the endothelial membrane to vessel wall. The third level comprises of the modeling of LDL oxidation, macrophages differentiation, and foam cells formation. All modeling levels integrate experimental findings to describe the major mechanisms that occur in the arterial physiology. In order to validate the proposed approach, we utilize a patient specific scenario by comparing the baseline computational results with the changes in arterial wall thickness, lumen diameter, and plaque components using follow-up data. RESULTS The results of this model show that ESS and LDL concentration have a good correlation with the changes in plaque area [R2 = 0.365 (P = 0.029, adjusted R2 = 0.307) and R2 = 0.368 (P = 0.015, adjusted R2 = 0.342), respectively], whereas the introduction of the variables of oxidized LDL, macrophages, and foam cells as independent predictors improves the accuracy in predicting regions potential for atherosclerotic plaque development [R2 = 0.847 (P = 0.009, adjusted R2 = 0.738)]. CONCLUSION Advanced computational models can be used to increase the accuracy to predict regions which are prone to plaque development. SIGNIFICANCE Atherosclerosis is one of leading causes of death worldwide. For this purpose computational models have to be implemented to predict disease progression.
Collapse
|
25
|
Combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) prospective study. Rationale and design. Cardiovasc Diabetol 2016; 15:144. [PMID: 27724869 PMCID: PMC5057218 DOI: 10.1186/s12933-016-0464-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/30/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fractional flow reserve (FFR) is a widely used tool for the identification of ischaemia-generating stenoses and to guide decisions on coronary revascularisation. However, the safety of FFR-based decisions in high-risk subsets, such as patients with Diabetes Mellitus (DM) or vulnerable stenoses presenting thin-cap fibro-atheroma (TCFA), is unknown. This study will examine the impact of optical coherence tomography (OCT) plaque morphological assessment and the identification of TCFA, in combination with FFR to better predict clinical outcomes in DM patients. METHODS COMBINE (OCT-FFR) is a prospective, multi-centre study investigating the natural history of DM patients with ≥1 angiographically intermediate target lesion in three subgroups of patients; patients with FFR negative lesions without TCFA (group A) and patients with FFR negative lesions with TCFA (group B) as detected by OCT and to compare these two groups with each other, as well as to a third group with FFR-positive, PCI-treated intermediate lesions (group C). The study hypothesis is that DM patients with TCFA (group B) have a worse outcome than those without TCFA (group A) and also when compared to those patients with lesions FFR ≤0.80 who underwent complete revascularisation. The primary endpoint is the incidence of target lesion major adverse cardiac events (MACE); a composite of cardiac death, myocardial infarction or rehospitalisation for unstable/progressive angina in group B vs. group A. CONCLUSION COMBINE (OCT-FFR) is the first prospective study to examine whether the addition of OCT plaque morphological evaluation to FFR haemodynamic assessment of intermediate lesions in DM patients will better predict MACE and possibly lead to new revascularisation strategies. Trial Registration Netherlands Trial Register: NTR5376.
Collapse
|
26
|
Morofuji T, Inaba S, Hitsumoto T, Takahashi K, Aisu H, Higashi H, Saito M, Ohshima K, Ikeda S, Hamada M, Sumimoto T. Usefulness of Intravascular Ultrasound for Predicting Risk of Intraprocedural Stent Thrombosis. Am J Cardiol 2016; 117:918-25. [PMID: 26822168 DOI: 10.1016/j.amjcard.2015.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non-ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n = 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p <0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6 mm(2) [interquartile range, 4.3 to 6.5] vs 2.4 mm(2) [1.8 to 2.9]; p <0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST.
Collapse
|
27
|
Abstract
Atherosclerosis remains a major cause of morbidity and mortality worldwide, and a thorough understanding of the underlying pathophysiological mechanisms is crucial for the development of new therapeutic strategies. Although atherosclerosis is a systemic inflammatory disease, coronary atherosclerotic plaques are not uniformly distributed in the vascular tree. Experimental and clinical data highlight that biomechanical forces, including wall shear stress (WSS) and plaque structural stress (PSS), have an important role in the natural history of coronary atherosclerosis. Endothelial cell function is heavily influenced by changes in WSS, and longitudinal animal and human studies have shown that coronary regions with low WSS undergo increased plaque growth compared with high WSS regions. Local alterations in WSS might also promote transformation of stable to unstable plaque subtypes. Plaque rupture is determined by the balance between PSS and material strength, with plaque composition having a profound effect on PSS. Prospective clinical studies are required to ascertain whether integrating mechanical parameters with medical imaging can improve our ability to identify patients at highest risk of rapid disease progression or sudden cardiac events.
Collapse
|
28
|
Mintz GS. Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging 2016; 8:461-471. [PMID: 25882575 DOI: 10.1016/j.jcmg.2015.02.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/21/2015] [Accepted: 02/12/2015] [Indexed: 12/21/2022]
Abstract
Calcium impacts the natural history and treatment of coronary artery disease in many ways. Intravascular imaging studies, mostly intravascular ultrasound, but more recently studies using optical coherence tomography, have been instrumental in increasing our understanding of the relationship between calcium and coronary atherosclerosis, the predictors, the natural history of this relationship, and the impact on treatment. On one hand, stable coronary lesions are associated with more calcium than unstable lesions; and the amount of calcium may affect the success of percutaneous coronary intervention. On the other hand, calcium correlates with plaque burden; unstable lesions are associated with focal calcium deposits; and calcific nodules are one of the morphologies of vulnerable plaque. This review focuses on more than 20 years of intravascular imaging studies of the relationship between calcium and coronary atherosclerosis.
Collapse
Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, New York.
| |
Collapse
|
29
|
Toutouzas K, Karanasos A, Tousoulis D. Optical Coherence Tomography For the Detection of the Vulnerable Plaque. Eur Cardiol 2016; 11:90-95. [PMID: 30310454 DOI: 10.15420/ecr.2016:29:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Morphological characteristics of the atheromatous plaque have been associated with the development of plaque rupture and the pathogenesis of acute coronary syndromes (ACS). Plaques with a specific morphological phenotype that are at high risk of causing ACS are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that enables detailed visualization of atheromatous plaques. Consequently, OCT is a valuable research tool for examining the role of morphological characteristics of atheromatous plaques in the progression of coronary artery disease and plaque destabilisation, which leads to the clinical manifestation of ACS. This article summarises the pathophysiological insights obtained by OCT imaging in the formation and rupture of the vulnerable plaque.
Collapse
|
30
|
Predictors of Plaque Rupture Within Nonculprit Fibroatheromas in Patients With Acute Coronary Syndromes. JACC Cardiovasc Imaging 2015; 8:1180-1187. [DOI: 10.1016/j.jcmg.2015.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/09/2015] [Accepted: 06/14/2015] [Indexed: 11/23/2022]
|
31
|
Percutaneous Transcatheter Assessment of the Left Main Coronary Artery. JACC Cardiovasc Interv 2015; 8:1529-39. [DOI: 10.1016/j.jcin.2015.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022]
|
32
|
Akyildiz AC, Hansen HHG, Nieuwstadt HA, Speelman L, De Korte CL, van der Steen AFW, Gijsen FJH. A Framework for Local Mechanical Characterization of Atherosclerotic Plaques: Combination of Ultrasound Displacement Imaging and Inverse Finite Element Analysis. Ann Biomed Eng 2015; 44:968-79. [PMID: 26399991 PMCID: PMC4826666 DOI: 10.1007/s10439-015-1410-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/24/2015] [Indexed: 02/07/2023]
Abstract
Biomechanical models have the potential to predict plaque rupture. For reliable models, correct material properties of plaque components are a prerequisite. This study presents a new technique, where high resolution ultrasound displacement imaging and inverse finite element (FE) modeling is combined, to estimate material properties of plaque components. Iliac arteries with plaques were excised from 6 atherosclerotic pigs and subjected to an inflation test with pressures ranging from 10 to 120 mmHg. The arteries were imaged with high frequency 40 MHz ultrasound. Deformation maps of the plaques were reconstructed by cross correlation of the ultrasound radiofrequency data. Subsequently, the arteries were perfusion fixed for histology and structural components were identified. The histological data were registered to the ultrasound data to construct FE model of the plaques. Material properties of the arterial wall and the intima of the atherosclerotic plaques were estimated using a grid search method. The computed displacement fields showed good agreement with the measured displacement fields, implying that the FE models were able to capture local inhomogeneities within the plaque. On average, nonlinear stiffening of both the wall and the intima was observed, and the wall of the atheroslcerotic porcine iliac arteries was markedly stiffer than the intima (877 ± 459 vs. 100 ± 68 kPa at 100 mmHg). The large spread in the data further illustrates the wide variation of the material properties. We demonstrated the feasibility of a mixed experimental–numerical framework to determine the material properties of arterial wall and intima of atherosclerotic plaques from intact arteries, and concluded that, due to the observed variation, plaque specific properties are required for accurate stress simulations.
Collapse
Affiliation(s)
- Ali C. Akyildiz
- />Biomechanics Lab, Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- />Department of Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, USA
| | - Hendrik H. G. Hansen
- />Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm A. Nieuwstadt
- />Biomechanics Lab, Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lambert Speelman
- />Biomechanics Lab, Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Chris L. De Korte
- />Medical UltraSound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonius F. W. van der Steen
- />Biomechanics Lab, Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- />Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Frank J. H. Gijsen
- />Biomechanics Lab, Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
33
|
Costopoulos C, Brown AJ, Teng Z, Hoole SP, West NEJ, Samady H, Bennett MR. Intravascular ultrasound and optical coherence tomography imaging of coronary atherosclerosis. Int J Cardiovasc Imaging 2015; 32:189-200. [DOI: 10.1007/s10554-015-0701-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
|
34
|
Feldman MD, Phipps JE. Can Multimodal Invasive Imaging Be Used to Predict Periprocedural Myocardial Infarctions? JACC Cardiovasc Interv 2015; 8:946-8. [PMID: 26088512 DOI: 10.1016/j.jcin.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Marc D Feldman
- University of Texas Health Science Center San Antonio, San Antonio, Texas; Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, Texas.
| | - Jennifer E Phipps
- University of Texas Health Science Center San Antonio, San Antonio, Texas
| |
Collapse
|
35
|
Wang T, McElroy A, Halaney D, Vela D, Fung E, Hossain S, Phipps J, Wang B, Yin B, Feldman MD, Milner TE. Detection of plaque structure and composition using OCT combined with two-photon luminescence (TPL) imaging. Lasers Surg Med 2015; 47:485-94. [PMID: 26018531 DOI: 10.1002/lsm.22366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Atherosclerosis and plaque rupture leads to myocardial infarction and stroke. A novel hybrid optical coherence tomography (OCT) and two-photon luminescence (TPL) fiber-based imaging system was developed to characterize tissue constituents in the context of plaque morphology. STUDY DESIGN/MATERIALS AND METHODS Ex vivo coronary arteries (34 regions of interest) from three human hearts with atherosclerotic plaques were examined by OCT-TPL imaging. Histological sections (4 μm in thickness) were stained with Oil Red O for lipid, Von Kossa for calcium, and Verhoeff-Masson Tri-Elastic for collagen/elastin fibers and compared with imaging results. RESULTS Biochemical components in plaques including lipid, oxidized-LDL, and calcium, as well as a non-tissue component (metal) are distinguished by multi-channel TPL images with statistical significance (P < 0.001). TPL imaging provides complementary optical contrast to OCT (two-photon absorption/emission vs scattering). Merged OCT-TPL images demonstrate the distribution of lipid deposits in registration with detailed plaque surface profile. CONCLUSIONS Results suggest that multi-channel TPL imaging can effectively identify lipid sub-types and different plaque components. Furthermore, fiber-based hybrid OCT-TPL imaging simultaneously detects plaque structure and composition, improving the efficacy of vulnerable plaque detection and characterization.
Collapse
Affiliation(s)
- Tianyi Wang
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Austin McElroy
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - David Halaney
- Division of Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | | | - Edmund Fung
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Shafat Hossain
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Jennifer Phipps
- Division of Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas
| | - Bingqing Wang
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Biwei Yin
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| | - Marc D Feldman
- Division of Cardiology, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | - Thomas E Milner
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station C0800, Austin, Texas
| |
Collapse
|
36
|
Fujii K, Hao H, Shibuya M, Imanaka T, Fukunaga M, Miki K, Tamaru H, Sawada H, Naito Y, Ohyanagi M, Hirota S, Masuyama T. Accuracy of OCT, Grayscale IVUS, and Their Combination for the Diagnosis of Coronary TCFA. JACC Cardiovasc Imaging 2015; 8:451-460. [DOI: 10.1016/j.jcmg.2014.10.015] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
|
37
|
Lee T, Murai T, Yonetsu T, Suzuki A, Hishikari K, Kanaji Y, Matsuda J, Araki M, Niida T, Isobe M, Kakuta T. Relationship Between Subclinical Cardiac Troponin I Elevation and Culprit Lesion Characteristics Assessed by Optical Coherence Tomography in Patients Undergoing Elective Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001727. [DOI: 10.1161/circinterventions.114.001727] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The prevalence of subclinical, cardiac troponin I (cTnI) elevation in stable patients undergoing elective percutaneous coronary intervention and its relationship to culprit lesion characteristics assessed by optical coherence tomography (OCT) are unknown.
Methods and Results—
We studied 206 native de novo culprit coronary lesions from 206 patients with stable angina pectoris who underwent OCT before elective percutaneous coronary intervention. Patients were divided into 2 groups according to the presence (cTnI group; n=47; 22.8%) or absence (non-cTnI group; n=159; 77.2%) of cTnI ≥0.03 ng/mL at admission. The clinical and OCT findings were compared between these 2 groups. No significant difference was found in the clinical presentation between the groups except for the serum C-reactive protein levels and presence of multivessel disease. By OCT, cTnI elevation was associated with the presence of thin-cap fibroatheromas, a greater lipid arc, and a longer lipid length. In a multivariable analysis, the presence of positive C-reactive protein levels (odds ratio, 4.38; 95% confidence interval, 1.90–10.08;
P
=0.001) and OCT-derived thin-cap fibroatheromas (odds ratio, 2.89; 95% confidence interval, 1.22–6.86;
P
=0.016) were independent predictors of cTnI elevation. Periprocedural myocardial injury, defined as postpercutaneous coronary intervention peak cTnI levels >1.0 ng/mL (5× the upper reference limit), occurred more often in patients with cTnI elevation at admission (cTnI group: 41% versus non-cTnI group: 18%;
P
=0.001).
Conclusions—
The presence of subclinical cTnI elevation at admission was not uncommon and was associated with OCT-derived unstable plaque morphology in patients undergoing elective percutaneous coronary intervention, and may help to identify patients with stable angina pectoris at high risk for periprocedural myocardial injury.
Collapse
Affiliation(s)
- Tetsumin Lee
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Tadashi Murai
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Taishi Yonetsu
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Asami Suzuki
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Keiichi Hishikari
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Yoshihisa Kanaji
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Junji Matsuda
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Makoto Araki
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Takayuki Niida
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Mitsuaki Isobe
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| | - Tsunekazu Kakuta
- From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.)
| |
Collapse
|
38
|
Campos CM, Costa F, Garcia-Garcia HM, Bourantas C, Suwannasom P, Valgimigli M, Morel MA, Windecker S, Serruys PW. Anatomic Characteristics and Clinical Implications of Angiographic Coronary Thrombus. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002279. [DOI: 10.1161/circinterventions.114.002279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos M. Campos
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Francesco Costa
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Hector M. Garcia-Garcia
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Christos Bourantas
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Pannipa Suwannasom
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Marco Valgimigli
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Marie-Angele Morel
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Stephan Windecker
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| | - Patrick W. Serruys
- From the Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands (C.M.C., F.C., H.M.G.-G., C.B., P.S., M.V., P.W.S.); Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil (C.M.C.); Cardialysis, Rotterdam, The Netherlands (H.M.G.-G., M.-A.M.); Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.); and Department of Cardiology, International Centre
| |
Collapse
|
39
|
Kataoka Y, Puri R, Hammadah M, Duggal B, Uno K, Kapadia SR, Tuzcu EM, Nissen SE, Nicholls SJ. Cholesterol Crystals Associate With Coronary Plaque Vulnerability In Vivo. J Am Coll Cardiol 2015; 65:630-2. [DOI: 10.1016/j.jacc.2014.11.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/31/2014] [Accepted: 11/11/2014] [Indexed: 12/30/2022]
|
40
|
Brown AJ, Costopoulos C, West NE, Bennett MR. Contemporary invasive imaging modalities that identify and risk-stratify coronary plaques at risk of rupture. Expert Rev Cardiovasc Ther 2014; 13:9-13. [PMID: 25470576 DOI: 10.1586/14779072.2015.989836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerotic plaque rupture is responsible for the majority of myocardial infarctions, with ruptured plaques exhibiting specific morphological features, including large lipid cores, thinner overlying fibrous caps and micro-calcifications. Contemporary imaging modalities are increasingly able to characterize plaques, potentially leading to the identification of precursor lesions that are at high risk of rupture. Observational studies using invasive imaging consistently find that plaques responsible for an acute coronary event display these high-risk morphological features, and recent prospective imaging studies have now established links between baseline plaque characteristics and future cardiovascular events. Despite these promising advances, subsequent overall event rates remain too low for clinical utility. Novel technologies are now required to refine and improve our ability to identify and risk-stratify lesions at risk of rupture, if plaque-based risk evaluation is ever to become reality.
Collapse
Affiliation(s)
- Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | | | | | | |
Collapse
|
41
|
Teraguchi I, Imanishi T, Ozaki Y, Tanimoto T, Orii M, Shiono Y, Shimamura K, Ishibashi K, Yamano T, Ino Y, Yamaguchi T, Hirata K, Kubo T, Akasaka T. Impact of glucose fluctuation and monocyte subsets on coronary plaque rupture. Nutr Metab Cardiovasc Dis 2014; 24:309-314. [PMID: 24418379 DOI: 10.1016/j.numecd.2013.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/24/2013] [Accepted: 08/18/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS It remains unclear whether glycemic fluctuation can affect plaque rupture in acute myocardial infarction (AMI). Here we investigate the impact of glucose fluctuation on plaque rupture, as observed by optical coherence tomography (OCT), and monocyte subsets in patients with AMI. METHODS AND RESULTS We studied 37 consecutive patients with AMI. All patients underwent OCT examination, which revealed 24 patients with plaque rupture and 13 patients without plaque rupture at the culprit site. Peripheral blood sampling was performed on admission. Three monocyte subsets (CD14(+)CD16(-), CD14(bright)CD16(+), and CD14(dim)CD16(+)) were assessed by flow cytometry. Glycemic variability, expressed as the mean amplitude of glycemic excursion (MAGE), was determined by a continuous glucose monitoring system 7 days after the onset of AMI. MAGE was significantly higher in the rupture patients than in the non-rupture patients (P=0.036). Levels of CD14(bright)CD16(+) monocytes from the rupture patients were significantly higher than those from the non-rupture patients (P=0.042). Of interest, levels of CD14(bright)CD16(+) monocytes correlated positively and significantly with MAGE (r=0.39, P=0.02). CONCLUSION Dynamic glucose fluctuation may be associated with coronary plaque rupture, possibly through the preferential increase in CD14(bright)CD16(+) monocyte levels.
Collapse
Affiliation(s)
- I Teraguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - T Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan.
| | - Y Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - T Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - M Orii
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - Y Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - K Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - K Ishibashi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - T Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - Y Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - T Yamaguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - K Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - T Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| | - T Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
| |
Collapse
|
42
|
Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
43
|
Abstract
PURPOSE We investigated whether local hemodynamics were associated with sites of plaque erosion and hypothesized that patients with plaque erosion have locally elevated WSS magnitude in regions where erosion has occurred. METHODS We generated 3D, patient-specific models of coronary arteries from biplane angiographic images in 3 human patients with plaque erosion diagnosed by optical coherence tomography (OCT). Using computational fluid dynamics, we simulated pulsatile blood flow and calculated both wall shear stress (WSS) and oscillatory shear index (OSI). We also investigated anatomic features of plaque erosion sites by examining branching and local curvature in x-ray angiograms of barium-perfused autopsy hearts. RESULTS Neither high nor low magnitudes of mean WSS were associated with sites of plaque erosion. OSI and local curvature were also not associated with erosion. Anatomically, 8 of 13 hearts had a nearby bifurcation upstream of the site of plaque erosion. CONCLUSIONS This study provides preliminary evidence that neither hemodynamics nor anatomy are predictors of plaque erosion, based upon a very unique dataset. Our sample sizes are small, but this dataset suggests that high magnitudes of wall shear stress, one potential mechanism for inducing plaque erosion, are not necessary for erosion to occur.
Collapse
|
44
|
Comparison of lipid deposition at coronary bifurcations versus at nonbifurcation portions of coronary arteries as determined by near-infrared spectroscopy. Am J Cardiol 2013; 112:369-72. [PMID: 23642506 DOI: 10.1016/j.amjcard.2013.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/24/2013] [Accepted: 03/24/2013] [Indexed: 11/21/2022]
Abstract
Atherosclerosis has been shown to develop preferentially at sites of coronary bifurcation, yet culprit lesions resulting in ST-elevation myocardial infarction do not occur more frequently at these sites. We hypothesized that these findings can be explained by similarities in intracoronary lipid and that lipid and lipid core plaque would be found with similar frequency in coronary bifurcation and nonbifurcation segments. One hundred seventy bifurcations were identified, 156 of which had comparative nonbifurcation segments proximal and/or distal to the bifurcation. We compared lipid deposition at bifurcation and nonbifurcation segments in coronary arteries using near-infrared spectroscopy (NIRS), a novel method for the in vivo detection of coronary lipid. Any NIRS signal for the presence of lipid was found with similar frequency in bifurcation and nonbifurcation segments (79% vs 74%, p = NS). Lipid core burden index, a measure of total lipid quantity indexed to segment length, was similar across bifurcation segments as well as their proximal and distal controls (lipid core burden index 66.3 ± 106, 67.1 ± 116, and 66.6 ± 104, p = NS). Lipid core plaque, identified as a high-intensity focal NIRS signal, was found in 21% of bifurcation segments, and 20% of distal nonbifurcation segments (p = NS). In conclusion, coronary bifurcations do not appear to have higher levels of intracoronary lipid or lipid core plaque than their comparative nonbifurcation regions.
Collapse
|
45
|
Comparison of nonculprit coronary plaque characteristics between patients with and without diabetes: a 3-vessel optical coherence tomography study. JACC Cardiovasc Interv 2013; 5:1150-8. [PMID: 23174639 DOI: 10.1016/j.jcin.2012.06.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of the present study was to compare the characteristics of nonculprit coronary plaques between diabetes mellitus (DM) and non-DM patients using 3-vessel optical coherence tomography (OCT) imaging. BACKGROUND DM patients have a higher recurrent cardiovascular event rate. METHODS Patients who had undergone 3-vessel OCT imaging were identified from the Massachusetts General Hospital OCT Registry. Characteristics of nonculprit plaques were compared between DM and non-DM patients. RESULTS A total of 230 nonculprit plaques were identified in 98 patients. Compared with non-DM patients, DM patients had a larger lipid index (LI) (averaged lipid arc × lipid length; 778.6 ± 596.1 vs. 1358.3 ± 939.2, p < 0.001) and higher prevalence of calcification (48.4% vs. 72.2%, p = 0.034) and thrombus (0% vs. 8.3%, p = 0.047). DM patients were divided into 2 groups based on glycated hemoglobin (A(1C)) levels of ≤7.9% and ≥8.0%. LI was significantly correlated with diabetic status (778.6 ± 596.1 [non-DM] vs. 1,171.5 ± 708.1 [A(1C) ≤7.9%] vs. 1,638.5 ± 1,173.8 [A(1C) ≥8%], p value for linear trend = 0.005), and fibrous cap thickness was inversely correlated with the A(1C) level (99.4 ± 46.7 μm [non-DM] vs. 91.7 ± 29.6 μm [A(1C) ≤7.9%] vs. 72.9 ± 22.7 μm [A(1C) ≥8%], p value for linear trend = 0.014). Patients with A(1C) ≥8% also had the highest prevalence of thin-cap fibroatheroma (TCFA) and macrophage infiltration. CONCLUSIONS Compared with non-DM patients, DM patients have a larger LI and a higher prevalence of calcification and thrombus. The LI was larger and TCFA and macrophage infiltration were frequent in patients with A(1C) ≥8%.
Collapse
|
46
|
Imanishi T. Which is better for predicting ischemic events: Physiology or morphology? J Cardiol Cases 2013; 8:e67-e68. [PMID: 30533164 PMCID: PMC6275386 DOI: 10.1016/j.jccase.2013.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Indexed: 11/21/2022] Open
Affiliation(s)
- Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| |
Collapse
|
47
|
Early detection and invasive passivation of future culprit lesions: a future potential or an unrealistic pursuit of chimeras? Am Heart J 2013; 165:869-881.e4. [PMID: 23708157 DOI: 10.1016/j.ahj.2013.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/18/2013] [Indexed: 11/22/2022]
Abstract
New advances in image and signal processing have allowed the development of numerous invasive and noninvasive imaging modalities that have revealed details of plaque pathology and allowed us to study in vivo the atherosclerotic evolution. Recent natural history of atherosclerosis studies permitted us to evaluate changes in the compositional and morphological characteristics of the plaque and identify predictors of future events. The idea of being able to identify future culprit lesions and passivate these plaques has gradually matured, and small scale studies have provided proofs about the feasibility of this concept. This review article summarizes the recent advances in the study of atherosclerosis, cites the current evidence, highlights our limitations in understanding the evolution of the plaque and in predicting plaque destabilization, and discusses the potentiality of an early invasive sealing of future culprit lesions.
Collapse
|
48
|
Frueh J, Maimari N, Homma T, Bovens SM, Pedrigi RM, Towhidi L, Krams R. Systems biology of the functional and dysfunctional endothelium. Cardiovasc Res 2013; 99:334-41. [PMID: 23650287 DOI: 10.1093/cvr/cvt108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This review provides an overview of the effect of blood flow on endothelial cell (EC) signalling pathways, applying microarray technologies to cultured cells, and in vivo studies of normal and atherosclerotic animals. It is found that in cultured ECs, 5-10% of genes are up- or down-regulated in response to fluid flow, whereas only 3-6% of genes are regulated by varying levels of fluid flow. Of all genes, 90% are regulated by the steady part of fluid flow and 10% by pulsatile components. The associated gene profiles show high variability from experiment to experiment depending on experimental conditions, and importantly, the bioinformatical methods used to analyse the data. Despite this high variability, the current data sets can be summarized with the concept of endothelial priming. In this concept, fluid flows confer protection by an up-regulation of anti-atherogenic, anti-thrombotic, and anti-inflammatory gene signatures. Consequently, predilection sites of atherosclerosis, which are associated with low-shear stress, confer low protection for atherosclerosis and are, therefore, more sensitive to high cholesterol levels. Recent studies in intact non-atherosclerotic animals confirmed these in vitro studies, and suggest that a spatial component might be present. Despite the large variability, a few signalling pathways were consistently present in the majority of studies. These were the MAPK, the nuclear factor-κB, and the endothelial nitric oxide synthase-NO pathways.
Collapse
Affiliation(s)
- Jennifer Frueh
- Department of Bioengineering, Royal School of Mines, Imperial College London, Exhibition Road, SW7 2AZ London, UK
| | | | | | | | | | | | | |
Collapse
|
49
|
Kato K, Yonetsu T, Jia H, Abtahian F, Vergallo R, Hu S, Tian J, Kim SJ, Lee H, McNulty I, Lee S, Uemura S, Jang Y, Park SJ, Mizuno K, Yu B, Jang IK. Nonculprit coronary plaque characteristics of chronic kidney disease. Circ Cardiovasc Imaging 2013; 6:448-56. [PMID: 23536265 DOI: 10.1161/circimaging.112.000165] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) promotes the development of atherosclerosis and increases the risk of cardiovascular disease. The aim of the present study was to compare the coronary plaque characteristics of patients with and without CKD using optical coherence tomography. METHODS AND RESULTS We identified 463 nonculprit plaques from 287 patients from the Massachusetts General Hospital (MGH) optical coherence tomography registry. CKD was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2). A total of 402 plaques (250 patients) were in the non-CKD group and 61 plaques (37 patients) were in the CKD group. Compared with non-CKD plaques, plaques with CKD had a larger lipid index (mean lipid arc×lipid length, 1248.4±782.8 mm° [non-CKD] versus 1716.1±1116.2 mm° [CKD]; P=0.003). Fibrous cap thickness was not significantly different between the groups. Calcification (34.8% [non-CKD] versus 50.8% [CKD]; P=0.041), cholesterol crystals (11.2% [non-CKD] versus 23.0% [CKD]; P=0.048), and plaque disruption (5.5% [non-CKD] versus 13.1% [CKD]; P=0.049) were more frequently observed in the CKD group. In the multivariate linear regression model, a lower estimated glomerular filtration rate and diabetes mellitus were independent risk factors for a larger lipid index. CONCLUSIONS Compared with non-CKD patients, the patients with CKD had a larger lipid index with a higher prevalence of calcium, cholesterol crystals, and plaque disruption. The multivariate linear regression model demonstrated that a lower estimated glomerular filtration rate was an independent risk factor for a larger lipid index.
Collapse
Affiliation(s)
- Koji Kato
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Comparison of coronary plaque subtypes in male and female patients using 320-row MDCTA. Atherosclerosis 2012; 226:428-32. [PMID: 23287639 DOI: 10.1016/j.atherosclerosis.2012.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 11/09/2012] [Accepted: 11/22/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Determine plaque subtype and volume difference in male and female patients with obstructive and non-obstructive CAD using 320-row MDCTA. MATERIALS AND METHODS 128 patients with suspected CAD underwent MDCTA. All studies were divided into two groups based on disease severity. 0-70% stenosis (non-obstructive CAD) & >70% (obstructive). All were compared for plaque quantity and subtypes by gender. Main arteries, RCA, LM, LAD and LCX were analyzed using Vitrea 5.2 software to quantify fatty, fibrous and calcified plaque. Thresholds for coronary plaque quantification (volume in mm(3)) were preset at 35 ± 12 HU for fatty, 90 ± 24 HU for fibrous and >130 HU for calcified/mixed plaque and analyzed using STATA software. RESULTS Total plaque burden in 118 patients [65M: 53F] was significantly higher in all arteries in males compared to females with non-obstructive disease. Total plaque volume for males vs. females was: RCA: 10.10 ± 5.02 mm(3) vs. 6.89 ± 2.75 mm(3), respectively, p = 0.001; LAD: 7.21 ± 3.38 mm(3) vs. 5.89 ± 1.93 mm(3), respectively, p = 0.04; LCX: 9.13 ± 3.27 mm(3) vs. 7.16 ± 1.73 mm(3), respectively, p = 0.002; LM 15.13 ± 4.51 mm(3) vs. 11.85 ± 4.03 mm(3), respectively, p = 0.001. In sub-analyses, males had significantly more fibrous and fatty plaque in LM, LAD & LCX than females. However in the RCA, only fibrous plaque was significantly greater in males. Calcified plaque volume was not significantly different in both genders. Only 8% of patients had obstructive CAD (>70% stenosis); there was no significant difference in plaque volume or subtypes. CONCLUSION In patients with non-obstructive CAD, males were found to have significantly higher total coronary plaque volume with predominance of fibrous and fatty subtypes compared to females of the same age and BMI. There was no significant difference in plaque subtype or volume in patients with obstructive disease.
Collapse
|