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Sakai K, Mizukami T, Leipsic J, Belmonte M, Sonck J, Nørgaard BL, Otake H, Ko B, Koo BK, Maeng M, Jensen JM, Buytaert D, Munhoz D, Andreini D, Ohashi H, Shinke T, Taylor CA, Barbato E, Johnson NP, De Bruyne B, Collet C. Coronary Atherosclerosis Phenotypes in Focal and Diffuse Disease. JACC Cardiovasc Imaging 2023; 16:1452-1464. [PMID: 37480908 DOI: 10.1016/j.jcmg.2023.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The interplay between coronary hemodynamics and plaque characteristics remains poorly understood. OBJECTIVES The aim of this study was to compare atherosclerotic plaque phenotypes between focal and diffuse coronary artery disease (CAD) defined by coronary hemodynamics. METHODS This multicenter, prospective, single-arm study was conducted in 5 countries. Patients with functionally significant lesions based on an invasive fractional flow reserve ≤0.80 were included. Plaque analysis was performed by using coronary computed tomography angiography and optical coherence tomography. CAD patterns were assessed using motorized fractional flow reserve pullbacks and quantified by pullback pressure gradient (PPG). Focal and diffuse CAD was defined according to the median PPG value. RESULTS A total of 117 patients (120 vessels) were included. The median PPG was 0.66 (IQR: 0.54-0.75). According to coronary computed tomography angiography analysis, plaque burden was higher in patients with focal CAD (87% ± 8% focal vs 82% ± 10% diffuse; P = 0.003). Calcifications were significantly more prevalent in patients with diffuse CAD (Agatston score per vessel: 51 [IQR: 11-204] focal vs 158 [IQR: 52-341] diffuse; P = 0.024). According to optical coherence tomography analysis, patients with focal CAD had a significantly higher prevalence of circumferential lipid-rich plaque (37% focal vs 4% diffuse; P = 0.001) and thin-cap fibroatheroma (TCFA) (47% focal vs 10% diffuse; P = 0.002). Focal disease defined by PPG predicted the presence of TCFA with an area under the curve of 0.73 (95% CI: 0.58-0.87). CONCLUSIONS Atherosclerotic plaque phenotypes associate with intracoronary hemodynamics. Focal CAD had a higher plaque burden and was predominantly lipid-rich with a high prevalence of TCFA, whereas calcifications were more prevalent in diffuse CAD. (Precise Percutaneous Coronary Intervention Plan [P3]; NCT03782688).
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Affiliation(s)
- Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, University of Milan, Milan, Italy; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy; Department of Internal Medicine, Discipline of Cardiology, University of Campinas (Unicamp), Campinas, Brazil
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Hirofumi Ohashi
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Toshiro Shinke
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET Center, McGovern Medical School, UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
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2
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Biccirè FG, Häner J, Losdat S, Ueki Y, Shibutani H, Otsuka T, Kakizaki R, Hofbauer TM, van Geuns RJ, Stortecky S, Siontis GCM, Bär S, Lønborg J, Heg D, Kaiser C, Spirk D, Daemen J, Iglesias JF, Windecker S, Engstrøm T, Lang I, Koskinas KC, Räber L. Concomitant Coronary Atheroma Regression and Stabilization in Response to Lipid-Lowering Therapy. J Am Coll Cardiol 2023; 82:1737-1747. [PMID: 37640248 DOI: 10.1016/j.jacc.2023.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The frequency, characteristics, and outcomes of patients treated with high-intensity lipid-lowering therapy and showing concomitant atheroma volume reduction, lipid content reduction, and increase in fibrous cap thickness (ie, triple regression) are unknown. OBJECTIVES This study was designed to investigate rates, determinants, and prognostic implications of triple regression in patients presenting with acute myocardial infarction and treated with high-intensity lipid-lowering therapy. METHODS The PACMAN-AMI (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction) trial used serial intravascular ultrasound, near-infrared spectroscopy, and optical coherence tomography to compare the effects of alirocumab vs placebo in patients receiving high-intensity statin therapy. Triple regression was defined by the combined presence of percentage of atheroma volume reduction, maximum lipid core burden index within 4 mm reduction, and minimal fibrous cap thickness increase. Clinical outcomes at 1-year follow-up were assessed. RESULTS Overall, 84 patients (31.7%) showed triple regression (40.8% in the alirocumab group vs 23.0% in the placebo group; P = 0.002). On-treatment low-density lipoprotein cholesterol levels were lower in patients with vs without triple regression (between-group difference: -27.1 mg/dL; 95% CI: -37.7 to -16.6 mg/dL; P < 0.001). Triple regression was independently predicted by alirocumab treatment (OR: 2.83; 95% CI: 1.57-5.16; P = 0.001) and a higher baseline maximum lipid core burden index within 4 mm (OR: 1.03; 95% CI: 1.01-1.06; P = 0.013). The composite clinical endpoint of death, myocardial infarction, and ischemia-driven revascularization occurred less frequently in patients with vs without triple regression (8.3% vs 18.2%; P = 0.04). CONCLUSIONS Triple regression occurred in one-third of patients with acute myocardial infarction who were receiving high-intensity lipid-lowering therapy and was associated with alirocumab treatment, higher baseline lipid content, and reduced cardiovascular events. (Vascular Effects of Alirocumab in Acute MI-Patients [PACMAN-AMI]; NCT03067844).
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Affiliation(s)
- Flavio G Biccirè
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/FBiccire
| | - Jonas Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit of the University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ryota Kakizaki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas M Hofbauer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dik Heg
- Clinical Trials Unit of the University of Bern, Bern, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - David Spirk
- Institute of Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland; Sanofi, Vernier, Switzerland
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Juan F Iglesias
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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3
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Ota H, Matsuo H, Imai S, Nakashima Y, Kawase Y, Okubo M, Takahashi H, Kawai H, Sobue Y, Kawasaki M, Kondo T, Muramatsu T, Izawa H. Multimodality imaging to identify lipid-rich coronary plaques and predict periprocedural myocardial injury: Association between near-infrared spectroscopy and coronary computed tomography angiography. Front Cardiovasc Med 2023; 10:1127121. [PMID: 37077746 PMCID: PMC10108678 DOI: 10.3389/fcvm.2023.1127121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThis study compares the efficacy of coronary computed tomography angiography (CCTA) and near-infrared spectroscopy intravascular ultrasound (NIRS–IVUS) in patients with significant coronary stenosis for predicting periprocedural myocardial injury during percutaneous coronary intervention (PCI).MethodsWe prospectively enrolled 107 patients who underwent CCTA before PCI and performed NIRS–IVUS during PCI. Based on the maximal lipid core burden index for any 4-mm longitudinal segments (maxLCBI4mm) in the culprit lesion, we divided the patients into two groups: lipid-rich plaque (LRP) group (maxLCBI4mm ≥ 400; n = 48) and no-LRP group (maxLCBI4mm < 400; n = 59). Periprocedural myocardial injury was a postprocedural cardiac troponin T (cTnT) elevation of ≥5 times the upper limit of normal.ResultsThe LRP group had a significantly higher cTnT (p = 0.026), lower CT density (p < 0.001), larger percentage atheroma volume (PAV) by NIRS–IVUS (p = 0.036), and larger remodeling index measured by both CCTA (p = 0.020) and NIRS–IVUS (p < 0.001). A significant negative linear correlation was found between maxLCBI4mm and CT density (rho = −0.552, p < 0.001). Multivariable logistic regression analysis identified maxLCBI4mm [odds ratio (OR): 1.006, p = 0.003] and PAV (OR: 1.125, p = 0.014) as independent predictors of periprocedural myocardial injury, while CT density was not an independent predictor (OR: 0.991, p = 0.22).ConclusionCCTA and NIRS–IVUS correlated well to identify LRP in culprit lesions. However, NIRS–IVUS was more competent in predicting the risk of periprocedural myocardial injury.
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Affiliation(s)
- Hideaki Ota
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
- Correspondence: Hideaki Ota
| | - Hitoshi Matsuo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Shunsuke Imai
- Department of Radiology, Gifu Heart Center, Gifu, Japan
| | | | | | - Munenori Okubo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshihiro Sobue
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | - Takeshi Kondo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
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4
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Okamura A, Okura H, Iwai S, Kyodo A, Kamon D, Hashimoto Y, Ueda T, Soeda T, Watanabe M, Saito Y. Detection of myocardial bridge by optical coherence tomography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1169-1176. [PMID: 35015165 DOI: 10.1007/s10554-021-02497-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Myocardial bridge (MB) is less commonly documented by angiography than autopsy. Optical coherence tomography (OCT) may be useful to detect angiographically undetectable MB. To investigate OCT characteristics of MB, 86 LAD vessels were imaged by OCT. MB was defined as presence of intermediate optical intensity, "fine" layer surrounding coronary artery by OCT. Frequency and characteristics of the angio-detectable and angio-undetectable but OCT-detectable MB were investigated. In a subset of patients with angio-detectable MB, cyclic changes in coronary arterial dimensions were analyzed. OCT detected MB in 44 of 86 (51%). Arc of the MB was significantly larger (334.8 ± 58.5° vs. 268.4 ± 92.1°, P = 0.008) and length was significantly longer (22.6 ± 11.7 mm vs. 14.5 ± 8.1 mm, P = 0.014) in angio-detectable MB than OCT-detectable but angio-undetectable MB. Both vessel (6.8 ± 1.5 to 5.3 ± 1.0 mm2, P = 0.035) and lumen area (4.4 ± 1.5 to 3.1 ± 0.7 mm2, P = 0.040) decreased significantly from diastole to systole. Adventitial (0.08 ± 0.03 to 0.08 ± 0.02 mm, P = 0.828) and intima + plaque thickness (0.12 ± 0.05 to 0.10 ± 0.03 mm, P = 0.398) did not change significantly during cardiac cycle. On the other hand, medial thickness increased significantly from diastole to systole (0.08 ± 0.03 to 0.12 ± 0.03 mm, P = 0.022). In conclusion, MB is frequently detected as intermediate intensity, fine layer by OCT. During systole, vessel and lumen size decrease with increased medial thickness. Therefore, we should be careful for OCT interpretation of the coronary arteries with MB.
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Affiliation(s)
- Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
- Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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5
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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] [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.
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Affiliation(s)
| | | | | | | | | | - Tej Sheth
- Department of Medicine, McMaster University.,Population Health Research Institute, McMaster University
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6
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Okura H, Watanabe M, Miura A, Kurokawa M, Ueda T, Soeda T, Saito Y. Comparison of quantitative measurements between two different intravascular ultrasound catheters and consoles: in vitro and in vivo studies. Cardiovasc Interv Ther 2021; 37:109-115. [PMID: 33638763 PMCID: PMC8789722 DOI: 10.1007/s12928-021-00759-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
Previous studies suggested possible discordant quantitative measurements between different IVUS catheters and/or systems. The purpose of this study was to assess compatibility of two different IVUS catheters and consoles for quantitative measurements of coronary arteries. (1). In vitro study: IVUS imaging was performed in a concentric cylindrical phantom with 6 sections of known, cross-sectional diameter ranging from 3.0 to 8.0 mm. The lumen diameter (LD) and lumen cross-sectional area (LA) were measured and compared. To compare between 2 different IVUS consoles, IVUS images were obtained using a single IVUS catheter (catheter 1) connected to 2 different IVUS consoles (console 1 and 2). To compare between 2 different IVUS catheters, IVUS imaging was obtained using 2 different IVUS catheters (catheter 1 and 2) connected to a single IVUS console (console 2). (2). In vivo study: IVUS imaging was performed in 40 stented coronary arterial segments from 40 patients. The maximal stent diameter (Max SD), minimal stent diameter (minSD), and stent area (SA) were measured at both distal and proximal stent edges and compared between the two IVUS consoles (console 1 and 2) connected to a single IVUS catheter (catheter 1) (n = 20). IVUS imaging was also performed to compare between catheter 1 and 2 connected to IVUS console 2 (n = 20). Both in vitro and in vivo studies showed good correlation between the two IVUS consoles as well as two IVUS catheters. In conclusion, two IVUS catheters and consoles provide comparable IVUS measures both in vitro and in vivo.
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Affiliation(s)
- Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan. .,Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Akihiro Miura
- Department of Medical Engineering, Nara Medical University, Kashihara, Japan
| | - Muneo Kurokawa
- Department of Medical Engineering, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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7
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Lv R, Maehara A, Matsumura M, Wang L, Wang Q, Zhang C, Guo X, Samady H, Giddens DP, Zheng J, Mintz GS, Tang D. Using optical coherence tomography and intravascular ultrasound imaging to quantify coronary plaque cap thickness and vulnerability: a pilot study. Biomed Eng Online 2020; 19:90. [PMID: 33256759 PMCID: PMC7706023 DOI: 10.1186/s12938-020-00832-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background Detecting coronary vulnerable plaques in vivo and assessing their vulnerability have been great challenges for clinicians and the research community. Intravascular ultrasound (IVUS) is commonly used in clinical practice for diagnosis and treatment decisions. However, due to IVUS limited resolution (about 150–200 µm), it is not sufficient to detect vulnerable plaques with a threshold cap thickness of 65 µm. Optical Coherence Tomography (OCT) has a resolution of 15–20 µm and can measure fibrous cap thickness more accurately. The aim of this study was to use OCT as the benchmark to obtain patient-specific coronary plaque cap thickness and evaluate the differences between OCT and IVUS fibrous cap quantifications. A cap index with integer values 0–4 was also introduced as a quantitative measure of plaque vulnerability to study plaque vulnerability. Methods Data from 10 patients (mean age: 70.4; m: 6; f: 4) with coronary heart disease who underwent IVUS, OCT, and angiography were collected at Cardiovascular Research Foundation (CRF) using approved protocol with informed consent obtained. 348 slices with lipid core and fibrous caps were selected for study. Convolutional Neural Network (CNN)-based and expert-based data segmentation were performed using established methods previously published. Cap thickness data were extracted to quantify differences between IVUS and OCT measurements. Results For the 348 slices analyzed, the mean value difference between OCT and IVUS cap thickness measurements was 1.83% (p = 0.031). However, mean value of point-to-point differences was 35.76%. Comparing minimum cap thickness for each plaque, the mean value of the 20 plaque IVUS-OCT differences was 44.46%, ranging from 2.36% to 91.15%. For cap index values assigned to the 348 slices, the disagreement between OCT and IVUS assignments was 25%. However, for the OCT cap index = 2 and 3 groups, the disagreement rates were 91% and 80%, respectively. Furthermore, the observation of cap index changes from baseline to follow-up indicated that IVUS results differed from OCT by 80%. Conclusions These preliminary results demonstrated that there were significant differences between IVUS and OCT plaque cap thickness measurements. Large-scale patient studies are needed to confirm our findings.
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Affiliation(s)
- Rui Lv
- School of Biological Science and Medical Engineering, Southeast University, #2 SiPailou, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, USA
| | - Mitsuaki Matsumura
- The Cardiovascular Research Foundation, Columbia University, New York, USA
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, #2 SiPailou, Nanjing, China
| | - Qingyu Wang
- School of Biological Science and Medical Engineering, Southeast University, #2 SiPailou, Nanjing, China
| | - Caining Zhang
- School of Biological Science and Medical Engineering, Southeast University, #2 SiPailou, Nanjing, China
| | - Xiaoya Guo
- School of Science, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Don P Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, USA
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, #2 SiPailou, Nanjing, China. .,Mathematical Sciences Department, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA.
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8
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Ono M, Kawashima H, Hara H, Gao C, Wang R, Kogame N, Takahashi K, Chichareon P, Modolo R, Tomaniak M, Wykrzykowska JJ, Piek JJ, Mori I, Courtney BK, Wijns W, Sharif F, Bourantas C, Onuma Y, Serruys PW. Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging. Front Cardiovasc Med 2020; 7:119. [PMID: 32850981 PMCID: PMC7411139 DOI: 10.3389/fcvm.2020.00119] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field.
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Affiliation(s)
- Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariusz Tomaniak
- Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Brian K Courtney
- Schulich Heart Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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9
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Okada K, Hibi K, Honda Y, Fitzgerald PJ, Tamura K, Kimura K. Association between abdominal fat distribution and coronary plaque instability in patients with acute coronary syndrome. Nutr Metab Cardiovasc Dis 2020; 30:1169-1178. [PMID: 32448720 DOI: 10.1016/j.numecd.2020.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/06/2020] [Accepted: 03/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS This study aimed to assess possible association of detailed abdominal fat profiles with coronary plaque characteristics in patients with acute coronary syndrome (ACS). METHODS AND RESULTS In 60 patients with ACS, culprit arteries were evaluated at 1-mm intervals (length analyzed: 66 ± 28 mm) by grayscale and integrated backscatter intravascular ultrasound (IB-IVUS) before percutaneous coronary intervention. Standard IVUS indexes (as a volume index: volume/length), plaque components (as percent tissue volume) and fibrous cap thickness (FCT) were assessed by IB-IVUS. Plain abdominal computed tomography was performed to evaluate subcutaneous adipose tissue (SAT) area, visceral adipose tissue (VAT) area, and VAT/SAT ratio. While SAT area only correlated with vessel volume (r = 0.27, p = 0.04), VAT area correlated positively with vessel (r = 0.30, p = 0.02) and plaque (r = 0.33, p = 0.01) volumes and negatively with FCT (r = -0.26, p = 0.049), but not with percent plaque volume and plaque tissue components. In contrast, higher VAT/SAT ratio significantly correlated with higher percent lipid (r = 0.34, p = 0.008) and lower percent fibrous (r = -0.34, p = 0.007) volumes with a trend toward larger percent plaque volume (r = 0.19, p = 0.15), as well as thinner FCT (r = -0.53, p < 0.0001). In the multiple regression analysis, higher VAT/SAT ratio was independently associated with higher percent lipid with lower percent fibrous volumes (p = 0.03 for both) and thinner fibrous cap thickness (p = 0.0001). CONCLUSION Coronary plaque vulnerability, defined as increased lipid content with thinner fibrous cap thickness, appears to be more related to abnormal abdominal fat distribution, or so-called hidden obesity, compared with visceral or subcutaneous fat amount alone in patients with ACS.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Yokohama, Japan
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
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10
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Majeed K, Hartman E, Mori TA, Alcock R, Spiro J, Ligthart J, Witberg K, Hillis G, van Soest G, Schultz C. The Effect of Stent Artefact on Quantification of Plaque Features Using Optical Coherence Tomography (OCT): A Feasibility and Clinical Utility Study. Heart Lung Circ 2019; 29:874-882. [PMID: 31353214 DOI: 10.1016/j.hlc.2019.05.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/15/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) can detect detailed plaque features in native coronary arteries. Stent struts cause shadows that partially obscure the vessel wall, but plaque features can still be seen. We investigated the impact of stent artefact on plaque quantification and whether the plaque behind struts is associated with microvascular dysfunction. METHODS Patients retrospectively recruited from two centres, underwent OCT pre- and post-stenting on the same vessel segment. Lipid (LA) and calcium (CA) were measured as arcs. Macrophages, microchannels and cholesterol crystals were counted. Subsequently, we determined whether stented plaque features were associated with reduced Thrombolysis in Myocardial Infarction (TIMI) flow grade in consecutive patients who underwent OCT post-stenting. RESULTS In 52 patients the lipid arc was similar pre- vs post-stent: median (55º [13º-93º] vs. 40º [18º-87°]; difference 1º [-7º to 16º], p = NS). Pre- and post-stent lipid were strongly correlated (r = 0.92, p < 0.001). In a further 128 patients those with reduced (TIMI ≤ II) vs normal flow post percutaneous coronary intervention (PCI) showed more plaque behind struts: lipid (89º [50º-139º] vs 62º [29º-88°]; p < 0.001); and calcium (24º [6º-45º] vs 7° [0º-34º]; p = 0.031). Multivariate logistic regression analysis showed that abnormal TIMI flow post-stenting was associated with diabetes (Odds ratio [OR] 2.87, CI 1.01-8.19, p = 0.048), LA (OR 1.29, 95% CI 1.14-1.38, p < 0.001) and CA (OR 1.26, CI 1.07-1.40, p = 0.005). CONCLUSIONS Plaque behind the struts can be accurately quantified using OCT. Furthermore, OCT plaque features in stented segments are associated with microvascular dysfunction post PCI.
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Affiliation(s)
- Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia.
| | - Eline Hartman
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Richard Alcock
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Jon Spiro
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Jurgen Ligthart
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Karen Witberg
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - Gijs van Soest
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands; Optical and Biomedical Engineering Laboratory, School of Electrical Engineering, University of Western Australia, Perth, WA, Australia
| | - Carl Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
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11
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Impact of baseline plaque characteristic on the development of neoatherosclerosis in the very late phase after stenting. J Cardiol 2019; 74:67-73. [DOI: 10.1016/j.jjcc.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/16/2018] [Accepted: 01/18/2019] [Indexed: 11/17/2022]
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12
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Multimodality coronary imaging to predict periprocedural myocardial necrosis after an elective percutaneous coronary intervention. Coron Artery Dis 2019; 29:237-245. [PMID: 29215469 DOI: 10.1097/mca.0000000000000595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although multiple imaging modalities have been tested to predict periprocedural myocardial necrosis (PMN), the superior predictive efficacy of these imaging findings has not been established fully. We sought to evaluate which findings of the coronary imaging tools would best provide predictive efficacy of PMN among optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography (CCT) angiography. PATIENTS AND METHODS A total of 130 patients with stable angina pectoris who underwent OCT, IVUS, and CCT examinations for a single de-novo preprocedural lesion were investigated. PMN was defined on the basis of two different thresholds of cardiac troponin I (cTnI) elevation: moderate PMN [five times the upper reference limit (URL)<postpercutaneous coronary intervention peak cTnI level<20 times the URL] and major PMN (peak cTnI levels>20 times the URL). RESULTS Moderate PMN and major PMN were observed in 25 (19.2%) and 10 (7.7%) patients, respectively. Multivariate logistic regression analysis identified four independent predictors of PMN (moderate PMN and major PMN): IVUS-defined echo-attenuated plaque (EAP), OCT-defined thin-cap fibroatheroma, OCT-defined plaque rupture, and CCT-defined low-attenuation plaque (P<0.05 for all variables). For major PMN, EAP length [odds ratio=1.80 (95% confidence interval: 1.20-2.69), P<0.01] and OCT minimum cap thickness [odds ratio=0.95 (95% confidence interval: 0.91-0.99), P<0.01] were identified as independent predictors. CONCLUSION IVUS-derived EAP length and OCT minimum cap thickness were significant and specific predictors of major PMN among the examined multimodality plaque features, although all three modalities independently provided imaging findings of significant predictive efficacy for PMN more than five times the URL for cTnI.
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13
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Konishi T, Sunaga D, Funayama N, Yamamoto T, Murakami H, Hotta D, Nojima M, Tanaka S. Eicosapentaenoic acid therapy is associated with decreased coronary plaque instability assessed using optical frequency domain imaging. Clin Cardiol 2019; 42:618-628. [PMID: 30993750 PMCID: PMC6553360 DOI: 10.1002/clc.23185] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 01/26/2023] Open
Abstract
Background The relationship between eicosapentaenoic acid (EPA) therapy and coronary plaque stability assessed by optical frequency domain imaging (OFDI) has not been thoroughly described. Hypothesis EPA therapy is associated with decreased plaque instability in patients undergoing percutaneous coronary intervention (PCI) using OFDI. Methods Data on coronary artery plaques from 121 patients who consecutively underwent PCI between October 2015 and July 2018 were retrospectively analyzed. Of these patients, 109 were untreated (no‐EPA group), whereas 12 were treated with EPA (EPA group). Each plaque's morphological characteristics were analyzed using OFDI. Results We used 1:4 propensity score matching for patients who received or did not receive EPA therapy before PCI. Baseline characteristics were balanced between both groups (age, sex, body mass index, diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, smoking, previous PCI or coronary artery bypass grafting, previous myocardial infarction, prior statin use, acute coronary syndrome, hemoglobin A1c level, low‐density lipoprotein cholesterol concentration, triglyceride concentration, and high‐density lipoprotein cholesterol concentration). OFDI data from 60 patients were analyzed in this study. The EPA group had significantly lower mean lipid index (818 ± 806 vs 1574 ± 891) and macrophage grade (13.5 ± 5.9 vs 19.3 ± 7.4) but higher mean minimum fibrous cap thickness (109.2 ± 55.7 vs 81.6 ± 36.4 μm) than the no‐EPA group (P = 0.010, 0.019, and 0.040, respectively). Multiple logistic regression analyses showed that prior EPA use was independently associated with lower lipid index and macrophage grade (P = 0.043 and 0.024, respectively). Conclusion This OFDI analysis suggests that EPA therapy is associated with decreased plaque instability in patients undergoing PCI.
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Affiliation(s)
- Takao Konishi
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan.,Department of Cancer Pathology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Daisuke Sunaga
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Naohiro Funayama
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Tadashi Yamamoto
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hironori Murakami
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Daisuke Hotta
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Faculty of Medicine, Sapporo, Japan
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14
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Obstructive sleep apnea is associated with increased coronary plaque instability: an optical frequency domain imaging study. Heart Vessels 2019; 34:1266-1279. [PMID: 30790035 PMCID: PMC6620247 DOI: 10.1007/s00380-019-01363-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/15/2019] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD) and with an increased risk for myocardial infarction, stroke or death due to cardiovascular disease. Optical frequency-domain imaging (OFDI) is a useful modality for evaluating the characteristics of atherosclerotic plaque. The purpose of the study was to use OFDI to investigate the association of OSA with coronary plaque characteristics in patients undergoing percutaneous coronary intervention (PCI). We retrospectively analyzed OFDI data for coronary artery plaques from 15 patients with OSA and 35 non–OSA patients treated between October 2015 and October 2018. Plaque morphology was evaluated for 70 lesions, including 21 from patients with OSA and 49 from non–OSA patients. Compared with the non–OSA group, patients with OSA had significantly higher prevalences of thinned cap fibroatheroma (TCFA) (67% vs. 35%, P = 0.014) and microchannels (86% vs. 55%, P = 0.014); a significantly higher mean lipid index (1392 ± 982 vs. 817 ± 699, P = 0.021), macrophage grade (8.4 ± 6.4 vs. 4.8 ± 4.5, P = 0.030), and maximum number of microchannels (1.5 ± 1.0 vs. 0.7 ± 0.7, P = 0.001); and a significantly lower mean minimum fibrous cap thickness (69.4 ± 28.7 vs. 96.1 ± 51.8 μm, P = 0.008). This OFDI analysis suggests that OSA is associated with unstable plaque characteristics in patients with CAD. More intensive medical management for stabilization of coronary atherosclerotic plaque is required in patients with OSA.
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15
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Frequency and prognostic impact of intravascular imaging-guided urgent percutaneous coronary intervention in patients with acute myocardial infarction: results from J-MINUET. Heart Vessels 2018; 34:564-571. [DOI: 10.1007/s00380-018-1285-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
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16
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Sugawara Y, Ueda T, Soeda T, Watanabe M, Okura H, Saito Y. Plaque modification of severely calcified coronary lesions by scoring balloon angioplasty using Lacrosse non-slip element: insights from an optical coherence tomography evaluation. Cardiovasc Interv Ther 2018; 34:242-248. [DOI: 10.1007/s12928-018-0553-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
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17
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Mintz GS. Understanding Why and When Optical Coherence Tomography Does Not Detect Vulnerable Plaques: Is It Important? Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004144. [PMID: 27406991 DOI: 10.1161/circinterventions.116.004144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gary S Mintz
- From the Cardiovascular Research Foundation, New York, NY.
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18
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Coronary CT angiography characteristics of OCT-defined thin-cap fibroatheroma: a section-to-section comparison study. Eur Radiol 2017; 28:833-843. [DOI: 10.1007/s00330-017-4992-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/11/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022]
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19
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20
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Otto S, Nitsche K, Jung C, Kryvanos A, Zhylka A, Heitkamp K, Gutiérrez-Chico JL, Goebel B, Schulze PC, Figulla HR, Poerner TC. Endothelial progenitor cells and plaque burden in stented coronary artery segments: an optical coherence tomography study six months after elective PCI. BMC Cardiovasc Disord 2017; 17:103. [PMID: 28441929 PMCID: PMC5405468 DOI: 10.1186/s12872-017-0534-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/08/2017] [Indexed: 02/03/2023] Open
Abstract
Background Endothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity. They might be protective in atherosclerosis. Optical coherence tomography (OCT) is a precise intracoronary imaging modality that allows assessment of subintimal plaque development. We evaluated the influence of EPC on coronary plaque burden in stable disease and implemented a novel computational plaque analysis algorithm using OCT. Methods Forty-three patients (69.8% males, 69.6 ± 7.7 years) were investigated by OCT during re-angiography 6 months after elective stent implantation. Different subpopulations of EPCs were identified by flow cytometry according to their co-expression of antigens (CD34+, CD133+, kinase domain receptor, KDR+). An algorithm was applied to calculate the underlying total plaque burden of the stented segments from OCT images. Plaque morphology was assessed according to international consensus in OCT imaging. Results A cumulative sub-strut plaque volume of 10.87 ± 12.7 mm3 and a sub-stent plaque area of 16.23 ± 17.0 mm2 were found within the stented vessel segments with no significant differences between different stent types. All EPC subpopulations (mean of EPC levels: CD34+/CD133+: 2.66 ± 2.0%; CD34+/KDR+: 7.50 ± 5.0%; CD34+/CD133+/KDR+: 1.12 ± 1.0%) inversely correlated with the identified underlying total plaque volume and plaque area (p ≤ 0.012). Conclusions This novel analysis algorithm allows for the first time comprehensive quantification of coronary plaque burden by OCT and illustration as spread out vessel charts. Increased EPC levels are associated with less sub-stent coronary plaque burden which adds to previous findings of their protective role in atherosclerosis.
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Affiliation(s)
- Sylvia Otto
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Kristina Nitsche
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, University, Duesseldorf, Medical Faculty and Vascular Diseases, Düsseldorf, Germany
| | | | - Andrey Zhylka
- Belarusian State University, Faculty of Applied Mathematics and Computer Science, Minsk, Belarus
| | - Kerstin Heitkamp
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | | | - Björn Goebel
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hans R Figulla
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tudor C Poerner
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
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21
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Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017; 6:JAHA.117.005543. [PMID: 28314799 PMCID: PMC5524044 DOI: 10.1161/jaha.117.005543] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Dimitrios Tsiachris
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| | - Panagiota Pietri
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
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22
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Souza CF, Maehara A, Mintz GS, Matsumura M, Alves CMR, Carlos Carvalho A, Caixeta A. Tissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study. Catheter Cardiovasc Interv 2017; 90:1107-1114. [PMID: 28191713 DOI: 10.1002/ccd.26954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 01/01/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We sought to assess a new modality of radiofrequency intravascular ultrasound (IVUS) called iMAP-IVUS (Boston Scientific, Santa Clara, California) during the evaluation of patients presenting with high-risk acute coronary syndromes. BACKGROUND There are limited data on plaque tissue characterization and phenotype classification using iMAP-IVUS. METHODS In the iWonder study patients presenting with ST-elevation myocardial infarction (STEMI) or non-STEMI underwent three-vessel grayscale IVUS and iMAP-IVUS tissue characterization prior to percutaneous intervention. In total 385 lesions from 100 patients were divided into culprit (n = 100) and nonculprit (n = 285) lesions. Lesion phenotype was classified as (i) thin-cap fibroatheroma (iMAP-derived TCFA); (ii) thick-cap fibroatheroma; (iii) pathological intimal thickening; (iv) fibrotic plaque; and (v) fibrocalcific plaque. RESULTS Culprit lesions had smaller minimum lumen cross-sectional area (MLA) with greater plaque burden compared to non-culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non-culprit lesions. iMAP-IVUS revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the MLA site (all P < 0.001). Any fibroatheroma was more frequently identified in culprit lesions compared with non-culprit lesions (93% vs. 78.9%, P = 0.001), anywhere within the lesion 19.0%, P < 0.001) as well as at the MLA site (18.0% vs. 9.5%, P = 0.07). CONCLUSIONS Three-vessel radiofrequency iMAP-IVUS demonstrated a greater plaque burden and higher prevalence of any fibroatheroma as well as iMAP-derived TCFAs in culprit versus non-culprit lesions in patients presenting with STEMI or non-STEMI undergoing percutaneous coronary intervention. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Cristiano F Souza
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | - Akiko Maehara
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York.,Department of Interventional Cardiology, Columbia University Medical Center, New York, New York
| | - Gary S Mintz
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York
| | - Mitsuaki Matsumura
- IVUS core laboratory, Cardiovascular Research Foundation, New York, New York
| | - Claudia M R Alves
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Adriano Caixeta
- Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil.,Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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23
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Abstract
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.
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Affiliation(s)
- Jonathan A Batty
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Shristy Subba
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Peter Luke
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Li Wing Chi Gigi
- Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
| | - Hannah Sinclair
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
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24
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Kang SJ, Ahn JM, Han S, Park DW, Lee SW, Kim YH, Lee CW, Park SW, Mintz GS, Park SJ. Multimodality imaging of attenuated plaque using grayscale and virtual histology intravascular ultrasound and optical coherent tomography. Catheter Cardiovasc Interv 2016; 88:E1-E11. [DOI: 10.1002/ccd.25786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 12/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Soo-Jin Kang
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Jung-Min Ahn
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Seungbong Han
- Department of Biostatistics; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Duk-Woo Park
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Seung-Whan Lee
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Young-Hak Kim
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Cheol Whan Lee
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Seong-Wook Park
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Gary S. Mintz
- Cardiovascular Research Foundation; New York New York
| | - Seung-Jung Park
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
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Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease - An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy. PLoS One 2016; 11:e0154025. [PMID: 27105207 PMCID: PMC4841583 DOI: 10.1371/journal.pone.0154025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/07/2016] [Indexed: 01/26/2023] Open
Abstract
Background Age is a strong predictor of survival in patients with coronary artery disease. In elder patients with increasing co-morbidities percutaneous coronary intervention (PCI) is associated with more complications and worse outcome. The calculation of relative survival rates adjusts for the “background” mortality in the general population by correcting for age and gender. We analyzed if elder patients after elective PCI have a worse relative survival compared to younger patient groups. Methods A total of 8,342 patients who underwent elective PCI at two high volume centers between 1998 and 2009 were analyzed. Results The survival of our patients after PCI (observed survival) was slightly lower compared to the general population (expected survival) resulting in a slightly decreasing relative survival curve. In a multivariate Cox regression model age amongst others was a strong predictor of survival. Stratifying patients according to their age the relative survival curves of younger patients (Quartile 1: <58 years; 2,046 patients), elder patients (Quartile 3: 66–73 years; 2,090 patients) and very old patients (Quartile 4: >73 years; 2,307 patients) were similar. The relative survival of mid-aged patients (Quartile 2: 58–65 years; 1,899 patients) was better than that of all other patient groups. The profile of cardiovascular risk factors differs between the various groups resulting in different composition and burden of coronary plaques in an optical coherence tomography sub-study. Conclusion Patients after elective PCI have a slightly worse long-term survival compared to the age- and sex-matched general population. This is also true for different groups of age except for mid-aged patients between 58 and 63 years. Elder patients between 66 and 73 years and above 73 years have a similar relative survival compared to younger patients below 58 years, and might therefore have similar benefit from elective PCI.
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Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB, Yock PG, Fitzgerald PJ, Schnittger I, Honda Y. Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque. J Am Heart Assoc 2016; 5:e001735. [PMID: 27098967 PMCID: PMC4843493 DOI: 10.1161/jaha.114.001735] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by intravascular ultrasound. Methods and Results We enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an intravascular ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with intravascular ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the intravascular ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance (r=0.254, P=0.011 overall; r=0.545, P<0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance. Conclusions In patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.
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Affiliation(s)
- Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shin Lin
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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Abstract
Molecular imaging offers great potential for noninvasive visualization and quantitation of the cellular and molecular components involved in atherosclerotic plaque stability. In this chapter, we review emerging molecular imaging modalities and approaches for quantitative, noninvasive detection of early biological processes in atherogenesis, including vascular endothelial permeability, endothelial adhesion molecule up-regulation, and macrophage accumulation, with special emphasis on mouse models. We also highlight a number of targeted imaging nanomaterials for assessment of advanced atherosclerotic plaques, including extracellular matrix degradation, proteolytic enzyme activity, and activated platelets using mouse models of atherosclerosis. The potential for clinical translation of molecular imaging nanomaterials for assessment of atherosclerotic plaque biology, together with multimodal approaches is also discussed.
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Analysis of the Usefulness of Optical Coherence Tomography and Intravascular Ultrasonography for the Examination of Rabbit Atherosclerotic Plaques. Ultrasound Q 2016; 32:75-81. [DOI: 10.1097/ruq.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah N, Ussen B, Mahmoudi M. Adjunctive intra-coronary imaging for the assessment of coronary artery disease. JRSM Cardiovasc Dis 2016; 5:2048004016658142. [PMID: 27540480 PMCID: PMC4959304 DOI: 10.1177/2048004016658142] [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: 03/23/2016] [Accepted: 06/13/2016] [Indexed: 01/08/2023] Open
Abstract
Atherosclerotic coronary artery disease remains a leading cause of worldwide morbidity and mortality. Invasive angiography currently remains the gold standard method of diagnosing and treating coronary disease; however, more sophisticated adjunctive interventional technologies have been developed to combat the inter and intra-observer variability frequently encountered in the assessment of lesion severity. Intravascular imaging now plays a key role in optimising percutaneous coronary interventions and provides invaluable information as part of the interventional cardiologist's diagnostic arsenal. The principles, technical aspects and uses of two modalities of intracoronary imaging, intravascular ultrasound and optical coherence tomography, are discussed. We additionally provide examples of cases where the adjunctive intracoronary imaging was superior to angiography alone in successfully identifying and treating acute coronary syndromes.
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Affiliation(s)
- Nikunj Shah
- Department of Cardiology, Ashford & St Peter's Hospitals NHS Foundation Trust, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Bassey Ussen
- Department of Cardiology, Ashford & St Peter's Hospitals NHS Foundation Trust, UK
| | - Michael Mahmoudi
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, UK
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Lee SY, Shin DH, Shehata I, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Association between fractional flow reserve and coronary plaque characteristics assessed by optical coherence tomography. J Cardiol 2015; 68:342-5. [PMID: 26603326 DOI: 10.1016/j.jjcc.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/10/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The assessment of fractional flow reserve (FFR) in coronary lesions determines the strategy of percutaneous coronary intervention. However, the association between FFR and characteristics of the underlying coronary plaque has not been sufficiently investigated. METHODS A total of 110 coronary lesions in 106 patients were evaluated using both FFR and optical coherence tomography (OCT). Coronary plaques were classified into fibrous, fibrocalcific, or fibroatheroma according to OCT evaluation at the site of minimal lumen area. Plaque microstructures such as cap thickness, macrophage accumulation, intimal vasculature, or cholesterol crystals were also evaluated. RESULTS Lesions with FFR≤0.8 showed a higher frequency of fibroatheroma, macrophage accumulation, and cholesterol crystals when compared to those with FFR>0.8. The angle of lipid was wider in lesions with FFR≤0.8 (145.1±63.0° vs. 120.7±48.9°, p=0.047), and the longitudinal length was longer in those with FFR≤0.8 (4.2±2.8mm vs. 2.5±2.9mm, p=0.007). However, multiple linear regression analysis revealed that the morphological characteristics of plaques assessed by OCT were not independently associated with FFR. Minimal lumen area [coefficient, 0.035; 95% confidence interval (CI), 0.022-0.048; p<0.001] and area stenosis (coefficient, -0.003; 95% CI, -0.005 to -0.001; p=0.001) assessed by OCT significantly correlated with FFR. CONCLUSION The morphological characteristics of coronary plaque derived from OCT are not directly related to FFR.
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Affiliation(s)
- Seung-Yul Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Islam Shehata
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Okada K, Hibi K, Gohbara M, Kataoka S, Takano K, Akiyama E, Matsuzawa Y, Saka K, Maejima N, Endo M, Iwahashi N, Tsukahara K, Kosuge M, Ebina T, Fitzgerald PJ, Honda Y, Umemura S, Kimura K. Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromes. Cardiovasc Diabetol 2015; 14:111. [PMID: 26289581 PMCID: PMC4546046 DOI: 10.1186/s12933-015-0275-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Blood glucose variability is receiving considerable attention as a new risk factor for coronary artery disease. This study aimed to investigate the association between blood glucose variability and coronary plaque tissue characteristics. Methods In 57 patients with acute coronary syndrome, integrated backscatter intravascular ultrasound (IB-IVUS) and gray-scale IVUS were performed before balloon dilatation or stent implantation in the culprit vessels. Standard IVUS indices were evaluated for volume index (volume/length), and plaque components were measured by IB-IVUS for percent tissue volume. In addition to conventional glucose indicators, blood glucose variability in a stable state was determined by calculating the mean amplitude of glycemic excursions (MAGE) using a continuous glucose monitoring system. Results Higher MAGE values were significantly correlated with larger percent plaque volumes (r = 0.32, p = 0.015), and increased lipid (r = 0.44, p = 0.0006) and decreased fibrous (r = −0.45, p = 0.0005) plaque components. In contrast, HbA1c or fasting plasma glucose values were not significantly correlated with plaque volumes and percent plaque components. Homeostasis model assessment of insulin resistance values were positively correlated with vessel (r = 0.35, p = 0.007) and plaque (r = 0.27, p = 0.046) volumes, but not with percent plaque components. In multiple regression analysis, higher MAGE values were independently associated with increased lipid (β = 0.80, p = 0.0035) and decreased fibrous (β = -0.79, p = 0.0034) contents in coronary plaques. Conclusions Among all glucose indicators studied, only higher blood glucose variability was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting blood glucose variability as one of the important factors related to coronary plaque vulnerability.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Shunsuke Kataoka
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Keiko Takano
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Kenichiro Saka
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Mitsuaki Endo
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Kengo Tsukahara
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, USA.
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, USA.
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
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Direct relationship of local C-reactive protein production and lipid pool characterized by integrated backscatter intravascular ultrasound. Coron Artery Dis 2015; 26:425-31. [DOI: 10.1097/mca.0000000000000250] [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: 11/26/2022]
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The basics of intravascular optical coherence tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:74-83. [PMID: 26161097 PMCID: PMC4495121 DOI: 10.5114/pwki.2015.52278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/12/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022] Open
Abstract
Optical coherence tomography (OCT) has opened new horizons for intravascular coronary imaging. It utilizes near-infrared light to provide a microscopic insight into the pathology of coronary arteries in vivo. Optical coherence tomography is also capable of identifying the chemical composition of atherosclerotic plaques and detecting traits of their vulnerability. At present it is the only tool to measure the thickness of the fibrous cap covering the lipid core of the atheroma, and thus it is an exceptional modality to detect plaques that are prone to rupture (thin fibrous cap atheromas). Moreover, it facilitates distinguishing between plaque rupture and plaque erosion as a cause of acute intracoronary thrombosis. Optical coherence tomography is applied to guide angioplasties of coronary lesions and to assess outcomes of percutaneous coronary interventions broadly. It identifies stent malapposition, dissections, and thrombosis with unprecedented precision. Furthermore, OCT helps to monitor vessel healing after stenting. It evaluates the coverage of stent struts by the neointima and detects in-stent neoatherosclerosis. With so much potential, new studies are warranted to determine OCT's clinical impact. The following review presents the technical background, basics of OCT image interpretation, and practical tips for adequate OCT imaging, and outlines its established and potential clinical application.
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Fatakdawala H, Gorpas D, Bishop JW, Bec J, Ma D, Southard JA, Margulies KB, Marcu L. Fluorescence Lifetime Imaging Combined with Conventional Intravascular Ultrasound for Enhanced Assessment of Atherosclerotic Plaques: an Ex Vivo Study in Human Coronary Arteries. J Cardiovasc Transl Res 2015; 8:253-63. [PMID: 25931307 PMCID: PMC4473095 DOI: 10.1007/s12265-015-9627-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/15/2015] [Indexed: 11/16/2022]
Abstract
This study evaluates the ability of label-free fluorescence lifetime imaging (FLIm) to complement intravascular ultrasound (IVUS) for concurrent visualization of human coronary vessel composition, structure, and pathology. Co-registered FLIm and IVUS data from 16 coronary segments were correlated to eight distinct pathological features including thin-cap fibroatheroma (TCFA). The sensitivity, specificity, and positive predictive value for combined FLIm-IVUS (89, 99, 89 %) were better than FLIm (70, 98, 88 %) and IVUS (45, 94, 62 %) alone in distinguishing between pathologies. FLIm can assess compositional changes in luminal surface through variations in fluorescence lifetime values (<3.5 ns for lipid-rich areas; >4 ns for collagen-rich areas) enabling detection of macrophages in fibrous caps (sensitivity, 86 %) and distinguishing between relatively stable thick-cap fibroatheromas and rupture-prone TCFA (sensitivity, 80 %) amongst other features. Current results demonstrate the potential of FLIm-IVUS as a new intravascular method for improved evaluation of plaques that may subsequently aid in guiding coronary intervention.
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Affiliation(s)
- Hussain Fatakdawala
- Department of Biomedical Engineering, University of California Davis, 451 E. Health Sciences Drive, Davis, CA, 95616, USA
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Xie Z, Tian J, Ma L, Du H, Dong N, Hou J, He J, Dai J, Liu X, Pan H, Liu Y, Yu B. Comparison of optical coherence tomography and intravascular ultrasound for evaluation of coronary lipid-rich atherosclerotic plaque progression and regression. Eur Heart J Cardiovasc Imaging 2015; 16:1374-80. [PMID: 25911116 DOI: 10.1093/ehjci/jev104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/02/2015] [Indexed: 02/04/2023] Open
Abstract
AIMS Compared with intravascular ultrasound (IVUS), optical coherence tomography (OCT) has relative merits and demerits for detecting plaque characteristics. It remains unknown whether the IVUS and OCT evaluations of plaque progression/regression are consistent. We sought to analyse the correlations between IVUS and OCT evaluations of plaques at single time points, and compare temporal changes in the IVUS and OCT data. METHODS AND RESULTS Eighty-eight lipid-rich plaques from 65 patients with coronary artery disease were analysed with IVUS and OCT at baseline and 12-month follow-up. Fibrous cap thickness on OCT was negatively correlated with total atheroma volume on IVUS (r = -0.28, P = 0.009), but not with percent atheroma volume (P = 0.84). Changes on OCT were not significantly correlated with changes on IVUS. Plaques that showed progression, regression, or no change on IVUS showed no differences in terms of changes in the OCT parameters fibrous cap thickness (P = 0.199), maximum lipid core arc (P = 0.755), mean lipid core arc (P = 0.936), and lipid index (P = 0.91). The incidence of thin-cap fibroatheroma (TCFA) was similar among the above three plaque groups at baseline (P = 0.79) and follow-up (P = 0.609). CONCLUSION Although fibrous cap thickness on OCT was negatively correlated with plaque size on IVUS at single time points, changes in OCT parameters were not correlated with changes in IVUS measures over time. Lesion progression/regression on IVUS was not associated with changes in OCT parameters (fibrous cap thickness, lipid core arc, lipid index, and TCFA).
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Affiliation(s)
- Zulong Xie
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jinwei Tian
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lijia Ma
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Hongwei Du
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Nana Dong
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jingbo Hou
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jieqiong He
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jiannan Dai
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Xinxin Liu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Hong Pan
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Youbin Liu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Bo Yu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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Roleder T, Kovacic JC, Ali Z, Sharma R, Cristea E, Moreno P, Sharma SK, Narula J, Kini AS. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EUROINTERVENTION 2015; 10:303-11. [PMID: 24769522 DOI: 10.4244/eijv10i3a53] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The presence of thin-cap fibroatheromas (TCFA) is associated with high risk of acute coronary syndrome, hence their early detection may identify high-risk patients. In the present study we investigated the ability of a combined imaging catheter with near-infrared spectroscopy (NIRS) plus intravascular ultrasound (IVUS) to detect TCFA in patients with stable coronary artery disease. METHODS AND RESULTS Optical coherence tomography (OCT) and combined NIRS-IVUS assessment were performed on identical coronary segments. IVUS analysis provided per-segment minimal cross-sectional area (CSA), plaque length (PL), plaque burden (PB), plaque volume (PV), and remodelling index (RI). OCT was used as the gold-standard reference to define TCFA (fibrous cap thickness <65 μm). Plaque lipid content was estimated by NIRS (lipid core burden index [LCBI]). OCT-defined TCFA was present in 18 of 76 segments. IVUS revealed that OCT-defined TCFA were positively remodelled lesions with greater PB and PV, smaller CSA, and longer PL, while NIRS revealed greater LCBI per 2 mm segment (LCBI2mm) (all p<0.001). Greatest accuracy for OCT-defined TCFA detection was achieved using LCBI2mm >315 with RI >1.046 as a combined criterion value. CONCLUSIONS OCT-defined TCFA are characterised by positive vessel remodelling, high plaque burden and greater lipid core burden as assessed by dual NIRS-IVUS imaging.
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Affiliation(s)
- Tomasz Roleder
- Mount Sinai Medical Center and Mount Sinai School of Medicine, New York, NY, USA
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Ozaki Y, Ohota M, Ismail TF, Okumura M, Ishikawa M, Muramatsu T. Thin Cap Fibroatheroma Defined as Lipid Core Abutting Lumen (LCAL) on Integrated Backscatter Intravascular Ultrasound – Comparison With Optical Coherence Tomography and Correlation With Peri-Procedural Myocardial Infarction –. Circ J 2015; 79:808-17. [DOI: 10.1253/circj.cj-14-0758] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masaya Ohota
- Department of Cardiology, Fujita Health University Hospital
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Okura H. Intravascular ultrasound-derived tissue characterization of the in-stent neointima: Are they “true colors” shining through? J Cardiol 2014; 64:421-2. [DOI: 10.1016/j.jjcc.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 11/25/2022]
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39
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The role of integrated backscatter intravascular ultrasound in characterizing bare metal and drug-eluting stent restenotic neointima as compared to optical coherence tomography. J Cardiol 2014; 64:488-95. [DOI: 10.1016/j.jjcc.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 11/21/2022]
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40
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Okura H. Vessel response after first- and second-generation drug-eluting stent detected by optical coherence tomography. Circ J 2014; 78:2622-3. [PMID: 25283792 DOI: 10.1253/circj.cj-14-1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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41
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Dohi T, Maehara A, Moreno PR, Baber U, Kovacic JC, Limaye AM, Ali ZA, Sweeny JM, Mehran R, Dangas GD, Xu K, Sharma SK, Mintz GS, Kini AS. The relationship among extent of lipid-rich plaque, lesion characteristics, and plaque progression/regression in patients with coronary artery disease: a serial near-infrared spectroscopy and intravascular ultrasound study. Eur Heart J Cardiovasc Imaging 2014; 16:81-7. [PMID: 25190072 DOI: 10.1093/ehjci/jeu169] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIMS To evaluate the relationship between lipid content and plaque morphometry as well as the process of lesion progression and regression in patients with significant coronary artery disease. METHODS AND RESULTS The present study, using data from the YELLOW trial, was conducted in patients having significant coronary lesions (fractional flow reserve <0.8) who underwent serial intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) at baseline and after 7 weeks. For each coronary plaque (≥50% plaque burden that was ≥5 mm in length), we evaluated plaque characteristics and the extent of lipid-rich plaque [LRP, defined as the 4 mm long segment with the maximum lipid-core burden index (maxLCBI4 mm)] on NIRS. Among 66 patients (age 63.0 ± 10.1 years; 82% statin use at baseline), 94 plaques were identified. The extent of LRP at baseline was positively correlated with IVUS plaque burden (r = 0.317, P = 0.002). A large LRP (maxLCBI4 mm ≥500) was present only in plaques with a large plaque burden (≥70%). Multivariate analysis demonstrated that plaque burden was the best predictor of the extent of LRP (P < 0.001). In lesions with a large plaque burden and a large amount of LRP at baseline, a reduction in LRP was seen in all lesions in patients receiving intensive statin therapy (P = 0.004) without a significant change in plaque burden. CONCLUSIONS Coronary lesions containing a large amount of LRP also had a large plaque burden. Short-term regression of LRP (without a change in plaque burden) was observed mainly in plaques with a large plaque burden and a large amount of LRP at baseline. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT01567826.
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Affiliation(s)
- Tomotaka Dohi
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Pedro R Moreno
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Usman Baber
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason C Kovacic
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Atul M Limaye
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ziad A Ali
- Columbia University Medical Center, New York, NY, USA The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George D Dangas
- Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ke Xu
- Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Samin K Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Annapoorna S Kini
- The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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42
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Okura H, Kataoka T, Yoshiyama M, Yoshikawa J, Yoshida K. Long-term prognostic impact of the attenuated plaque in patients with acute coronary syndrome. Heart Vessels 2014; 31:23-8. [PMID: 25183306 DOI: 10.1007/s00380-014-0575-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
Several intravascular ultrasound studies have reported that culprit lesion-attenuated plaque (AP) is related to slow flow/no reflow after percutaneous coronary intervention (PCI). Long-term prognostic impact of the AP is unknown. The aim of this study was to investigate acute and long-term clinical impact of the AP in patients with acute coronary syndrome (ACS). A total of 110 ACS patients who underwent successful PCI were enrolled. Acute and long-term clinical outcomes were compared between patients with AP (AP group: n = 73) and those without AP (non-AP group: n = 37). Long-term cardiac event was defined as a composite of death and ACS. Baseline characteristics in 2 groups were similar. AP was associated with higher TIMI frame count immediately after the first balloon inflation. After thrombectomy and intracoronary drug administration, final TIMI frame count became similar between AP and non-AP group. Although AP was associated with higher incidence of fatal arrhythmia during hospitalization, in-hospital mortality did not differ between the 2 groups. During follow-up (median 6.2 years), cardiac event-free survival did not differ between the 2 groups. Despite the initial unfavorable effect on coronary reflow, presence of AP did not affect acute as well as long-term clinical outcome in patients with ACS.
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Affiliation(s)
- Hiroyuki Okura
- The Division of Cardiology, Bell Land General Hospital, Sakai, Japan. .,The Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Toru Kataoka
- The Division of Cardiology, Bell Land General Hospital, Sakai, Japan
| | - Minoru Yoshiyama
- The Division of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junichi Yoshikawa
- The Division of Internal Medicine and Cardiology, Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan
| | - Kiyoshi Yoshida
- The Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
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43
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Daidoji H, Takahashi H, Otaki Y, Tamura H, Arimoto T, Shishido T, Miyashita T, Miyamoto T, Watanabe T, Kubota I. A combination of plaque components analyzed by integrated backscatter intravascular ultrasound and serum pregnancy-associated plasma protein a levels predict the no-reflow phenomenon during percutaneous coronary intervention. Catheter Cardiovasc Interv 2014; 85:43-50. [PMID: 24227626 DOI: 10.1002/ccd.25294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 10/11/2013] [Accepted: 11/10/2013] [Indexed: 11/10/2022]
Abstract
AIMS Previous studies reported that integrated backscatter intravascular ultrasound (IB-IVUS) provides high diagnostic accuracy for tissue characterization of coronary plaques and that pregnancy-associated plasma protein A (PAPP-A) could be a marker of adverse cardiac outcome in patients with cardiovascular disease. We examined whether IB-IVUS and PAPP-A levels could predict the incidence of no-reflow during percutaneous coronary intervention (PCI) METHODS AND RESULTS: About 176 consecutive patients (138 men, mean age 68 ± 11 years) who underwent PCI with IB-IVUS were prospectively enrolled. Combined no-reflow, including transient filter no-reflow by using distal protection devices, was observed in 31 patients. The percentages of coronary lipid volume (%LV) analyzed by IB-IVUS and serum PAPP-A were significantly higher in patients with combined no-reflow than normal-reflow. To predict no-reflow, a receiver operating characteristic (ROC) analysis determined cut-off values of %LV as 62% and serum PAPP-A as 7.71 ng/mL. The multivariate logistic regression analysis showed that %LV (hazard ratio 4.5, 95% confidence interval 1.6-13.4, P < 0.01) and PAPP-A (hazard ratio 4.32, 95% confidence interval 1.5-12.7, P < 0.01) were independent predictors of combined no-reflow CONCLUSIONS %LV analyzed by IB-IVUS and serum PAPP-A levels were closely associated with the coronary no-reflow phenomenon. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Hyuma Daidoji
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Feig JE. Regression of atherosclerosis: insights from animal and clinical studies. Ann Glob Health 2013; 80:13-23. [PMID: 24751561 DOI: 10.1016/j.aogh.2013.12.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 02/25/2014] [Accepted: 03/15/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Based on studies that date back to the 1920s, regression and stabilization of atherosclerosis in humans has gone from just a dream to one that is achievable. Review of the literature indicates that the successful attempts at regression generally applied robust measures to improve plasma lipoprotein profiles. Examples include extensive lowering of plasma concentrations of atherogenic apolipoprotein B and enhancement of reverse cholesterol transport from atheromata to the liver. FINDINGS Possible mechanisms responsible for lesion shrinkage include decreased retention of atherogenic apolipoprotein B within the arterial wall, efflux of cholesterol and other toxic lipids from plaques, emigration of lesional foam cells out of the arterial wall, and influx of healthy phagocytes that remove necrotic debris as well as other components of the plaque. This review will highlight the role key players such as LXR, HDL and CCR7 have in mediating regression. CONCLUSION Although much progress has been made, there are many unanswered questions. There is, therefore, a clear need for preclinical and clinical testing of new agents expected to facilitate atherosclerosis regression with the hope that additional mechanistic insights will allow further progress.
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Affiliation(s)
- Jonathan E Feig
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY.
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45
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Neishi Y, Okura H, Yoshida K. Unusual peri-stent strut contrast staining 6 years after sirolimus-eluting stent implantation: an "ant colony-like" appearance. Heart Vessels 2013; 29:699-702. [PMID: 24196524 DOI: 10.1007/s00380-013-0431-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/18/2013] [Indexed: 11/28/2022]
Abstract
A 60-year-old man with a previous history of sirolimus-eluting stent implantation was admitted because of chest pain. Coronary angiography revealed nonsignificant in-stent luminal narrowing at the previously stented segment with an unusual linear peri-stent strut contrast staining. Frequency-domain optical coherence tomography showed a cavity at the segment connecting to the coronary lumen at the distal part of the stent. This unusual "ant-colony"-like appearance of the stented segment may be a subtype of the incomplete stent apposition and/or interstrut hollows.
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Affiliation(s)
- Yoji Neishi
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
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46
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Kashiwagi M, Tanaka A, Kitabata H, Ozaki Y, Komukai K, Tanimoto T, Ino Y, Kubo T, Hirata K, Imanishi T, Akasaka T. Comparison of diagnostic accuracy between multidetector computed tomography and virtual histology intravascular ultrasound for detecting optical coherence tomography-derived fibroatheroma. Cardiovasc Interv Ther 2013; 29:102-8. [PMID: 24150708 DOI: 10.1007/s12928-013-0219-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/09/2013] [Indexed: 11/25/2022]
Abstract
Histopathological studies have reported that optical coherence tomography (OCT) can accurately detect fibroatheroma that is involved in not only culprit lesion of acute coronary syndrome but also no-reflow phenomenon after percutaneous coronary intervention. Studies have demonstrated superiority of OCT in plaque characterization and interruption of arterial wall component. At current, multidetector computed tomography (MDCT) and virtual histology intravascular ultrasound (VH-IVUS) are considered as alternative imaging devices for coronary plaque characterization. This study aimed to compare the diagnostic accuracy for detecting fibroatheroma between MDCT and VH-IVUS using OCT as the reference standard. Forty-three lesions from 27 patients assessed by MDCT, VH-IVUS, and OCT were included in this study. Fibroatheroma was defined by OCT as a signal-poor region with a fast signal drop-off and little or no signal backscattering within the lesion. From 43 lesions, OCT revealed 21 fibroatheromas. Ring-like sign assessed by MDCT and positive remodeling assessed by IVUS were more frequently observed in OCT-fibroatheroma than non-OCT-fibroatheroma. The remodeling index of OCT-fibroatheroma assessed by MDCT and IVUS were higher than those of non-OCT-fibroatheroma. The sensitivity, specificity, positive predict values, negative predict values and accuracy of ring-like sign by MDCT and VH-IVUS for detecting OCT-fibroatheroma were 43, 95, 90, 64, 70 % and 71, 45, 56, 63, 58 %, respectively. Our results suggest that both accuracies of MDCT and VH-IVUS to detect OCT-fibroatheroma are insufficient. We need to apply appropriate device for searching vulnerable plaque.
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Affiliation(s)
- Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan,
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47
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Yajima J. What imaging modality do you want to select for prediction of the no-reflow phenomenon? J Cardiol 2013; 62:138-9. [DOI: 10.1016/j.jjcc.2013.05.013] [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] [Received: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
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49
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Casciani E, De Vincentiis C, Colaiacomo MC, Gualdi GF. Multi-modal imaging technologies in cardiovascular risk assessment. Ther Apher Dial 2013; 17:138-49. [PMID: 23551670 DOI: 10.1111/j.1744-9987.2012.01132.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Atherosclerotic plaques can be responsible for life-threatening cardiovascular and cerebrovascular events. Some features of the plaque, such as a thin fibrous cap, large necrotic core, macrophage infiltration, neovascularization, and intraplaque hemorrhage, are associated with a major risk of such events and so their assessment is fundamental. Novel imaging techniques, each one with its own strength and drawbacks, can help in the evaluation and quantification of atherosclerosis. An analysis of the recent literature was carried out. The different techniques were compared by evaluating the accuracy of each one in the detection and assessment of the atherosclerotic plaque's features named above.
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Affiliation(s)
- Emanuele Casciani
- Emergency Department, Sant'andrea's Hospital, University of Rome La Sapienza, Rome, Italy.
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50
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Yamada R, Okura H, Kume T, Neishi Y, Kawamoto T, Miyamoto Y, Imai K, Saito K, Hayashida A, Yoshida K. A comparison between 40MHz intravascular ultrasound iMap imaging system and integrated backscatter intravascular ultrasound. J Cardiol 2013; 61:149-54. [DOI: 10.1016/j.jjcc.2012.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/23/2012] [Accepted: 10/28/2012] [Indexed: 11/16/2022]
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