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Homorodean C, Leucuta DC, Ober M, Homorodean R, Spinu M, Olinic M, Tataru D, Olinic DM. Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13671. [PMID: 34411283 DOI: 10.1111/eci.13671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients. METHODS A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models. RESULTS Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina. CONCLUSION Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non-culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.
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Affiliation(s)
- Calin Homorodean
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Ober
- Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | | | - Mihail Spinu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan Tataru
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
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Stable Angina Pectoris. Coron Artery Dis 2018. [DOI: 10.1016/b978-0-12-811908-2.00011-8] [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: 11/21/2022]
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3
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Schwindt AG, Bennett JG, Crowder WH, Dohad S, Janzer SF, George JC, Tedder B, Davis TP, Cawich IM, Gammon RS, Muck PE, Pigott JP, Dishmon DA, Lopez LA, Golzar JA, Chamberlin JR, Moulton MJ, Zakir RM, Kaki AK, Fishbein GJ, McDaniel HB, Hezi-Yamit A, Simpson JB, Desai A. Lower Extremity Revascularization Using Optical Coherence Tomography-Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study. J Endovasc Ther 2017; 24:355-366. [PMID: 28393673 DOI: 10.1177/1526602817701720] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of a novel optical coherence tomography (OCT)-guided atherectomy catheter in treating patients with symptomatic femoropopliteal disease. METHODS The VISION trial ( ClinicalTrials.gov identifier NCT01937351) was a single-arm, multicenter, global investigational device exemption study enrolling 158 subjects (mean age 67.2±10.5 years; 87 men) across 20 participating sites. In this cohort, 198 lesions were treated with an average length of 53±40 mm using the Pantheris catheter alone or Pantheris + adjunctive therapy. The primary safety endpoint was the composite of major adverse events (MAEs) through 6 months (objective performance goal 43.2%). Technical success (primary efficacy outcome) was defined as the percent of target lesions with a residual diameter stenosis ≤50% after treatment with the Pantheris device alone (objective performance goal 87.0%). Procedural success was defined as reduction in stenosis to ≤30% after Pantheris ± adjunctive therapy. Tissue specimens retrieved from each treated lesion were histologically analyzed to evaluate the accuracy and precision of OCT image guidance. RESULTS The primary efficacy outcome was achieved in 192 (97.0%) of the 198 lesions treated with the Pantheris catheter. Across all lesions, mean diameter stenosis was reduced from 78.7%±15.1% at baseline to 30.3%±11.8% after Pantheris alone (p<0.001) and to 22.4%±9.9% after Pantheris ± adjunctive therapy (p<0.001). Of the 198 target lesions, 104 (52.5%) were treated with the Pantheris alone, 84 (42.4%) were treated with Pantheris + adjunctive angioplasty, and 10 (5.1%) with Pantheris + angioplasty + stenting. The composite MAE outcome through 6 months occurred in 25 (16.6%) of 151 subjects. There were no clinically significant perforations, 1 (0.5%) catheter-related dissection, 4 (2%) embolic events, and a 6.4% clinically driven target lesion revascularization rate at 6 months. The 40-lesion chronic total occlusion (CTO) subset (mean lesion length 82±38 mm) achieved a similar significant reduction in stenosis to 35.5%±13.6% after Pantheris alone (p<0.001). Histological analysis of atherectomy specimens confirmed <1% adventitia in 82.1% of the samples, highlighting the precision of OCT guidance. Characterization of the OCT-guided lesions revealed evidence of an underestimation of disease burden when using fluoroscopy. CONCLUSION OCT-guided atherectomy for femoropopliteal disease is safe and effective. Additionally, the precision afforded by OCT guidance leads to greater removal of plaque during atherectomy while sparing the adventitia.
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Affiliation(s)
- Arne G Schwindt
- 1 Department of Vascular Surgery, St Franziskus-Hospital Münster, Germany
| | - J Gray Bennett
- 2 St Dominic-Jackson Memorial Hospital, Jackson, MI, USA
| | | | - Suhail Dohad
- 3 Cedars Sinai Medical Center, West Hollywood, CA, USA
| | | | - Jon C George
- 5 Deborah Heart and Lung Center, Brown Mills, NJ, USA
| | - Barry Tedder
- 6 St Bernards Medical Center, Jonesboro, AR, USA
| | | | | | | | | | - John P Pigott
- 11 Jobst Vascular Institute Promedica Toledo Hospital, Toledo, OH, USA
| | | | - Lou A Lopez
- 13 St Joseph's Hospital, Fort Wayne, IN, USA
| | - Jaafer A Golzar
- 14 Advocate Christ Hospital and Medical Center, Oak Lawn, IL, USA
| | | | | | - Ramzan M Zakir
- 17 St Peters University Hospital, New Brunswick, NJ, USA
| | - Amir K Kaki
- 18 DMC Cardiovascular Institute Harper-Hutzel Hospital, Detroit, MI, USA
| | | | | | | | - John B Simpson
- 21 Avinger Inc, Redwood City, CA, USA.,22 Sequoia Hospital, Redwood City, CA, USA
| | - Arjun Desai
- 21 Avinger Inc, Redwood City, CA, USA.,23 Stanford University Medical Center, Stanford, CA, USA
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[Is regression of atherosclerotic plaque possible?]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2016; 29:46-50. [PMID: 27692635 DOI: 10.1016/j.arteri.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/17/2016] [Indexed: 12/21/2022]
Abstract
As it is well-known, a thrombus evolving into a disrupted/eroded atherosclerotic plaque causes most acute coronary syndromes. Plaque stabilization via reduction of the lipid core and/or thickening of the fibrous cap is one of the possible mechanisms accounted for the clinical benefits displayed by different anti-atherosclerotic strategies. The concept of plaque stabilization was developed to explain how lipid-lowering agents could decrease adverse coronary events without substantial modifications of the atherosclerotic lesion ('angiographic paradox'). A number of imaging modalities (vascular ultrasound and virtual histology, MRI, optical coherence tomography, positron tomography, etc.) are used for non-invasive assessment of atherosclerosis; most of them can identify plaque volume and composition beyond lumen stenosis. An 'aggressive' lipid-lowering strategy is able to reduce the plaque burden and the incidence of cardiovascular events; this may be attributable, at least in part, to plaque-stabilizing effects.
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Puri R, Madder RD, Madden SP, Sum ST, Wolski K, Muller JE, Andrews J, King KL, Kataoka Y, Uno K, Kapadia SR, Tuzcu EM, Nissen SE, Virmani R, Maehara A, Mintz GS, Nicholls SJ. Near-Infrared Spectroscopy Enhances Intravascular Ultrasound Assessment of Vulnerable Coronary Plaque: A Combined Pathological and In Vivo Study. Arterioscler Thromb Vasc Biol 2015; 35:2423-31. [PMID: 26338299 DOI: 10.1161/atvbaha.115.306118] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/24/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Pathological studies demonstrate the dual significance of plaque burden (PB) and lipid composition for mediating coronary plaque vulnerability. We evaluated relationships between intravascular ultrasound (IVUS)-derived PB and arterial remodeling with near-infrared spectroscopy (NIRS)-derived lipid content in ex vivo and in vivo human coronary arteries. APPROACH AND RESULTS Ex vivo coronary NIRS and IVUS imaging was performed through blood in 116 coronary arteries of 51 autopsied hearts, followed by 2-mm block sectioning (n=2070) and histological grading according to modified American Heart Association criteria. Lesions were defined as the most heavily diseased 2-mm block per imaged artery on IVUS. IVUS-derived PB and NIRS-derived lipid core burden index (LCBI) of each block and lesion were analyzed. Block-level analysis demonstrated significant trends of increasing PB and LCBI across more complex atheroma (Ptrend <0.001 for both LCBI and PB). Lesion-based analyses demonstrated the highest LCBI and remodeling index within coronary fibroatheroma (Ptrend <0.001 and 0.02 versus all plaque groups, respectively). Prediction models demonstrated similar abilities of PB, LCBI, and remodeling index for discriminating fibroatheroma (c indices: 0.675, 0.712, and 0.672, respectively). A combined PB+LCBI analysis significantly improved fibroatheroma detection accuracy (c index 0.77, P=0.028 versus PB; net-reclassification index 43%, P=0.003), whereas further adding remodeling index did not (c index 0.80, P=0.27 versus PB+LCBI). In vivo comparisons of 43 age- and sex-matched patients (to the autopsy cohort) undergoing combined NIRS-IVUS coronary imaging yielded similar associations to those demonstrated ex vivo. CONCLUSIONS Adding NIRS to conventional IVUS-derived PB imaging significantly improves the ability to detect more active, potentially vulnerable coronary atheroma.
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Affiliation(s)
- Rishi Puri
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Ryan D Madder
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Sean P Madden
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Stephen T Sum
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Kathy Wolski
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - James E Muller
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Jordan Andrews
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Karilane L King
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Yu Kataoka
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Kiyoko Uno
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Samir R Kapadia
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - E Murat Tuzcu
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Steven E Nissen
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Renu Virmani
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Akiko Maehara
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Gary S Mintz
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Stephen J Nicholls
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., K.W., K.L.K., K.U., S.E.N.), and Department of Cardiovascular Medicine (R.P., S.R.K., E.M.T., S.E.N.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, South Australia (R.P., S.J.N.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M.); InfraRedX Inc., Burlington, MA (S.P.M., S.T.S., J.E.M.); South Australian Health and Medical Research Institute, Adelaide, South Australia (J.A., Y.K., S.J.N.); CVPath Institute, Gaithersburg, MD (R.V.); and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
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6
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Puri R, Nissen SE, Shao M, Kataoka Y, Uno K, Kapadia SR, Tuzcu EM, Nicholls SJ. The beneficial effects of raising high-density lipoprotein cholesterol depends upon achieved levels of low-density lipoprotein cholesterol during statin therapy: Implications for coronary atheroma progression and cardiovascular events. Eur J Prev Cardiol 2015; 23:474-85. [DOI: 10.1177/2047487315572920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/25/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Rishi Puri
- Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio, USA
| | - Steven E Nissen
- Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio, USA
| | - Mingyuan Shao
- Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio, USA
| | - Yu Kataoka
- South Australian Health and Medical Research Institute, University of Adelaide, South Australia
| | - Kiyoko Uno
- Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio, USA
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio, USA
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, South Australia
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7
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Wang P, Ma T, Slipchenko MN, Liang S, Hui J, Shung KK, Roy S, Sturek M, Zhou Q, Chen Z, Cheng JX. High-speed intravascular photoacoustic imaging of lipid-laden atherosclerotic plaque enabled by a 2-kHz barium nitrite raman laser. Sci Rep 2014; 4:6889. [PMID: 25366991 PMCID: PMC4219167 DOI: 10.1038/srep06889] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/14/2014] [Indexed: 11/09/2022] Open
Abstract
Lipid deposition inside the arterial wall is a key indicator of plaque vulnerability. An intravascular photoacoustic (IVPA) catheter is considered a promising device for quantifying the amount of lipid inside the arterial wall. Thus far, IVPA systems suffered from slow imaging speed (~50 s per frame) due to the lack of a suitable laser source for high-speed excitation of molecular overtone vibrations. Here, we report an improvement in IVPA imaging speed by two orders of magnitude, to 1.0 s per frame, enabled by a custom-built, 2-kHz master oscillator power amplifier (MOPA)-pumped, barium nitrite [Ba(NO3)2] Raman laser. This advancement narrows the gap in translating the IVPA technology to the clinical setting.
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Affiliation(s)
- Pu Wang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 47906, USA
| | - Teng Ma
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, California 90089, USA
| | - Mikhail N Slipchenko
- 1] Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 47906, USA [2] Spectral Energy, LLC, Dayton, Ohio, 45431, USA
| | - Shanshan Liang
- 1] Department of Biomedical Engineering, University of California, Irvine, California 92697, USA [2] Beckman Laser Institute, University of California, Irvine, California 92612, USA and Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, California 92697, USA
| | - Jie Hui
- Physics Department, Purdue University, West Lafayette, 47906, USA
| | - K Kirk Shung
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, California 90089, USA
| | - Sukesh Roy
- Spectral Energy, LLC, Dayton, Ohio, 45431, USA
| | - Michael Sturek
- Department of Cellular &Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana, 46202, USA
| | - Qifa Zhou
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, California 90089, USA
| | - Zhongping Chen
- Department of Biomedical Engineering, University of California, Irvine, California 92697, USA
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 47906, USA
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Puri R, Nicholls SJ, Brennan DM, Andrews J, King KL, Liew GY, Carbone A, Copus B, Nelson AJ, Kapadia SR, Tuzcu EM, Beltrame JF, Worthley SG, Worthley MI. Left main coronary arterial endothelial function and heterogenous segmental epicardial vasomotor reactivity in vivo: novel insights with intravascular ultrasonography. Eur Heart J Cardiovasc Imaging 2014; 15:1270-80. [PMID: 25024410 DOI: 10.1093/ehjci/jeu133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS While the relationship between epicardial coronary vasomotor reactivity and cardiovascular events is well established, this observation has yet to be evaluated within the left main coronary artery (LMCA) in humans in vivo. Our aims were to test the endothelium-dependent vasomotor properties of the LMCA, and to compare these responses to downstream epicardial segments. METHODS AND RESULTS Thirty patients referred for coronary angiography underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound imaging within a non-critically diseased, left-sided conduit vessel. Macrovascular vasomotor response [change in average lumen area (LA) at baseline and following 5 min of 0.30 µg/min IC salbutamol] and percent atheroma volume (PAV) were evaluated in 30 LMCA, 42 proximal, 109 mid, and 132 distal epicardial coronary segments. In comparison with all other segments, the LMCA had the greatest lumen and vessel areas (P < 0.001), yet the proximal epicardial segments contained the greatest PAV (P < 0.02). The mid and distal epicardial segments displayed significant endothelium-dependent vasodilatation from baseline (P = 0.017 and <0.001, respectively); however, the proximal epicardial and LMCA segments did not (P = 0.45 and 0.16, respectively). Significant segmental vasomotor heterogeneity was noted in all 30 patients, with opposing vasomotor responses between adjacent LMCA and epicardial segments. Across all segments, baseline LA inversely correlated with the % change in LA (r = -0.16, P = 0.0005). CONCLUSION Endothelium-dependent vasomotor reactivity is heterogenous within the conduit coronary system. Vascular dynamic responses were less prominent in the larger calibre LMCA and proximal epicardial segments. This may, in part, relate to higher shear stress in smaller, distal segments and yet also may explain the propensity for culprit plaques to cluster proximally.
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Affiliation(s)
- Rishi Puri
- Discipline of Medicine, University of Adelaide, Adelaide, Australia Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA C5Research, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Jordan Andrews
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Gary Y Liew
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Angelo Carbone
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Barbara Copus
- Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Adam J Nelson
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Emin Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephen G Worthley
- Discipline of Medicine, University of Adelaide, Adelaide, Australia Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia Department of Medicine, Cardiovascular Research Centre, Royal Adelaide Hospital, Level 6, Theatre Block, North Terrace, Adelaide, SA 5000, Australia
| | - Matthew I Worthley
- Discipline of Medicine, University of Adelaide, Adelaide, Australia Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia Department of Medicine, Cardiovascular Research Centre, Royal Adelaide Hospital, Level 6, Theatre Block, North Terrace, Adelaide, SA 5000, Australia
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9
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Abstract
Atherosclerosis causes clinical disease through luminal narrowing or by precipitating thrombi that obstruct blood flow to the heart (coronary heart disease), brain (ischemic stroke), or lower extremities (peripheral vascular disease). The most common of these manifestations is coronary heart disease, including stable angina pectoris and the acute coronary syndromes. Atherosclerosis is a lipoprotein-driven disease that leads to plaque formation at specific sites of the arterial tree through intimal inflammation, necrosis, fibrosis, and calcification. After decades of indolent progression, such plaques may suddenly cause life-threatening coronary thrombosis presenting as an acute coronary syndrome. Most often, the culprit morphology is plaque rupture with exposure of highly thrombogenic, red cell–rich necrotic core material. The permissive structural requirement for this to occur is an extremely thin fibrous cap, and thus, ruptures occur mainly among lesions defined as thin-cap fibroatheromas. Also common are thrombi forming on lesions without rupture (plaque erosion), most often on pathological intimal thickening or fibroatheromas. However, the mechanisms involved in plaque erosion remain largely unknown, although coronary spasm is suspected. The calcified nodule has been suggested as a rare cause of coronary thrombosis in highly calcified and tortious arteries in older individuals. To characterize the severity and prognosis of plaques, several terms are used. Plaque burden denotes the extent of disease, whereas plaque activity is an ambiguous term, which may refer to one of several processes that characterize progression. Plaque vulnerability describes the short-term risk of precipitating symptomatic thrombosis. In this review, we discuss mechanisms of atherosclerotic plaque initiation and progression; how plaques suddenly precipitate life-threatening thrombi; and the concepts of plaque burden, activity, and vulnerability.
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Tomey MI, Narula J, Kovacic JC. Advances in the Understanding of Plaque Composition and Treatment Options. J Am Coll Cardiol 2014; 63:1604-16. [DOI: 10.1016/j.jacc.2014.01.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/02/2014] [Accepted: 01/28/2014] [Indexed: 12/11/2022]
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Puri R, Libby P, Nissen SE, Wolski K, Ballantyne CM, Barter PJ, Chapman MJ, Erbel R, Raichlen JS, Uno K, Kataoka Y, Tuzcu EM, Nicholls SJ. Long-term effects of maximally intensive statin therapy on changes in coronary atheroma composition: insights from SATURN. Eur Heart J Cardiovasc Imaging 2014; 15:380-8. [DOI: 10.1093/ehjci/jet251] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Puri R, Nicholls SJ, Nissen SE, Brennan DM, Andrews J, Liew GY, Nelson AJ, Carbone A, Copus B, Tuzcu EM, Beltrame JF, Worthley SG, Worthley MI. Coronary Endothelium-Dependent Vasoreactivity and Atheroma Volume in Subjects With Stable, Minimal Angiographic Disease Versus Non–ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2013; 6:674-82. [DOI: 10.1161/circimaging.113.000460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epicardial plaque burden and endothelial function are recognized predictors of coronary events. We aimed to investigate mechanistic relationships between atheroma volume and endothelial function in patients with non–ST-segment–elevation myocardial infarction (NSTEMI) using intravascular ultrasound.
Methods and Results—
In coronary vessels of patients with near-normal or minimal angiographic disease (n=23) and NSTEMI (n=24), intravascular ultrasound-derived measures (percent atheroma volume), arterial remodeling index, and segmental lumen volumes were performed in contiguous 5-mm epicardial segments. Repeat intravascular ultrasound imaging was performed after consecutive 5-minute intracoronary infusions (vehicle solution, 0.30 μg/min and 0.60 μg/min intracoronary salbutamol) to measure changes in segmental lumen volume (endothelium-dependent function). Male sex, diabetes mellitus, smoking, higher triglycerides, and lower high-density lipoprotein cholesterol were more prevalent in the NSTEMI group. Patients with NSTEMI demonstrated greater segmental percent atheroma volume (40.4±12 versus 27.5±14%, P<0.001), remodeling index (1.2 [1.0–1.5] versus 1.0 [0.9–1.0], P<0.001), and displayed less endothelium-dependent vasomotion (% change segmental lumen volume: 2.1±0.89 versus 5.1±0.89%, P=0.02) compared to patients with minimal angiographic disease. No significant difference in endothelial function between both groups was observed when controlling for plaque burden. Multivariate analysis for change in segmental lumen volume identified percent atheroma volume (β=−0.18, P=0.0004), high-sensitivity C-reactive protein >2 mg/L (β=−3.1, P=0.03), diabetes mellitus (β=−6.9, P<0.0001), low-density lipoprotein cholesterol levels (β=−0.04, P=0.01), and smoking (β=–3.2, P=0.01) as independent associates.
Conclusions—
Although coronary endothelial vasoreactivity is blunted in the setting of NSTEMI, this is a reflection of the greater volume of atherosclerosis and cardiovascular risk factors. Thus, the relationship between coronary endothelium-dependent vasomotor reactivity and atheroma volume remains constant irrespective of the nature of the clinical presentation.
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Affiliation(s)
- Rishi Puri
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Stephen J. Nicholls
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Steven E. Nissen
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Danielle M. Brennan
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Jordan Andrews
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Gary Y. Liew
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Adam J. Nelson
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Angelo Carbone
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Barbara Copus
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - E. Murat Tuzcu
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - John F. Beltrame
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Stephen G. Worthley
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Matthew I. Worthley
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
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Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists' view. Eur Heart J 2012; 34:719-28. [PMID: 23242196 DOI: 10.1093/eurheartj/ehs411] [Citation(s) in RCA: 694] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although mortality rates from coronary heart disease in the western countries have declined in the last few decades, morbidity caused by this disease is increasing and a substantial number of patients still suffer acute coronary syndrome (ACS) and sudden cardiac death. Acute coronary syndrome occurs as a result of myocardial ischaemia and its manifestations include acute myocardial infarction and unstable angina. Culprit plaque morphology in these patients varies from thrombosis with or without coronary occlusion to sudden narrowing of the lumen from intraplaque haemorrhage. The coronary artery plaque morphologies primarily responsible for thrombosis are plaque rupture, and plaque erosion, with plaque rupture being the most common cause of acute myocardial infarction, especially in men. Autopsy data demonstrate that women <50 years of age more frequently have erosion, whereas in older women, the frequency of rupture increases with each decade. Ruptured plaques are associated with positive (expansive) remodelling and characterized by a large necrotic core and a thin fibrous cap that is disrupted and infiltrated by foamy macrophages. Plaque erosion lesions are often negatively remodelled with the plaque itself being rich in smooth muscle cells and proteoglycans with minimal to absence of inflammation. Plaque haemorrhage may expand the plaque rapidly, leading to the development of unstable angina. Plaque haemorrhage may occur from plaque rupture (fissure) or from neovascularization (angiogenesis). Atherosclerosis is now recognized as an inflammatory disease with macrophages and T-lymphocytes playing a dominant role. Recently at least two subtypes of macrophages have been identified. M1 is a pro-inflammatory macrophage while M2 seems to play a role in dampening inflammation and promoting tissue repair. A third type of macrophage, termed by us as haemoglobin associated macrophage or M(Hb) which is observed at site of haemorrhage also can be demonstrated in human atherosclerosis. In order to further our understanding of the specific biological events which trigger plaque instability and as well as to monitor the effects of novel anti-atherosclerotic therapies newer imaging modalities in vivo are needed.
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Affiliation(s)
- Erling Falk
- Aarhus University Hospital Skejby, Aarhus, Denmark
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