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Zhang W, Zhang W, Deng Y, Gu N, Qiu Z, Deng C, Yang S, Pan L, Long S, Wang Y, Zhao Y, Shi B. Non-target lesion progression: Unveiling critical predictors and outcomes in patients with in-stent restenosis. Int J Cardiol 2024; 416:132451. [PMID: 39147280 DOI: 10.1016/j.ijcard.2024.132451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/30/2024] [Accepted: 08/13/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has become the primary treatment for coronary artery disease. However, while PCI effectively addresses severe stenosis or occlusive lesions in target vessels, the progression of non-target vessel plaque remains a critical determinant of long-term patient prognosis. AIMS The purpose of this study was to investigate the impact of non-target vascular plaque progression on prognosis after PCI for ISR. METHODS This study included 195 patients diagnosed with ISR and multivessel disease who underwent successful PCI with drug-eluting stent (DES) placement, along with intraoperative optical coherence tomography (OCT) assessment of the culprit stent. Subsequent rechecked coronary angiography categorized eligible patients into non-target lesion progression (N-TLP) and no-N-TLP groups. We evaluated the baseline morphological characteristics of N-TLP by OCT and investigated the relationship between N-TLP, non-culprit vessel-related major adverse cardiovascular events (NCV-MACE), and pan-vascular disease-related clinical events (PVD-CE) incidence. RESULTS Multivariate logistic regression analysis revealed that diabetes mellitus (OR 3.616, 95% CI: 1.735-7.537; P = 0.001), uric acid level (OR 1.005, 95% CI: 1.001-1.009; P = 0.006), in-stent neoatherosclerosis (ISNA) (OR 1.334, 95% CI: 1.114-1.985; P = 0.047) and heterogeneous neointima morphology (OR 2.48, 95% CI: 1.18-5.43; P = 0.019) were independent predictors for N-TLP. Furthermore, N-TLP was associated with a high incidence of NCV-MACE (19.4% vs 6.9%, P = 0.009) and PVD-CE (83.9% [95% CI: 79.7%-88.3%] vs 93.1% [95% CI: 88.4%-98.0%], P = 0.038) after PCI in ISR patients. CONCLUSION Diabetes, uric acid levels, ISNA, and heterogeneous neointima are predictive factors for subsequent rapid plaque progression, with N-TLP exacerbating the incidence of NCV-MACE and PVD-CE after PCI.
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Affiliation(s)
- Wei Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Wei Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yi Deng
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Ning Gu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Zhimei Qiu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Chancui Deng
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Shuangya Yang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Li Pan
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Shiwen Long
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yan Wang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yongchao Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China.
| | - Bei Shi
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China.
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Wu H, Yin Y, Lei F, Ma X, Lu W, Shen Y, Zhang L, Liu X, Hu W, Ye X, Yang C. Influence of metabolic syndrome on plaque features and clinical outcomes in patients with acute coronary syndrome. Clin Res Cardiol 2024:10.1007/s00392-024-02540-0. [PMID: 39297939 DOI: 10.1007/s00392-024-02540-0] [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] [Received: 10/03/2023] [Accepted: 08/30/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND AND AIMS Currently, the influence of metabolic syndrome (Mets) on the plaque characteristics and prognosis of patients with acute coronary syndrome (ACS) is poorly understood. Thus, the study aimed to characterize the pancoronay plaques of ACS patients with Mets using optical coherence tomography (OCT) and to evaluate the cohort's prognosis. METHODS Between February 2015 and September 2020, 745 ACS patients who underwent OCT imaging of the three coronary arteries were included, divided into Mets (n = 252) and non-Mets (n = 493) groups. The major adverse cardiovascular event (MACE) was a composite of cardiac death, non-fatal myocardial infarction (MI), and revascularization. RESULTS Compared to the non-Mets group, the Mets group exhibited a higher proportion of females and cases of multivessel disease. In the Mets group, culprit lesions were found to have a greater degree of stenosis, thinner fibrous cap thickness and more thin-cap fibroatheroma (TCFA). Additionally, nonculprit lesions were more likely to exhibit plaque rupture, high-risk plaque characteristics, TCFA, macrophage infiltration, cholesterol crystals, and layered plaque. After a median follow-up of 2 years, 8.3% of patients experienced MACE, a rate that was higher in the Mets group, primarily attributed to non-fatal myocardial infarction and cardiac death. Multivariate analysis showed that Mets (aHR 1.73, p = 0.037), high-risk plaque (aHR 2.63, p < 0.001), age (aHR 1.03, p = 0.020), and left ventricular ejection fraction (aHR 0.96, p = 0.002) were independent predictors of MACE. CONCLUSIONS The presence of Mets increased the vulnerability of the entire coronary tree and worsened the prognosis for patients with ACS.
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Affiliation(s)
- Hanzhi Wu
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Changzhou Traditional Chinese Medicine Hospital, 25 Heping North Road, Tianning District, Changzhou, 213000, China
| | - Yanwei Yin
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Fangmeng Lei
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Xiaoxue Ma
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Wenlin Lu
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Yanqing Shen
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Lizhu Zhang
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Xiaoxiao Liu
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Wenjing Hu
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China
| | - Xinhe Ye
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China.
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China.
| | - Chengjian Yang
- Department of Cardiology, Wuxi No. 2 People's Hospital, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China.
- Department of Cardiology, Jiangnan University Medical Center, 68 Zhongshan Road, Liangxi District, Wuxi, 214000, China.
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Zeng M, Chu M, Xu L, Yi B, Yu W, Sun Q, Zhang Y, Liu Y, Zhao C, Weng Z, He L, Qin Y, Xu Y, Liu H, Wang N, Feng X, Koniaeva E, Mohammad D, Hu S, Tu S, Yu B, Jia H. Value of Combined Optical Coherence Tomography and Optical Flow Ratio Measurements After Percutaneous Coronary Intervention. Can J Cardiol 2024:S0828-282X(24)00938-3. [PMID: 39245340 DOI: 10.1016/j.cjca.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Optical flow ratio (OFR) is a novel computational fractional flow reserve derived from optical coherence tomography (OCT). However, the impact of combining post-stenting morphology (OCT) and physiology (OFR) remains largely unknown. METHODS OCT and OFR were analysed at an independent core laboratory. Target lesion failure (TLF) was defined as the composite of cardiac death, target lesion myocardial infarction, and target lesion revascularisation. Suboptimal stent deployment was identified with at least 1 TLF-related OCT or OFR characteristic. RESULTS A total of 448 patients with acute coronary syndrome (459 vessels) were assessed. Stent expansion < 80%, minimal stent area < 4.5 mm2, stent edge lipid-rich plaque and OFR < 0.90 were independent predictors of TLF (all P < 0.001). Patients with OCT-suboptimal (adjusted hazard ratio [aHR] 7.88, 95% CI 2.73-22.72,-P < 0.001) or OFR-suboptimal (aHR 5.78, 95% CI 2.54-13.14; P < 0.001) stent deployment showed significantly higher risk of TLF compared with those with optimal stent deployment, with a significant interaction (Pinteraction < 0.001). OCT and OFR both-suboptimal stent deployment was confirmed as an independent predictor of TLF (aHR 9.39, 95% CI 4.25-20.76; P < 0.001). CONCLUSIONS Combined OCT and OFR conferred an optimal reclassification of stent deployment, which may aid in decision making regarding a tailored PCI strategy for optimal stent deployment.
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Affiliation(s)
- Ming Zeng
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Liangxiao Xu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Boling Yi
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qianhui Sun
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yixuan Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yue Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chen Zhao
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ziqian Weng
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Luping He
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yuhan Qin
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yishuo Xu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Huimin Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ning Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xue Feng
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ekaterina Koniaeva
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Diler Mohammad
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Sining Hu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
| | - Haibo Jia
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
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Ji SS, Zhao LX, Chen W, Wang YF, Liu FC, Li HP, He GW, Zhang J. The Characteristics of Coronary Artery Lesions in COVID-19 Infected Patients With Coronary Artery Disease: An Optical Coherence Tomography Study. Am J Cardiol 2024; 226:108-117. [PMID: 39009056 DOI: 10.1016/j.amjcard.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/16/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024]
Abstract
COVID-19 may predispose patients to cardiac injuries but whether COVID-19 infection affects the morphological features of coronary plaques to potentially influence the outcome of patients with coronary artery disease (CAD) remains unknown. By using optical coherence tomography (OCT), this study compared the characteristics of coronary plaque in patients with CAD with/without COVID-19 infection. The 206 patients were divided into 2 groups. The COVID-19 group had 113 patients between December 7, 2022, and March 31, 2023, who received OCT assessment after China decided to lift the restriction on COVID-19 and had a history of COVID-19 infection. The non-COVID-19 group had 93 patients without COVID-19 infection who underwent OCT before December 7, 2022. The COVID-19 group demonstrated a higher incidence of plaque ruptures (53.1% vs 38.7%, p = 0.039), erosions (28.3% vs 11.8%, p = 0.004), fibrous (96.5% vs 89.2%, p = 0.041) and diffuse lesions (73.5% vs 50.5%, p <0.001) compared with the non-COVID-19 group, whereas non-COVID-19 group exhibited a higher frequency of cholesterol crystals (83.9% vs 70.8%, p = 0.027), deep calcifications (65.6% vs 51.3%, p = 0.039) and solitary lesions (57.0% vs 34.5%, p = 0.001). Kaplan-Meier survival analysis revealed a significantly lower major adverse cardiac events-free probability in the COVID-19 group (91.6% vs 95.5%, p = 0.006) than in the non-COVID-19 group. In conclusion, OCT demonstrated that COVID-19 infection is associated with coronary pathological changes such as more plaque ruptures, erosions, fibrosis, and diffuse lesions. Further, COVID-19 infection is associated with a higher propensity for acute coronary events and a higher risk of major adverse cardiac events in patients with CAD.
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Affiliation(s)
- Shan-Shan Ji
- Faculty of Graduate Studies, Chengde Medical University, Chengde, China & Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Li-Xuan Zhao
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Weiqiang Chen
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Yi-Fan Wang
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Fang-Chun Liu
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Hai-Peng Li
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Guo-Wei He
- Department of Cardiac Surgery & The Institute of Cardiovascular Diseases, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China.
| | - Jian Zhang
- Faculty of Graduate Studies, Chengde Medical University, Chengde, China & Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China; Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China.
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5
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Shen L, Bi Y, Yu J, Zhong Y, Chen W, Zhao Z, Ding J, Shu G, Chen M, Lu C, Ji J. The biological applications of near-infrared optical nanomaterials in atherosclerosis. J Nanobiotechnology 2024; 22:478. [PMID: 39135099 PMCID: PMC11320980 DOI: 10.1186/s12951-024-02703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 07/05/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE OF REVIEW Atherosclerosis, a highly pathogenic and lethal disease, is difficult to locate accurately via conventional imaging because of its scattered and deep lesions. However, second near-infrared (NIR-II) nanomaterials show great application potential in the tracing of atherosclerotic plaques due to their excellent penetration and angiographic capabilities. RECENT FINDINGS With the development of nanotechnology, among many nanomaterials available for the visual diagnosis and treatment of cardiovascular diseases, optical nanomaterials provide strong support for various biomedical applications because of their advantages, such as noninvasive, nondestructive and molecular component imaging. Among optical nanomaterials of different wavelengths, NIR-II-range (900 ~ 1700 nm) nanomaterials have been gradually applied in the visual diagnosis and treatment of atherosclerosis and other vascular diseases because of their deep biological tissue penetration and limited background interference. This review explored in detail the prospects and challenges of the biological imaging and clinical application of NIR-II nanomaterials in treating atherosclerosis.
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Affiliation(s)
- Lin Shen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Yanran Bi
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Junchao Yu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Yi Zhong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Weiqian Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Zhongwei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Jiayi Ding
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Gaofeng Shu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Chenying Lu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China.
- Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, No 289, Kuocang Road, Lishui, 323000, China.
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6
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Zhao J, Wu T, Tan J, Chen Y, Xu X, Guo Y, Jin C, Xiu L, Zhao R, Sun S, Peng C, Li S, Yu H, Liu Y, Wei G, Li L, Wang Y, Hou J, Dai J, Fang C, Yu B. Pancoronary plaque characteristics in STEMI patients with rapid plaque progression: An optical coherence tomography study. Int J Cardiol 2024; 400:131821. [PMID: 38301829 DOI: 10.1016/j.ijcard.2024.131821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Non-culprit plaque progression is associated with recurrent cardiac ischemic events and worse clinical outcomes. Given that atherosclerosis is a systemic disease, the pancoronary characteristics of patients with rapid plaque progression are unknown. This study aims to identify pancoronary plaque features in patients with ST-segment elevation myocardial infarction (STEMI) with and without rapid plaque progression, focused on the patient level. METHODS AND RESULTS From January 2017 to July 2019, 291 patients underwent 3-vessel optical coherence tomography imaging at the time of the primary procedure and a follow-up angiography interval of 12 months. The final analysis included 237 patients. Overall, 308 non-culprit lesions were found in 78 STEMI patients with rapid plaque progression, and 465 non-culprit plaques were found in 159 STEMI patients without rapid plaque progression. These patients had a higher pancoronary vulnerability (CLIMA-defined high-risk plaque: 47.4% vs. 33.3%; non-culprit plaque rupture: 25.6% vs. 14.5%) and a significantly higher prevalence of other vulnerable plaque characteristics (i.e., lipid-rich plaque, cholesterol crystal, microchannels, calcification, spotty calcification, and thrombus) at baseline versus those without rapid plaque progression. Lesions with rapid progression were highly distributed at the LAD, tending to be near the bifurcation. In multivariate analysis, age ≥ 65 years was an independent predictor of subsequent rapid lesion progression at the patient level, whereas microchannel, spotty calcification, and cholesterol crystal were independent predictors for STEMI patients ≥65 years old. CONCLUSIONS STEMI patients with subsequent rapid plaque progression had higher pancoronary vulnerability and commonly presented vulnerable plaque morphology. Aging was the only predictor of subsequent rapid plaque progression.
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Affiliation(s)
- Jiawei Zhao
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Tianyu Wu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Jinfeng Tan
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yuzhu Chen
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Xueming Xu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yibo Guo
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Chengmei Jin
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Lili Xiu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Rui Zhao
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Sibo Sun
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Cong Peng
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Shuang Li
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Huai Yu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yanchao Liu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Guo Wei
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Lulu Li
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Yini Wang
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Jingbo Hou
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Jiannan Dai
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China
| | - Chao Fang
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China.
| | - Bo Yu
- Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Harbin 150086, China.
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7
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Li J, Chen R, Zhou J, Wang Y, Zhao X, Liu C, Zhou P, Chen Y, Song L, Yan S, Yan H, Zhao H. Lipid Content Distribution and its Clinical Implication in Patients with Acute Myocardial Infarction-Plaque Erosion: Results from the Prospective OCTAMI Study. J Atheroscler Thromb 2024; 31:23-35. [PMID: 37423723 PMCID: PMC10776303 DOI: 10.5551/jat.64144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
AIMS Plaque erosion (PE) is one of the main plaque phenotypes of acute coronary syndrome (ACS). However, the underlying plaque component and distribution have not been systematically analysed. This study aims to investigate the distribution of lipid and calcium content in culprit lesions assessed by optical coherence tomography (OCT) in patients with PE and explore its relationship with prognosis in a cohort of ST segment elevation myocardial infarction (STEMI) patients. METHODS A prospective cohort of 576 patients with STEMI was enrolled in our study. After exclusion, 152 PE patients with clear underlying plaque components were ultimately analysed. The culprit lesion was divided into the border zone, external erosion zone and erosion site in the longitudinal view. Each pullback of the culprit lesions was assessed by 3 independent investigators frame-by-frame, and the quantity and distribution of lipid and calcium components were recorded. RESULTS Of the 152 PE patients, lipid and calcium contents were more likely to exist in the external erosion zone than in the other regions. In particular, a high level of lipid content proximal to the erosion site was significantly associated with plaque vulnerability and a higher incidence of MACEs. CONCLUSION This study revealed that high level of lipid content in the proximal external erosion zone was related to high-risk plaque characteristics and poor prognosis, which provided a novel method for risk stratification and precise management in patients with plaque erosion.
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Affiliation(s)
- Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zhang W, Zhang W, Gu N, Qiu Z, Pan L, Zhao Y, Shi B. Naturally Occurring Atherosclerosis Progression and In-Stent Restenosis: Exploring Histomorphological Associations Using Optical Coherence Tomography. J Cardiovasc Pharmacol 2023; 83:00005344-990000000-00262. [PMID: 38030142 PMCID: PMC11149940 DOI: 10.1097/fjc.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
ABSTRACT The mechanism of in-stent restenosis (ISR) remains elusive, and in-stent neoatherosclerosis (ISNA) may hold siginificant pathophysiological implications. Nevertheless, the correlation between ISNA and the progression of untreated coronary segments affected by native atherosclerosis remains incompletely investigated. This study enrolled 225 patients diagnosed with coronary heart disease and multivessel disease (MVD). These patients underwent successful percutaneous coronary intervention (PCI) and intraoperative placement of drug-eluting stent (DES), followed by optical coherence tomography (OCT) assessment of the culprit stent. The mechanism of ISR was emamined through qualitative and quantitative analysis of OCT imaging. A significantly higher proportion of patients in the ISR with non-target lesion progression (N-TLP) group exhibited lipid plaque formation compared to the ISR without N-TLP group (69.0% versus 39.8%, P < 0.001). The incidence of thin-cap fibroatheroma (TCFA) (33.3% versus 11.4%, P = 0.001) and ISNA (60.7% versus 38.6%, P < 0.001) was markedly elevated in the ISR with N-TLP group compared to the ISR without N-TLP group. Regarding manifestations, heterogeneous hyperplasia was predominantly observed in the ISR with N-TLP group (76.2% versus 38.6%, P < 0.001), while homogeneous hyperplasia was primarily presented in the ISR without N-TLP group (61.4% versus 23.8%, P < 0.001). Patients displaying notable progression of naturally occurring atherosclerosis manifest histomorphological features of ISR, primarily characterized by heterogeneous intimal hyperplasia and a higher prevalence of ISNA. In contrast, patients without substantial progression of naturally occurring atherosclerosis exhibit histomorphologic features of ISR primarily characterized by homogeneous intimal hyperplasia.
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Affiliation(s)
- Wei Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
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9
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Feng X, Xu Y, Zeng M, Qin Y, Weng Z, Sun Y, Gao Z, He L, Zhao C, Wang N, Zhang D, Wang C, Wang Y, Li L, Fang C, Dai J, Jia H, Yu B. Optical Coherence Tomography Assessment of Coronary Lesions Associated With Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction. Circ J 2023; 87:1625-1632. [PMID: 37407487 DOI: 10.1253/circj.cj-23-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Microvascular reperfusion following percutaneous coronary intervention (PCI) is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We investigated how plaque characteristics detected by optical coherence tomography (OCT) in STEMI patients affect the status of the microcirculation during PCI. METHODS AND RESULTS This retrospective, single-center study was a post hoc analysis basedon the multicenter SALVAGE randomized control trial (NCT03581513) that enrolled 629 STEMI patients, and finally we enrolled 235 patients who underwent PCI and pre-intervention OCT. Microvascular perfusion was evaluated using the Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion frame count (TMPFC). Patients were divided into 3 groups based on the change in TMPFC from before to after PCI: improving TMPFC (n=11; 4.7%), stable TMPFC (n=182; 77.4%), and worsening TMPFC group (n=42; 17.9%). The proportion of patients with a microcirculation dysfunction before reperfusion was 11.9%, which increased significantly by (P=0.079) 8.5% to 20.4% after reperfusion. Compared with plaque characteristics in the stable and worsening TMPFC groups, the improving TMPFC group had fewer thrombi (90.7% and 90.5% vs. 89.4%, respectively; P=0.018), a lower proportion of plaque rupture (66.5% and 66.3% vs. 54.5%, respectively; P=0.029), and a lower proportion of lipid-rich plaques (89.6% and 88.1% vs. 63.6%, respectively; P=0.036). CONCLUSIONS PCI may not always achieve complete myocardial reperfusion. Thrombi, plaque rupture, and lipid-rich plaques detected by OCT can indicate microcirculation dysfunction during the reperfusion period.
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Affiliation(s)
- Xue Feng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yishuo Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ming Zeng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yuhan Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ziqian Weng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yanli Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Zhanqun Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Luping He
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chen Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ning Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Dirui Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Fang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
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Hoshino M, Sugiyama T, Kanaji Y, Hada M, Nagamine T, Nogami K, Ueno H, Sayama K, Matsuda K, Yonetsu T, Sasano T, Kakuta T. Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction in Non-ST-Elevation acute coronary syndrome. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2051-2061. [PMID: 37486551 DOI: 10.1007/s10554-023-02903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Unrecognized myocardial infarction (UMI) detected by cardiac magnetic resonance (CMR) imaging is associated with adverse outcomes in patients with acute and chronic coronary syndrome. This study aimed to assess the predictors of optical coherence tomography (OCT) and coronary computed tomography angiography (CCTA) findings for non-infarct-related (non-IR) territory UMI in patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS We investigated 69 patients with a first clinical episode of NSTE-ACS who underwent pre-percutaneous coronary intervention (PCI) 320-slice CCTA, uncomplicated urgent PCI with OCT assessment within 24 h of admission, and post-PCI CMR. UMI was assessed using late gadolinium enhancement to identify regions of hyperenhancement with an ischemic distribution pattern in non-IR territories. RESULTS Non-IR UMI was detected in 11 patients (15.9%). Lower ejection fraction, higher Gensini score, higher Agatston score, high pericoronary adipose tissue attenuation (PCATA), OCT-defined culprit lesion plaque rupture, and OCT-defined culprit lesion cholesterol crystal were significantly associated with the presence of non-IR UMI. On dividing the total cohort was divided into five groups according to the numbers of two OCT-derived risk factors and two CCTA-derived risk factors, the frequency of non-IR UMI frequency significantly increased according to the number of these relevant risk features (p < 0.001). Patients with all of the non-IR UMI risk factors showed 50% prevalence of non-IR UMI, compared with 2.2% of patients with low risk factors (≤ 2). CONCLUSIONS Integrated CCTA and culprit lesion OCT assessment may help identify the presence of non-IR UMI, potentially providing prognostic information in patients with first NSTE-ACS episode.
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Affiliation(s)
- Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kodai Sayama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuki Matsuda
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
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11
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Weng Z, Zhao C, Qin Y, Liu C, Pan W, Hu S, He L, Xu Y, Zeng M, Feng X, Gao R, Yu X, Liu M, Yi B, Zhang D, Koniaeva E, Musin T, Mohammad D, Zhu B, Sun Y, Hou J, Tian J, Mintz GS, Jia H, Yu B. Peripheral atherosclerosis in acute coronary syndrome patients with plaque rupture vs plaque erosion: A prospective coronary optical coherence tomography and peripheral ultrasound study. Am Heart J 2023; 263:159-168. [PMID: 37327980 DOI: 10.1016/j.ahj.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Plaque rupture (PR) and plaque erosion (PE) are 2 distinct, different, and most common culprit lesion morphologies responsible for acute coronary syndrome (ACS). However, the prevalence, distribution, and characteristics of peripheral atherosclerosis in ACS patients with PR vs PE has never been studied. The aim of this study was to assess peripheral atherosclerosis burden and vulnerability evaluated by vascular ultrasound in ACS patients with coronary PR vs PE identified by optical coherence tomography (OCT). METHODS Between October 2018 and December 2019, 297 ACS patients who underwent preintervention OCT examination of the culprit coronary artery were enrolled. Peripheral ultrasound examinations of carotid, femoral, and popliteal arteries were performed before discharge. RESULTS Overall, 265 of 297 (89.2%) patients had at least one atherosclerotic plaque in a peripheral arterial bed. Compared with coronary PE, patients with coronary PR had a higher prevalence of peripheral atherosclerotic plaques (93.4% vs 79.1%, P < .001), regardless of location: carotid, femoral, or popliteal arteries. The number of peripheral plaques per patient was significantly larger in the coronary PR group than coronary PE (4 [2-7] vs 2 [1-5], P < .001). Additionally, there was a greater prevalence of peripheral vulnerable characteristics including plaque surface irregularity, heterogeneous plaque, and calcification in patients with coronary PR vs PE. CONCLUSIONS Peripheral atherosclerosis exists commonly in patients presenting with ACS. Patients with coronary PR had greater peripheral atherosclerosis burden and more peripheral vulnerability compared to those with coronary PE, suggesting that comprehensive evaluation of peripheral atherosclerosis and multidisciplinary cooperative management maybe necessary, especially in patients with PR. TRIAL REGISTRATION clinicaltrials.gov (NCT03971864).
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Affiliation(s)
- Ziqian Weng
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chen Zhao
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yuhan Qin
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Cong Liu
- Department of Ultrasound, The second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weili Pan
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Sining Hu
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Luping He
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yishuo Xu
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ming Zeng
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xue Feng
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Rui Gao
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xianghao Yu
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Minghao Liu
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Boling Yi
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Dirui Zhang
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ekaterina Koniaeva
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Timur Musin
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Diler Mohammad
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bin Zhu
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yanli Sun
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, The second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, 10019 NY, USA
| | - Haibo Jia
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The second Affiliated Hospital of Harbin Medical University, Harbin, China; National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
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12
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Wang C, Tian X, Feng X, Demuyakor A, Hu S, Wang Y, Li L, Cui L, Dong F, Dai J, Lei F, Xu Y, Du Z, Shi M, Liu J, Xing L, E M. Pancoronary plaque characteristics and clinical outcomes in acute coronary syndrome patients with cancer history. Atherosclerosis 2023; 378:117118. [PMID: 37127496 DOI: 10.1016/j.atherosclerosis.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/13/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND AIMS The prevalence of acute coronary syndrome (ACS) patients with cancer history is increasing and it is associated with higher mortality. However, there is limited evidence on the characteristics of coronary plaque in ACS patients with cancer history. This study explored the pancoronary plaque characteristics in ACS patients with cancer history by optical coherence tomography (OCT). METHODS A total of 306 ACS patients treated by 3-vessel OCT at the time of percutaneous coronary intervention (PCI) were included, retrospectively. Patients were divided into two groups according to the presence or absence of cancer history: one group with cancer history (n = 98) and a matched group without cancer history (n = 208). RESULTS A total of 314 culprit lesions and 514 nonculprit lesions were identified by OCT in this study. In culprit lesions, ACS patients with cancer history had higher incidence of thin cap fibroatheroma (TCFA) (p = 0.016), cholesterol crystals (p = 0.028), calcification (p = 0.001) and thrombus (p = 0.001), and had thinner fibrous cap thickness (FCT) (p = 0.011), greater maximum lipid arc (p = 0.042) and lipid index (p < 0.001), compared to matched ACS patients without cancer history. In nonculprit lesions, ACS patients with cancer history had higher prevalence of high-risk plaque (14.7% vs. 7.7%, p = 0.017), nonculprit rupture (14.7% vs. 6.3%, p = 0.003), and TCFA (52.2% vs. 28.3%, p < 0.001), and had higher incidence of calcification (p = 0.003), thrombus (p = 0.029), cholesterol crystals (p = 0.002) and microchannels (p = 0.029). These non-culprit lesions had longer lesion length (p = 0.001), thinner FCT (p < 0.001), greater maximum lipid arc (p = 0.016) and lipid index (p < 0.001). CONCLUSIONS ACS patients with cancer history showed more high-risk plaque features in culprit and nonculprit lesions, compared with ACS patients without cancer history. Therefore, ACS patients with cancer history may have greater pancoronary vulnerability. This may predict a poorer prognosis for ACS patients with cancer history.
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Affiliation(s)
- Chao Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Xueqin Tian
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Xue Feng
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Abigail Demuyakor
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Sining Hu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Yini Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Lulu Li
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Lina Cui
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Fuhong Dong
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Jiannan Dai
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Fangmeng Lei
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Yishuo Xu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Zhuo Du
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China
| | - Manru Shi
- Department of Radiation Oncology, Harbin Medical University Tumor Hospital, Harbin, China
| | - Jiayin Liu
- Department of Radiation Oncology, Harbin Medical University Tumor Hospital, Harbin, China
| | - Lei Xing
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, 150086, Harbin, China.
| | - Mingyan E
- Department of Radiation Oncology, Harbin Medical University Tumor Hospital, Harbin, China.
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13
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He L, Yi B, Zhang D, Hu S, Zhao C, Sun R, Ma J, Hou J, Jia H, Ma L, Yu B. Achieved low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio predicts the pathophysiological evolution of lipid-rich plaques in acute coronary syndromes: an optical coherence tomography study. Front Cardiovasc Med 2023; 10:1181074. [PMID: 37502186 PMCID: PMC10369790 DOI: 10.3389/fcvm.2023.1181074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Background As a novel lipoprotein ratio, baseline low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (LHR) is closely related to the clinical outcomes of acute coronary syndromes (ACS) after percutaneous coronary intervention. However, the pathophysiological impact of achieved LHR (aLHR) on the evolution of non-culprit lipid-rich plaques has not been systematically explored. Methods Between September 2013 and December 2018, ACS patients with both baseline and 1-year follow-up optical coherence tomography (OCT) examinations were included in current study. They were divided into two groups according to the median value of aLHR at 1 year. Results Overall, 132 patients with 215 lipid-rich plaques were enrolled, with a median aLHR: 1.62. There were thinner fibrous cap thickness (FCT) (133.3 [70.0-180.0] µm vs. 160.0 [100.0-208.3] µm, p = 0.025) and higher prevalence of thin-cap fibroatheroma (TCFA) (24 [22.4%] vs. 13 [12.0%], p = 0.044) and CLIMA-defined high-risk plaques (12 [11.2%] vs. 3[2.8%], p = 0.015) in the high aLHR group at 1 year. Compared with other serum lipid indexes, aLHR showed the best robust correlation with the evolution of plaque vulnerability in both unadjusted and adjusted analyses. Cut-off value of aLHR to predict the progression of maximal lipid arc and FCT was 1.51. In the adjusted model, aLHR ≥1.51 was an independent predictor of TCFA [odds ratio (OR): 3.008, 95% CI: 1.370 to 6.605, p = 0.006] at 1 year. Conclusions aLHR correlates well with the evolution of lipid-rich plaques and vulnerable phenotypes at 1-year follow-up, which might be an important and convenient serum indicator in the secondary prevention of ACS.
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Affiliation(s)
- Luping He
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Boling Yi
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Dirui Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Sining Hu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Chen Zhao
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Rui Sun
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Jianlin Ma
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Lijia Ma
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
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14
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Liu Z, Yang J, Chen Y. The Chinese Experience of Imaging in Cardiac Intervention: A Bird's Eye Review. J Thorac Imaging 2022; 37:374-384. [PMID: 36162061 DOI: 10.1097/rti.0000000000000680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.
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Affiliation(s)
- Zinuan Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, P.R. China
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
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15
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Chu X, Lu Y, Mei M, Peng P, Zhao Y, Fu G, Qiu F, Jin C. Correlation Between Serum Uric Acid Levels and Coronary Plaque Characteristics on Optical Coherence Tomography. Int Heart J 2022; 63:806-813. [PMID: 36104242 DOI: 10.1536/ihj.21-826] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Elevated serum uric acid (sUA) is associated with increasing risk of coronary heart disease (CHD). However, existing research is limited by potential confounders. Herein, our study aims to probe the association between sUA levels and the morphological characteristics of coronary plaque by a propensity score matching (PSM) analysis.All 420 patients with CHD who had undergone optical coherence tomography of culprit lesions were included. Eligible patients were assigned into 2 groups according to sUA level: high-sUA group (sUA ≥ 6.0 mg/dL) and low-sUA group (sUA < 6.0 mg/dL). PSM was applied to control the balance of baseline characteristics.After PSM, a total of 112 patients were included in our study (56 in each group). The high-sUA group showed a higher prevalence of TCFA (35.7% versus 16.1%, P = 0.03) and macrophage infiltration (33.9% versus 14.3%, P = 0.026) compared with the low-sUA group. Plaques in the high-sUA group had a wider maximum lipid arc (166.51° (115.77°, 224.14°) versus 142.29° (93.95°, 169.06°), P = 0.048), longer calcification length (6.77 (3.90, 20.55) mm versus 4.20 (1.95, 7.45) mm, P = 0.040), and thinner minimum fibrous cap thickness (43.81 (28.17, 62.26) μm versus 92.57 (46.25, 135.37) μm, P = 0.003). Correlation analysis indicated that the sUA value was inversely associated with the minimum fibrous cap thickness (r = -0.332, P = 0.015) and positively associated with the maximum lipid arc (r = 0.399, P = 0.003), average lipid arc (r = 0.347, P = 0.011), and calcification length (r = 0.386, P = 0.006).The relationship between high-sUA levels and typical vulnerable features of plaques persisted after balancing the traditional risk factors.
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Affiliation(s)
- Xiaopeng Chu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| | - Yanli Lu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| | - Menghan Mei
- Department of Blood Transfusion, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College
| | - Peng Peng
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| | - Yanbo Zhao
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| | - Fuyu Qiu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
| | - Chongying Jin
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
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16
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Theofilis P, Sagris M, Antonopoulos AS, Oikonomou E, Tsioufis K, Tousoulis D. Non-Invasive Modalities in the Assessment of Vulnerable Coronary Atherosclerotic Plaques. Tomography 2022; 8:1742-1758. [PMID: 35894012 PMCID: PMC9326642 DOI: 10.3390/tomography8040147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/26/2022] Open
Abstract
Coronary atherosclerosis is a complex, multistep process that may lead to critical complications upon progression, revolving around plaque disruption through either rupture or erosion. Several high-risk features are associated with plaque vulnerability and may add incremental prognostic information. Although invasive imaging modalities such as optical coherence tomography or intravascular ultrasound are considered to be the gold standard in the assessment of vulnerable coronary atherosclerotic plaques (VCAPs), contemporary evidence suggests a potential role for non-invasive methods in this context. Biomarkers associated with deleterious pathophysiologic pathways, including inflammation and extracellular matrix degradation, have been correlated with VCAP characteristics and adverse prognosis. However, coronary computed tomography (CT) angiography has been the most extensively investigated technique, significantly correlating with invasive method-derived VCAP features. The estimation of perivascular fat attenuation as well as radiomic-based approaches represent additional concepts that may add incremental information. Cardiac magnetic resonance imaging (MRI) has also been evaluated in clinical studies, with promising results through the various image sequences that have been tested. As far as nuclear cardiology is concerned, the implementation of positron emission tomography in the VCAP assessment currently faces several limitations with the myocardial uptake of the radiotracer in cases of fluorodeoxyglucose use, as well as with motion correction. Moreover, the search for the ideal radiotracer and the most adequate combination (CT or MRI) is still ongoing. With a look to the future, the possible combination of imaging and circulating inflammatory and extracellular matrix degradation biomarkers in diagnostic and prognostic algorithms may represent the essential next step for the assessment of high-risk individuals.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
- Correspondence:
| | - Marios Sagris
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
| | - Alexios S. Antonopoulos
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
| | - Evangelos Oikonomou
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
- 3rd Cardiology Department, Thoracic Diseases Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
| | - Dimitris Tousoulis
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
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17
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Clinical features and lipid profiles of plaque erosion over lipid-rich plaque versus fibrous plaque in patients with acute coronary syndrome. Atherosclerosis 2022; 360:47-52. [DOI: 10.1016/j.atherosclerosis.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/12/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022]
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18
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Qin Z, Cao M, Xi X, Zhang Y, Wang Z, Zhao S, Tian Y, Xu Q, Yu H, Tian J, Yu B. Cholesterol crystals in non-culprit plaques of STEMI patients: A 3-vessel OCT study. Int J Cardiol 2022; 364:162-168. [PMID: 35705168 DOI: 10.1016/j.ijcard.2022.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cholesterol crystals (CCs) are regular microstructures found within the necrotic core of atherosclerotic plaques and have been hypothesized to be related to plaque destabilization. We attempted to investigate the potential association between CCs and non-culprit plaque vulnerability in patients with ST-segment elevated myocardial infarction (STEMI) and study morphological features of CCs in ruptured non-culprit plaques. METHODS A total of 261 patients with ST-segment elevation myocardial infarction who underwent 3-vessel optical coherence tomography (OCT) imaging were included. Non-culprit plaques were divided into two groups according to the presence or absence of CCs in the plaque to compare the morphological characteristics of the plaques. The differences in parameters of the non-culprit plaque CCs were explored between ruptured plaques and unruptured plaques. RESULTS Totally, 530 non-culprit plaques (29 ruptured plaques and 501 unruptured plaques) were identified by OCT. The incidence of CCs was 21.1%. Compared with non-culprit plaques without CCs, those with CCs had a larger lipid burden. Macrophages (p < 0.001) and spotty calcification (p = 0.002) were more frequently observed in non-culprit plaques with CCs. The frequency of CCs was significantly higher (p = 0.001) and the CCs were larger (p = 0.046) and more superficial (p = 0.005) in ruptured non-culprit plaques than in unruptured non-culprit plaques. The maximum lipid arc and fibrous cap thickness were independent predictors of plaque rupture, but the presence of CCs was not. CONCLUSIONS Non-culprit plaques with CCs have more vulnerable features. CCs are more frequently found in ruptured non-culprit plaques and larger and more superficial CCs are associated with plaque rupture.
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Affiliation(s)
- Zhifeng Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Xiangwen Xi
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Yanwen Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Zhuozhong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Suhong Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Yanan Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Qinglu Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China.
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China.
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19
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Tao R, Burivalova Z, Masri SC, Dharmavaram N, Baber A, Deaño R, Hess T, Dhingra R, Runo J, Jarjour N, Vanderpool RR, Chesler N, Kusmirek JE, Eldridge M, Francois C, Raza F. Increased RV:LV ratio on chest CT-angiogram in COVID-19 is a marker of adverse outcomes. Egypt Heart J 2022; 74:37. [PMID: 35527310 PMCID: PMC9080642 DOI: 10.1186/s43044-022-00274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dilation has been used to predict adverse outcomes in acute pulmonary conditions. It has been used to categorize the severity of novel coronavirus infection (COVID-19) infection. Our study aimed to use chest CT-angiogram (CTA) to assess if increased RV dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the COVID-19 infection, and if it occurs out of proportion to lung parenchymal disease. RESULTS We reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n = 100), and two control groups: normal subjects (n = 10) and subjects with organizing pneumonia (n = 10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view, and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. Among the COVID-19 cohort, a higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06 ± 0.10, versus 0.95 ± 0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6 ± 9.0 vs. 32.7 ± 6.6), yet the RV:LV ratio was higher (1.06 ± 0.14 vs. 0.89 ± 0.07). In ROC analysis, RV:LV ratio had an AUC = 0.707 with an optimal cutoff of RV:LV ≥ 1.1 as a predictor of adverse outcomes. In a validation cohort (n = 25), an RV:LV ≥ 1.1 as a cutoff predicted adverse outcomes with an odds ratio of 76:1. CONCLUSIONS In COVID-19 patients, RV:LV ratio ≥ 1.1 on CTA chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing toward a vascular and/or thrombotic injury in the lungs.
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Affiliation(s)
- Ran Tao
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Zuzana Burivalova
- Nelson Institute for Environmental Studies, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - S Carolina Masri
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Naga Dharmavaram
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Aurangzeb Baber
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Roderick Deaño
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Timothy Hess
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Ravi Dhingra
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - James Runo
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Nizar Jarjour
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Medicine-Division of Pulmonary and Critical Care, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Rebecca R Vanderpool
- Department of Biomedical Engineering, The University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA
| | - Naomi Chesler
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA, 92697, USA
| | - Joanna E Kusmirek
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Marlowe Eldridge
- Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | | | - Farhan Raza
- Department of Medicine, CSC-E5/582B, University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
- Department of Medicine-Division of Cardiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA.
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20
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Wang Y, Zhao X, Zhou P, Liu C, Liao Z, Wang X, Yan S, Sheng Z, Li J, Zhou J, Chen R, Chen Y, Song L, Zhao H, Yan H. High-Risk Culprit Plaque Predicts Cardiovascular Outcomes Independently of Plaque Rupture in ST-Segment Elevation Myocardial Infarction: Insight From Optical Coherence Tomography. Angiology 2022; 73:946-955. [PMID: 35506476 DOI: 10.1177/00033197221087778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study explored the predictive value of culprit high-risk plaque (HRP) detected by optical coherence tomography (OCT) for predicting major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI). HRP was defined as the simultaneous presence of four criteria: minimum lumen area <3.5 mm2, fibrous cap thickness <75 μm, lipid plaque with lipid arc extension >180°, and presence of macrophages. Patients (n = 274) were divided into non-HRP group (n = 206) and HRP group (n = 68). MACEs were defined as a composite of all-cause death, myocardial infarction, stroke, and revascularization. During a mean follow-up of 2.2 years, 47 (17.5%) MACEs were observed: 28 (13.6%) in the non-HRP group and 19 (27.9%) in the HRP group (log-rank P = .005). Patients with HRP were 2.05 times more likely to suffer from a MACE than those without HRP (hazards ratio: 2.05, 95% confidence interval: 1.04-4.02, P = .038); MACE risk was comparable between plaque rupture and plaque erosion. In conclusion, HRP was present in 24.8% of STEMI patients and associated with higher cardiovascular risk independent of plaque rupture, suggesting that HRP detected by OCT may help identify patients at high risk of future cardiac events.
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Affiliation(s)
- Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyong Liao
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiaoqing Wang
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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21
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Yin Y, Fang C, Jiang S, Wang J, Wang Y, Guo J, Lei F, Sun S, Pei X, Jia R, Tang C, Li L, Wang Y, Yu H, Dai J, Yu B. Culprit and Non-Culprit Plaque Characteristics With vs. Without a Healed Phenotype in Patients With Acute Myocardial Infarction Caused by Plaque Erosion - A 3-Vessel OCT Study. Circ J 2022; 86:846-854. [PMID: 34955472 DOI: 10.1253/circj.cj-21-0635] [Citation(s) in RCA: 2] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Plaque erosion can occur quietly without causing clinical symptoms, followed by a healing process resulting in healed plaque. This study aimed to assess culprit and non-culprit plaque characteristics of patients with acute myocardial infarction (AMI) caused by plaque erosion with vs. without healed phenotype at the culprit plaque using optical coherence tomography (OCT). METHODS AND RESULTS A total of 117 AMI patients caused by plaque erosion who underwent OCT imaging of 3 coronary arteries were included. Patients were divided into 2 groups based on presence or absence of a healed phenotype at the culprit site. Culprit and non-culprit plaque characteristics were compared between the 2 groups. A healed phenotype at the culprit lesion was identified in 47.9% of AMI patients caused by plaque erosion. Patients with a healed phenotype at the culprit site were more frequently with hyperlipidemia, and had a higher prevalence of macrophage infiltration, microchannels, cholesterol crystals, and calcification at the culprit lesion. Moreover, patients with a healed phenotype at the culprit site had more non-culprit plaques and more characteristics of plaque vulnerability at the non-culprit lesion. In addition, patients with a healed phenotype at the culprit site presented with more severe luminal stenosis at both the culprit and non-culprit lesion. CONCLUSIONS A healed phenotype was identified in 47.9% of AMI patients caused by plaque erosion at the culprit site. A healed phenotype within eroded culprit plaque was associated with signs of pancoronary vulnerability and advanced atherosclerosis.
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Affiliation(s)
- Yanwei Yin
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Fang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Senqing Jiang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jifei Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yidan Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Junchen Guo
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Fangmeng Lei
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Sibo Sun
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Xueying Pei
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ruyi Jia
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Caiying Tang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Lulu Li
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yini Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Huai Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jiannan Dai
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
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22
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Optical Coherence Tomographic Features of Pancoronary Plaques in Patients With Acute Myocardial Infarction Caused by Layered Plaque Rupture Versus Layered Plaque Erosion. Am J Cardiol 2022; 167:35-42. [PMID: 34991841 DOI: 10.1016/j.amjcard.2021.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
Atherosclerotic plaque instability could occur on the basis of healed plaque which has a layered appearance on optical coherence tomography. This study aimed to investigate pancoronary plaque features of layered plaque rupture (LPR) and layered plaque erosion (LPE) in patients with acute myocardial infarction. Among 388 patients with acute myocardial infarction who underwent preintervention optical coherence tomography imaging of three coronary arteries, 190 patients with layered culprit plaque (49.0%) were identified and further divided into 2 groups: LPR group and LPE group. Clinical characteristics, pancoronary plaque features and clinical outcomes were compared between the 2 groups. Patients with LPR were older, less often male and current smoker, and had a lower coronary flow grade than those with LPE. At the culprit lesion, LPR group had a higher prevalence of lipid plaque, thin-cap fibroatheroma (TCFA), macrophage, and microchannel, and presented with more severe lumen area stenosis than LPE group. At nonculprit lesions, LPR group had a higher prevalence of TCFA and had greater layered tissue thickness and area than LPE group. The ischemia-driven revascularization rate was higher in LPR group. Moreover, we found that TCFA, diameter stenosis >56.5%, and mean lipid arc >179.1° were predictors for layered culprit plaque. In conclusion, patients with LPR had more vulnerable plaque features at culprit and nonculprit lesions and had higher incidence of ischemia-driven revascularization than those with LPE. TCFA, diameter stenosis >56.5%, and mean lipid arc >179.1° were predictors of layered culprit plaque.
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23
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Luo X, Lv Y, Bai X, Qi J, Weng X, Liu S, Bao X, Jia H, Yu B. Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:711453. [PMID: 34651023 PMCID: PMC8505887 DOI: 10.3389/fcvm.2021.711453] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Plaque erosion (PE) is one of the most important pathological mechanisms underlying acute coronary syndrome (ACS). The incidence of PE is being increasingly recognized owing to the development and popularization of intracavitary imaging. Unlike traditional vulnerable plaques, eroded plaques have unique pathological characteristics. Moreover, recent studies have revealed that there are differences in the physiopathological mechanisms, biomarkers, and clinical outcomes between PE and plaque rupture (PR). Accurate diagnosis and treatment of eroded plaques require an understanding of the pathogenesis of PE. In this review, we summarize recent scientific discoveries of the pathological characteristics, mechanisms, biomarkers, clinical strategies, and prognosis in patients with PE.
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Affiliation(s)
- Xing Luo
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Ying Lv
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xiaoxuan Bai
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Jinyu Qi
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xiuzhu Weng
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Shaoyu Liu
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China.,Bin Xian People's Hospital, Harbin, China
| | - Xiaoyi Bao
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
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24
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Cao M, Wu T, Zhao J, Du Z, Wang Z, Li L, Wei G, Tian J, Jia H, Mintz GS, Yu B. Focal Geometry and Characteristics of Erosion-Prone Coronary Plaques in vivo Angiography and Optical Coherence Tomography Study. Front Cardiovasc Med 2021; 8:709480. [PMID: 34568452 PMCID: PMC8457312 DOI: 10.3389/fcvm.2021.709480] [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: 05/14/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: This study compared focal geometry and characteristics of culprit plaque erosion (PE) vs. non-culprit plaques in ST-segment elevated myocardial infarction (STEMI) patients in whom optical coherence tomography (OCT) identified PE as the cause of the acute event. Background: Culprit PE is a distinct clinical entity with specific coronary risk factors and its own tailored management strategy. However, not all plaques develop erosion resulting in occlusive thrombus formation. Methods: Between January 2017 and July 2019, there were 484 STEMI patients in whom OCT at the time of primary percutaneous intervention identified culprit lesion PE to be the cause of the event; 484 culprit PE were compared to 1,132 non-culprit plaques within 1,196 imaged vessels. Results: Culprit PE were highly populated at “hot spots” within the proximal 40 mm in the left anterior descending artery (LAD) and tended to cluster proximal to a nearby bifurcation mainly in the LAD. Minimal lumen area (MLA) <2.51 mm2 and AS (area stenosis) >64.02% discriminated culprit PE from non-culprit plaques. In the multivariable analysis, focal geometry (LAD location, distance from coronary ostium <40 mm, and location proximal to a nearby bifurcation), luminal narrowing (MLA <2.51 mm2, AS > 64.02%), and TCFA phenotype were independent predictors of culprit PE overall. Cholesterol crystals were predictive of culprit PE with underlying LRP morphology while the absence of calcification and microchannels were risk factors for culprit PE with an underlying non-LRP. Similarities and differences in predictors of culprit PE were found between males and females; distance from coronary ostium <40 mm, MLA <2.51 mm2, TCFA, and less spotty calcium were risk factors of culprit PE in males, but not in females while smaller RVD was associated with culprit PE only in females. Conclusions: Irrespective of underlying lesion substrates and patient risk factors, there are lesion-specific and OCT-identifiable predictors of developing culprit PE in erosion-prone vulnerable patients.
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Affiliation(s)
- Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tianyu Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiawei Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhuo Du
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhuozhong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Guo Wei
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, United States
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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25
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Deng F, Li D, Lei L, Yang Q, Li Q, Wang H, Deng J, Zheng Q, Jiang W. Association between apolipoprotein B/A1 ratio and coronary plaque vulnerability in patients with atherosclerotic cardiovascular disease: an intravascular optical coherence tomography study. Cardiovasc Diabetol 2021; 20:188. [PMID: 34526013 PMCID: PMC8442358 DOI: 10.1186/s12933-021-01381-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background Apolipoprotein (Apo) A1 and Apo B are strongly associated with the risk of atherosclerotic cardiovascular disease (ASCVD). However, the relationship between the Apo B/A1 ratio and the morphology of coronary vulnerable plaques has not been fully elucidated in patients with ASCVD. Methods A total of 320 patients with ASCVD undergoing percutaneous coronary intervention were enrolled and assigned into acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) group. The morphology of culprit plaque was analyzed by intravascular optical coherence tomography. Association between the Apo B/A1 ratio and coronary vulnerable plaques were evaluated using logistic regression models and receiver operator characteristic (ROC) curve analyses. Results The Apo B/A1 ratio was higher in ACS patients than CCS patients (0.77 ± 0.28 vs. 0.64 ± 0.22, P < 0.001) and it was also higher in patients with plaque rupture, erosion or thrombus than those without culprit plaques. The high Apo B/A1 ratio was associated with high percent of vulnerable plaques compared with low ratio group. The Apo B/A1 ratio was negatively related to fibrous cap thickness in lipid-rich plaque (r = − 0.228, P = 0.043). Univariate and multivariate logistic regression analyses revealed that the Apo B/A1 ratio was an independent factor of plaque rupture, erosion, and thrombus. The area under the ROC curve of the Apo B/A1 ratio for plaque rupture, erosion, and thrombus were 0.632, 0.624, and 0.670 respectively (P < 0.001 for all), which were higher than that of low-density lipoprotein cholesterol. Conclusions The Apo B/A1 ratio is an independent predictor for plaque rupture, erosion, and thrombus in patients with ASCVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01381-9.
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Affiliation(s)
- Fuxue Deng
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China
| | - Danni Li
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China
| | - Lei Lei
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China
| | - Qiang Yang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China
| | - Qing Li
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China
| | - Hongtao Wang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China
| | - Jie Deng
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China.
| | - Qiangsun Zheng
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China.
| | - Wei Jiang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwulu 157#, Xi'an, 710004, Shaanxi, China.
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26
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Zhao L, Du Z, Wu T, Cao M, Wang Y, Zhao J, Dong H, Wang C, Jia H, Yu B. Association of the age shock index with coronary plaque characteristics in ST-segment elevation myocardial infarction: A 3-vessel optical coherence tomography study. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1080-1088. [PMID: 33780143 DOI: 10.1002/ccd.29652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We investigated whether the age shock index (SI) was associated with coronary plaque characteristics in patients with ST-segment elevation myocardial infarction (STEMI) using optical coherence tomography (OCT). BACKGROUND The age SI is a simple clinical parameter that effectively predicts poor clinical outcomes among patients with STEMI. METHODS This retrospective study evaluated 408 STEMI patients who underwent 3-vessel OCT during emergency percutaneous coronary interventions at a single center between January 2017 and October 2018. Patients were divided into groups with low or high age SI values (<41 vs. ≥41). Plaque characteristics were compared between the two groups for both culprit lesions (n = 408) and non-culprit lesions (n = 1,077). RESULTS In culprit lesions, patients with a high age SI (≥41) were more likely to have plaque rupture (61.0% vs. 56.8%, p = .002) and thinner fibrous caps (fibrous cap thickness [FCT]: 40.0 [33.0-53.0] μm vs. 46.0 [36.0-63.8] μm, p = .021). In non-culprit lesions, patients with a high age SI were more likely to have high-risk plaques (29.9% vs. 17.8%, p = .018; simultaneous presence of a minimal lumen area of <3.5 mm2 , maximum lipid arc of >180°, FCT of <75 μm, and macrophage accumulation). Plaque-based analyses revealed that patients with a high age SI had larger lipid cores and lesser FCT. CONCLUSIONS Patients with STEMI and a high age SI had increased risks of culprit plaque rupture and high-risk non-culprit plaques, and vulnerable plaque features at the culprit and non-culprit lesions. Therefore, a high age SI in patients with STEMI may indicate greater pancoronary vulnerability.
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Affiliation(s)
- Linlin Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhuo Du
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tianyu Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiawei Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Hui Dong
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chao Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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27
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Barman HA, Atici A, Tekin EA, Baycan OF, Alici G, Meric BK, Sit O, Genc O, Er F, Gungor B, Sahin I, Turgut N. Echocardiographic features of patients with COVID-19 infection: a cross-sectional study. Int J Cardiovasc Imaging 2021; 37:825-834. [PMID: 33030636 PMCID: PMC7541759 DOI: 10.1007/s10554-020-02051-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022]
Abstract
COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 63.3 ± 15.7 years, and 54% were male. The mean age of non-severe group (n = 46) was 49.7 ± 21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6 ± 5.9 mm vs. 33.1 ± 4.8 mm, p = 0.003; LV 47.3 ± 5.8 mm vs. 44.9 ± 3.8 mm, p = 0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0 ± 9.8% vs. 61.9 ± 4.8%, p < 0.001; RV-FAC, 41.4 ± 4.1% vs. 45.5 ± 4.5%, p < 0.001), and pericardial effusions were more frequent (23% vs. 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses.
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Affiliation(s)
- Hasan Ali Barman
- Institute of Cardiology, Department of Cardiology, Istanbul University, Cerrahpasa, Istanbul, Turkey.
- Department of Cardiology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Adem Atici
- Faculty of Medicine, Department of Cardiology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Esra Aktas Tekin
- Department of Anesthesiology and Intensive Care, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Omer Faruk Baycan
- Faculty of Medicine, Department of Cardiology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Gokhan Alici
- Department of Cardiology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bengisu Keskin Meric
- Institute of Cardiology, Department of Cardiology, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Omer Sit
- Department of Cardiology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Omer Genc
- Department of Cardiology, Agri State Hospital, Agri, Turkey
| | - Fahri Er
- Department of Cardiology, Agri State Hospital, Agri, Turkey
| | - Baris Gungor
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Irfan Sahin
- Department of Cardiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Namigar Turgut
- Department of Anesthesiology and Intensive Care, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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28
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Baycan OF, Barman HA, Atici A, Tatlisu A, Bolen F, Ergen P, Icten S, Gungor B, Caliskan M. Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography. Int J Cardiovasc Imaging 2021; 37:135-144. [PMID: 32803484 PMCID: PMC7429089 DOI: 10.1007/s10554-020-01968-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023]
Abstract
A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). In this prospective, single-center study, data were gathered from patients treated for COVID-19 between April 15 and April 30, 2020. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 59.1 ± 12.9, 40% of whom were male. The mean age of the non-severe group (n = 56) was 53.7 ± 15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LV-GLS: - 14.5 ± 1.8 vs. - 16.7 ± 1.3 vs. - 19.4 ± 1.6, respectively [p < 0.001]; RV-LS: - 17.2 ± 2.3 vs. - 20.5 ± 3.2 vs. - 27.3 ± 3.1, respectively [p < 0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR 1.63, 95% confidence interval [CI] 1.08-2.47; p = 0.010) and RV-LS (OR 1.55, 95% CI 1.07-2.25; p = 0.019) were identified as independent predictors of mortality via multivariate analysis. LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.
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Affiliation(s)
- Omer Faruk Baycan
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hasan Ali Barman
- Department of Cardiology, Institute of Cardiology, Istanbul University - Cerrahpasa, Istanbul, Turkey.
| | - Adem Atici
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Adem Tatlisu
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Furkan Bolen
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Pınar Ergen
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sacit Icten
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Baris Gungor
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Caliskan
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Balaban Kocas B, Cetinkal G, Ser OS, Kilci H, Keskin K, Ozcan SN, Verdi Y, Zeren MI, Kilickesmez K. The relation between left ventricular global longitudinal strain and troponin levels in patients hospitalized with COVID-19 pneumonia. Int J Cardiovasc Imaging 2020; 37:125-133. [PMID: 33206248 PMCID: PMC7673246 DOI: 10.1007/s10554-020-02102-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022]
Abstract
Left ventricular global longitudinal strain (LVGLS) from two-dimensional speckle-tracking echocardiography (2D-STE) provides a more accurate estimation of subclinical myocardial dysfunction. In patients with COVID-19, elevated high sensitive troponin (hs-TnI) levels are frequent independent from the underlying cardiovascular disease. However, the relationship between high troponin levels and LVGLS in such patients remains unknown. We aimed to investigate the relation between troponin levels and LVGLS values in patients with COVID-19. A total of thirty-eight patients diagnosed with COVID-19 pneumonia who underwent echocardiography examination within the first week of hospital admission were enrolled in our study. Patients were divided into two groups according to their hs-TnI levels. Conventional left venticular (LV) function parameters, including ejection fraction, LV diastolic and systolic volumes were obtained and LVGLS was determined using 2D-STE. Frequency of hypertension, diabetes mellitus and current smoking were similar among groups. Compared with the patients in the negative troponin group, those in the positive troponin group were more likely to have a higher age; higher levels of D-dimer, C-reactive protein and ferritin; higher need for high-flow oxygen, invasive mechanical ventilation therapy or both; and a higher number of intensive care unit admissions. There was no statistically significant difference in LVGLS and ejection fraction values between the two groups.(− 18.5 ± 2.9, − 19.8 ± 2.8, p = 0.19; 55.2 ± 9.9, 59.5 ± 5.9, p = 0.11 respectively). Despite troponin increase is highly related to in-hospital adverse events; no relevance was found between troponin increase and LVGLS values of COVID-19 patients.
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Affiliation(s)
- Betul Balaban Kocas
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey.
| | - Gokhan Cetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Ozgur Selim Ser
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Safiye Nur Ozcan
- Department of Infectious Disease and Microbiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Yildiz Verdi
- Department of Infectious Disease and Microbiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Mustafa Ismet Zeren
- Department of Infectious Disease and Microbiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Kadriye Kilickesmez
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
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30
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Ambrose JA, Poosti K. The Look Inside: Is it Clinically Relevant? JACC Cardiovasc Imaging 2020; 14:1246-1248. [PMID: 33221244 DOI: 10.1016/j.jcmg.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/10/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- John A Ambrose
- Department of Medicine, Division of Cardiology, University of California-San Francisco, Fresno Medical Education Program, Fresno, California, USA.
| | - Kassra Poosti
- Department of Medicine, Division of Cardiology, University of California-San Francisco, Fresno Medical Education Program, Fresno, California, USA
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Cardiac imaging phenotype in patients with coronavirus disease 2019 (COVID-19): results of the cocarde study. Int J Cardiovasc Imaging 2020; 37:449-457. [PMID: 32902783 PMCID: PMC7479389 DOI: 10.1007/s10554-020-02010-4] [Citation(s) in RCA: 12] [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: 07/18/2020] [Accepted: 08/31/2020] [Indexed: 01/20/2023]
Abstract
Biological cardiac injury related to the Severe Acute Respiratory Syndrome Coronavirus-2 infection has been associated with excess mortality. However, its functional impact remains unknown. The aim of our study was to explore the impact of biological cardiac injury on myocardial functions in patients with COVID-19. 31 patients with confirmed COVID-19 (CoV+) and 16 controls (CoV-) were prospectively included in this observational study. Demographic data, laboratory findings, comorbidities, treatments and myocardial function assessed by transthoracic echocardiography were collected and analysed in CoV+ with (TnT+) and without (TnT-) elevation of troponin T levels and compared with CoV-. Among CoV+, 13 (42%) exhibited myocardial injury. CoV+/TnT + patients were older, had lower diastolic arterial pressure and were more likely to have hypertension and chronic renal failure compared with CoV+/TnT-. The control group was comparable except for an absence of biological inflammatory syndrome. Left ventricular ejection fraction and global longitudinal strain were not different among the three groups. There was a trend of decreased myocardial work and increased peak systolic tricuspid annular velocity between the CoV- and CoV + patients, which became significant when comparing CoV- and CoV+/TnT+ (2167 ± 359 vs. 1774 ± 521%/mmHg, P = 0.047 and 14 ± 3 vs. 16 ± 3 cm/s, P = 0.037, respectively). There was a decrease of global work efficiency from CoV- (96 ± 2%) to CoV+/TnT- (94 ± 4%) and then CoV+/TnT+ (93 ± 3%, P = 0.042). In conclusion, biological myocardial injury in COVID 19 has low functional impact on left ventricular systolic function.
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