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Proaño-Bernal L, Gilabert-García A, Sharma-Sharma S, Mora-Barrera CM, Singer-De-la-Garza J, Beristain-de-la-Rosa PY, Basile-Alvarez MR, Guerra EC, Bermudez-Gonzalez JL, Luna-Alcala S, Espinola-Zavaleta N, Alexanderson-Rosas E. Positron emission tomography and its role in the assessment of vulnerable plaques in comparison to other imaging modalities. Front Med (Lausanne) 2024; 10:1293848. [PMID: 38425695 PMCID: PMC10902136 DOI: 10.3389/fmed.2023.1293848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
The diagnosis and management of vulnerable plaques are topics of high interest in the cardiovascular field. Although imaging techniques like computed tomography angiography (MCTA) and ultrasonography (USG) can structurally evaluate atherosclerotic plaques, they are limited in examining internal cellular processes. Positron emission tomography (PET) molecular imaging, on the other hand, can highlight these cellular processes, including inflammation, angiogenesis, and lipid oxidation. Magnetic resonance imaging (MRI) is also a valuable non-invasive imaging technique that can provide detailed anatomical and functional information on the cardiovascular system. In this review, we compare the advantages and drawbacks of MCTA, USG and MRI imaging techniques with PET molecular imaging in evaluating vulnerable plaques. PET imaging allows physicians to measure different pathophysiological events within the plaque using intravenous radiotracers, of which 18F-fluorodeoxyglucose (18F-FDG) is the most validated one. By using 18F-FDG, physicians can understand the formation of the plaque, assess the accumulation of macrophages, and predict major cardiovascular events. However, some limitations exist in using 18F-FDG, including myocardial uptake and low sensitivity in imaging coronary arteries. We also mention other radiotracers that can help in evaluating vulnerable plaques, including 18F-NaF. Although PET imaging is still challenging, it has shown promise in evaluating vulnerable plaques and could be used to intervene in high-risk patients before major cardiovascular events occur.
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Affiliation(s)
- Leonardo Proaño-Bernal
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Gilabert-García
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | | | | | | | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jorge Luis Bermudez-Gonzalez
- Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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2
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Fedak A, Chrzan R, Chukwu O, Urbanik A. Ultrasound methods of imaging atherosclerotic plaque in carotid arteries: examinations using contrast agents. J Ultrason 2020; 20:e191-e200. [PMID: 33365156 PMCID: PMC7705485 DOI: 10.15557/jou.2020.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/11/2020] [Indexed: 11/22/2022] Open
Abstract
The primary technique for detecting the presence and monitoring the development of carotid atherosclerotic plaque is ultrasound. The development of ultrasound techniques has made it possible to precisely visualise not only blood flow, but also vessel walls, including atherosclerotic plaque. Contrast-enhanced ultrasound examination enables one to make an objective observation of atherosclerotic plaque neovascularisation, clearly indicating active inflammation, which is an inherent feature of vulnerable (unstable) plaque. Depending on the examination method used, it is possible to precisely visualise different components of the plaque and its behaviour during blood flow through the vessel lumen or through the neovessels of the plaque, and, consequently, determine the possible presence of inflammation, which is a defining feature of plaque stability. The full utilisation of physical phenomena that underlie contrast-enhanced ultrasound will bring further enormous progress of diagnostic and probably also therapeutic methods for carotid atherosclerosis. The selection of the right examination method significantly accelerates diagnosis and adequate classification of plaque, and makes it possible to monitor the progression of atherosclerosis. However, one needs to bear in mind that ultrasound remains a very subjective method. The success of contrast-enhanced ultrasound also depends on the skills and experience of the examiner. Current attempts at increasing the objectivity of contrast-enhanced ultrasound examination using artificial intelligence will make it possible in the future to make a definitive evaluation of atherosclerotic plaque stability. This will allow one to assess the risk of ischaemic stroke adequately.
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Affiliation(s)
- Andrzej Fedak
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Ositadima Chukwu
- Student Science Club, Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
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3
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Jiao Y, Qin Y, Zhang Z, Zhang H, Liu H, Li C. Early identification of carotid vulnerable plaque in asymptomatic patients. BMC Cardiovasc Disord 2020; 20:429. [PMID: 33003997 PMCID: PMC7528473 DOI: 10.1186/s12872-020-01709-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was to explore the influencing factors of atherosclerotic plaque formation and stability in patients with asymptomatic carotid atherosclerotic plaques, so as to identify the vulnerable plaques at early stage, and then find high-risk group of cardio-cerebrovascular events for early clinical intervention to reduce related mortality and disability. METHODS A total of 302 enrolled patients with asymptomatic carotid atherosclerotic plaques were divided into 3 groups based on the results of carotid artery color Doppler ultrasound: atherosclerotic unstable plaque (UP) group, atherosclerotic stable plaque (SP) group, and control group without plaques. Serum markers were measured by ELISA. χ2 test, t test, Pearson correlation analysis, and Logistic multivariate regression analysis were used in the analysis, and P < 0.05 was considered statistically significant. RESULTS It revealed that high MMP-9, LOX-1and YKL-40 were independent risk factors for unstable plaque formation. The area under the curve (AUC) of serum markers combined with MMP-9, LOX-1 and YKL-40 was 0.850, with sensitivity 87.67%, specificity 81.13%, and diagnostic accuracy 84.92%, which was significantly better than the individual diagnostic efficacy of other three factors. The accuracy rate of Crouse Plaque Score (CPS) in the diagnosis of vulnerable plaques was 61.90%, the 10-year ICVD diagnosis accuracy rate was 56.75%, and the diagnostic accuracy of serum markers was significantly better than CPS and 10-year ICVD. CONCLUSION Noninvasive cervical color Doppler ultrasound combined with serum markers MMP-9, LOX-1 and YKL-40 have significant early recognition effect on asymptomatic carotid vulnerable plaque patients.
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Affiliation(s)
- Yungen Jiao
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China.
| | - Yahong Qin
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China.,521 Hospital of Norinco Group, 12# Zhangba East Road, Xi'an, 710065, Shaanxi Province, China
| | - Zhengang Zhang
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
| | - Hao Zhang
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
| | - Haiwei Liu
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
| | - Chen Li
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
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4
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Barrett TJ, Schlegel M, Zhou F, Gorenchtein M, Bolstorff J, Moore KJ, Fisher EA, Berger JS. Platelet regulation of myeloid suppressor of cytokine signaling 3 accelerates atherosclerosis. Sci Transl Med 2020; 11:11/517/eaax0481. [PMID: 31694925 DOI: 10.1126/scitranslmed.aax0481] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/19/2019] [Accepted: 10/04/2019] [Indexed: 12/19/2022]
Abstract
Platelets are best known as mediators of hemostasis and thrombosis; however, their inflammatory effector properties are increasingly recognized. Atherosclerosis, a chronic vascular inflammatory disease, represents the interplay between lipid deposition in the artery wall and unresolved inflammation. Here, we reveal that platelets induce monocyte migration and recruitment into atherosclerotic plaques, resulting in plaque platelet-macrophage aggregates. In Ldlr -/- mice fed a Western diet, platelet depletion decreased plaque size and necrotic area and attenuated macrophage accumulation. Platelets drive atherogenesis by skewing plaque macrophages to an inflammatory phenotype, increasing myeloid suppressor of cytokine signaling 3 (SOCS3) expression and reducing the Socs1:Socs3 ratio. Platelet-induced Socs3 expression regulates plaque macrophage reprogramming by promoting inflammatory cytokine production (Il6, Il1b, and Tnfa) and impairing phagocytic capacity, dysfunctions that contribute to unresolved inflammation and sustained plaque growth. Translating our data to humans with cardiovascular disease, we found that women with, versus without, myocardial infarction have up-regulation of SOCS3, lower SOCS1:SOCS3, and increased monocyte-platelet aggregate. A second cohort of patients with lower extremity atherosclerosis demonstrated that SOCS3 and the SOCS1:SOCS3 ratio correlated with platelet activity and inflammation. Collectively, these data provide a causative link between platelet-mediated myeloid inflammation and dysfunction, SOCS3, and cardiovascular disease. Our findings define an atherogenic role of platelets and highlight how, in the absence of thrombosis, platelets contribute to inflammation.
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Affiliation(s)
- Tessa J Barrett
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Martin Schlegel
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Felix Zhou
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Mike Gorenchtein
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Jennifer Bolstorff
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Kathryn J Moore
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Edward A Fisher
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Jeffrey S Berger
- Marc and Ruti Bell Program in Vascular Biology, Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA.
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5
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Nazarian-Samani Z, Sewell RDE, Rafieian-Kopaei M. Inflammasome Signaling and Other Factors Implicated in Atherosclerosis Development and Progression. Curr Pharm Des 2020; 26:2583-2590. [DOI: 10.2174/1381612826666200504115045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/17/2020] [Indexed: 12/20/2022]
Abstract
Chronic inflammation plays an extensive role in the onset and progression of metabolic disorders such
as atherosclerosis, type 2 diabetes, gout and obesity. Atherosclerosis accounts for up to 70% mortality in patients
with type 2 diabetes and is also a chronic condition that causes atrial stenosis due to a lipometabolism imbalance.
The purpose of this article is to consider the inflammatory factors implicated in atherosclerosis and their role in
the development and progression of this vascular disease. The inflammasome signaling pathway is an important
inflammatory mechanism involved in the development of atherosclerosis. The most important inflammasome
pathway in this respect is the NLRP3 inflammasome (Nucleotide-binding oligomerization domain (NOD)-like
receptor with a pyrin domain 3), whose activation leads to the generation of important inflammatory cytokines
including interleukins 1β and 18 (IL-1β and 18). The activities of these mature cytokines and inflammatory factors
produced by other inflammatory pathways lead to arterial inflammation and eventually arterial occlusion,
which can result in life-threatening complications such as myocardial infarction and stroke. Therefore, it is essential
to seek out more precise mechanisms for the activation of inflammasomes and other inflammatory pathways
for the development of therapeutic strategies of atherosclerosis.
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Affiliation(s)
- Zeinab Nazarian-Samani
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Robert D. E. Sewell
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, CF10 3NB. Wales, United Kingdom
| | - Mahmoud Rafieian-Kopaei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
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6
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Optimization of Computed Tomography Coronary Angiography for Improved Plaque Detection. J Comput Assist Tomogr 2018; 42:240-247. [PMID: 28937481 DOI: 10.1097/rct.0000000000000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study aims to optimize visualization of the coronary wall during computed tomography coronary angiography. METHODS A coronary plaque phantom was scanned on a wide-volume computed tomography scanner. Spatial resolution, contrast resolution, and vessel wall thickness were measured at different x-ray tube currents and voltages. RESULTS Spatial resolution ranged from 0.385 to 0.625 mm and was significantly lower at higher currents. Contrast-to-noise ratio was significantly higher at higher currents. The most accurate wall thickness measurements were quantified at 300 and 400 mA for 80 and 100 kVp and 300 mA for 120 and 135 kVp. CONCLUSIONS Lower spatial resolution at higher currents was due to added blur from increased focal spot size. Contrast-to-noise ratio was higher at higher currents owing to decreased quantum noise. Wall thickness was measured more accurately at intermediate currents with midrange contrast-to-noise ratio but optimal spatial resolution. For accurate coronary wall thickness measurement, contrast-to-noise ratio is compromised to achieve optimal spatial resolution.
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7
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Cao Y, Kole A, Lan L, Wang P, Hui J, Sturek M, Cheng JX. Spectral analysis assisted photoacoustic imaging for lipid composition differentiation. PHOTOACOUSTICS 2017. [PMID: 28649497 PMCID: PMC5472148 DOI: 10.1016/j.pacs.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Recent advances in atherosclerotic plaque detection have shown that not only does lipid core size and depth play important roles in plaque rupture and thrombi formation, but lipid composition, especially cholesterol deposition, is equally important in determining lesion vulnerability. Here, we demonstrate a spectral analysis assisted photoacoustic imaging approach to differentiate and map lipid compositions within an artery wall. The approach is based on the classification of spectral curves obtained from the sliding windows along time-of-flight photoacoustic signals via a numerical k-means clustering method. The evaluation result on a vessel-mimicking phantom containing cholesterol and olive oil shows accuracy and efficiency of this method, suggesting the potential to apply this approach in assessment of atherosclerotic plaques.
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Affiliation(s)
- Yingchun Cao
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Ayeeshik Kole
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lu Lan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Pu Wang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Jie Hui
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN 47907, USA
| | - Michael Sturek
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
- Corresponding author at: Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907, USA.
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8
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Ernst D, Weiberg D, Baerlecken NT, Schlumberger W, Daehnrich C, Schmidt RE, Bengel FM, Derlin T, Witte T. Anti-MYC-associated zinc finger protein antibodies are associated with inflammatory atherosclerotic lesions on 18 F-fluorodeoxyglucose positron emission tomography. Atherosclerosis 2017; 259:12-19. [DOI: 10.1016/j.atherosclerosis.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/29/2022]
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9
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Poder TG, Fisette JF. Are drug-coated balloons cost effective for femoropopliteal occlusive disease? A comparison of bare metal stents and uncoated balloons. J Comp Eff Res 2016; 5:335-44. [DOI: 10.2217/cer-2015-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: To perform a cost–effectiveness analysis to help hospital decision-makers with regard to the use of drug-coated balloons compared with bare metal stents and uncoated balloons for femoropopliteal occlusive disease. Methods: Clinical outcomes were extracted from the results of meta-analyses already published, and cost units are those used in the Quebec healthcare network. The literature review was limited to the last four years to obtain the most recent data. The cost–effectiveness analysis was based on a 2-year perspective, and risk factors of reintervention were considered. Results: The cost–effectiveness analysis indicated that drug-coated balloons were generally more efficient than bare metal stents, particularly for patients with higher risk of reintervention (up to CAD$1686 per patient TASC II C or D). Compared with uncoated balloons, results indicated that drug-coated balloons were more efficient if the reintervention rate associated with uncoated balloons is very high and for patients with higher risk of reintervention (up to CAD$3301 per patient). Conclusion: The higher a patient's risk of reintervention, the higher the savings associated with the use of a drug-coated balloon will be. For patients at lower risk, the uncoated balloon strategy is still recommended as a first choice for endovascular intervention.
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Affiliation(s)
- Thomas G Poder
- UETMIS, CIUSSS de l'Estrie – CHUS, Sherbrooke, QC, Canada
- CRCHUS, CIUSSS de l'Estrie – CHUS, Sherbrooke, QC, Canada
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10
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Time-dependent flow velocity measurement using two-dimensional color Doppler flow imaging and evaluation by Hagen-Poiseuille equation. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:755-66. [PMID: 26676566 DOI: 10.1007/s13246-015-0396-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/01/2015] [Indexed: 12/20/2022]
Abstract
This paper aims to develop a technique to assess velocity flow profile and wall shear stress (WSS) spatial distribution across a vessel phantom representing an artery. Upon confirming the reliability of the technique, it was then used on a set of carotid arteries from a cohort of human subjects. We implemented color Doppler flow imaging (CDFI) for measurement of velocity profile in the artery cross section. Two dimensional instantaneous and time-dependent flow velocity and WSS vector fields were measured and their waveforms of peak velocities based on the technique were compared with WSS values generated by Hagen-Poiseuille equation. Seventy-five patients with intima-media thickening were prospectively enrolled and were divided into an IMT group. At the same time, another 75 healthy volunteers were enrolled as the control group. All the subjects were scanned and the DICOM files were imported into our in-house program. Next, we determine the velocity profile of carotid arteries in a set of 150 human subjects and compared them again. The peak velocities by the CDFI and Hagen-Poiseuille equation techniques were compared and statistically evaluated. The amounts of deviation for the two measured WSS profiles were performed and we demonstrated that they are not significantly different. At two different flow settings with peak flow velocity of 0.1, 0.5 (×10(-11)) m/s, the obtained WSS were 0.021 ± 0.04, 0.038 ± 0.05 m/s, respectively. For the patient population study, the mean WSS value calculated by Hagen-Poiseuille equation was 2.98 ± 0.15 dyne/cm(2), while it was 2.31 ± 0.14 dyne/cm(2) by our CDFI analysis program. The difference was not statistically significant (t = -1.057, P = 0.259). Similar to the Hagen-Poiseuille equation, a negative linear correlation was also found between the calculated WSS and intima-media thickness (P = 0.000). Using CDFI analysis, we found that the WSS distribution at the middle of the proximal plaque shoulder was larger than the top of the shoulder. CDFI can assess the velocity and WSS profile accurately and efficiently and may be used for clinical diagnosis of cardiovascular conditions.
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11
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Banach M, Serban C, Sahebkar A, Mikhailidis DP, Ursoniu S, Ray KK, Rysz J, Toth PP, Muntner P, Mosteoru S, García-García HM, Hovingh GK, Kastelein JJP, Serruys PW. Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies. BMC Med 2015; 13:229. [PMID: 26385210 PMCID: PMC4575433 DOI: 10.1186/s12916-015-0459-4] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/21/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Virtual histology intravascular ultrasound (VH-IVUS) imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Evidence for the effects of statin therapy on VH-IVUS parameters have been inconclusive. Consequently, we performed a systematic review and meta-analysis to investigate the impact of statin therapy on plaque volume and its composition using VH-IVUS. METHODS The search included PubMed, Cochrane Library, Scopus and Embase (through 30 November 2014) to identify prospective studies investigating the effects of statin therapy on plaque volume and its composition using VH-IVUS. RESULTS We identified nine studies with 16 statin treatment arms and 830 participants. There was a significant effect of statin therapy in reducing plaque volume (standardized mean difference (SMD): -0.137, 95 % confidence interval (CI): -0.255, -0.019; P = 0.023), external elastic membrane volume (SMD: -0.097, 95 % CI: -0.183, -0.011; P = 0.027) but not lumen volume (SMD: -0.025, 95 % CI: -0.110, +0.061; P = 0.574). There was a significant reduction in fibrous plaque volume (SMD: -0.129, 95 % CI: -0.255, -0.003; P = 0.045) and an increase of dense calcium volume (SMD: +0.229, 95 % CI: +0.008, +0.450; P = 0.043), while changes in fibro-fatty (SMD: -0.247, 95 % CI: -0.592, +0.098; P = 0.16) and necrotic core (SMD: +0.011, 95 % CI: -0.144, +0.165; P = 0.892) tissue volumes were not statistically significant. CONCLUSIONS This meta-analysis indicates a significant effect of statin therapy on plaque and external elastic membrane volumes and fibrous and dense calcium volumes. There was no effect on lumen volume, fibro-fatty and necrotic tissue volumes.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
| | - Corina Serban
- Department of Functional Sciences, Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, UK.
| | - Sorin Ursoniu
- Department of Functional Sciences, Discipline of Public Health, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Kausik K Ray
- School of Public Health, Imperial College London, London, UK.
| | - Jacek Rysz
- Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
| | - Peter P Toth
- Preventive Cardiology, CGH Medical Center, Sterling, IL, USA.
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Svetlana Mosteoru
- Institute for Cardiovascular Medicine Timisoara, Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Hector M García-García
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands.
- Cardialysis BV, Rotterdam, The Netherlands.
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Patrick W Serruys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands.
- Imperial College, London, UK.
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12
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Molecular imaging of plaques in coronary arteries with PET and SPECT. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:259-73. [PMID: 25278976 PMCID: PMC4178519 DOI: 10.11909/j.issn.1671-5411.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 01/26/2023]
Abstract
Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lumen stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increasingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography (PET) and single photon emission computed tomography (SPECT) has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging techniques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coronary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.
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13
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Khan SR, Canales BK. Unified theory on the pathogenesis of Randall's plaques and plugs. Urolithiasis 2014; 43 Suppl 1:109-23. [PMID: 25119506 DOI: 10.1007/s00240-014-0705-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/23/2014] [Indexed: 01/19/2023]
Abstract
Kidney stones develop attached to sub-epithelial plaques of calcium phosphate (CaP) crystals (termed Randall's plaque) and/or form as a result of occlusion of the openings of the Ducts of Bellini by stone-forming crystals (Randall's plugs). These plaques and plugs eventually extrude into the urinary space, acting as a nidus for crystal overgrowth and stone formation. To better understand these regulatory mechanisms and the pathophysiology of idiopathic calcium stone disease, this review provides in-depth descriptions of the morphology and potential origins of these plaques and plugs, summarizes existing animal models of renal papillary interstitial deposits, and describes factors that are believed to regulate plaque formation and calcium overgrowth. Based on evidence provided within this review and from the vascular calcification literature, we propose a "unified" theory of plaque formation-one similar to pathological biomineralization observed elsewhere in the body. Abnormal urinary conditions (hypercalciuria, hyperoxaluria, and hypocitraturia), renal stress or trauma, and perhaps even the normal aging process lead to transformation of renal epithelial cells into an osteoblastic phenotype. With this de-differentiation comes an increased production of bone-specific proteins (i.e., osteopontin), a reduction in crystallization inhibitors (such as fetuin and matrix Gla protein), and creation of matrix vesicles, which support nucleation of CaP crystals. These small deposits promote aggregation and calcification of surrounding collagen. Mineralization continues by calcification of membranous cellular degradation products and other fibers until the plaque reaches the papillary epithelium. Through the activity of matrix metalloproteinases or perhaps by brute physical force produced by the large sub-epithelial crystalline mass, the surface is breached and further stone growth occurs by organic matrix-associated nucleation of CaOx or by the transformation of the outer layer of CaP crystals into CaOx crystals. Should this theory hold true, developing an understanding of the cellular mechanisms involved in progression of a small, basic interstitial plaque to that of an expanding, penetrating plaque could assist in the development of new therapies for stone prevention.
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Affiliation(s)
- Saeed R Khan
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, 32610, USA,
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