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Negi PC, Dsouza S, Kandoria A, Nijhavan R, Thakur P, Thakur M, Sharma M, Asotra S, Ganju N, Marwah R, Sharma R. Impact of capacity building and tele ECG based decision support on change in thrombolysis rate and inhospital and one year mortality in patients with STEMI, using hub and spoke model; multi-phasic intervention trial. Indian Heart J 2024; 76:167-171. [PMID: 38885880 DOI: 10.1016/j.ihj.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 04/11/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care. METHODS Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared. RESULTS 29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % p < 0.001) and was also significantly higher than in patients treated in a hub centre (65.5 % vs. 45.7 % p < 0.01). The in-hospital mortality was significantly lower in patients treated at spoke centres compared to those treated at the hub centre (7.8 % vs. 15.5 % < 0.003). The significant difference in mortality rate continued at one year (11.0 % vs.18.4 % p < 0.01). The median time from symptoms to thrombolytic therapy was significantly lower in STEMI patients treated in spoke centres compared to a hub centre (230 min vs. 356 min p < 0.001). CONCLUSION The hub and spoke model of STEMI care is effective in increasing thrombolysis rate, and decreasing in-hospital and one-year mortality rate.
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Das SS, Mahapatra SK. Comparative study of plaque surface temperature and blood heat transfer in a stenosed blood vessel with different symmetrical configurations. Comput Methods Biomech Biomed Engin 2024:1-21. [PMID: 38563314 DOI: 10.1080/10255842.2024.2330701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
The presence of macrophage cells inside plaque can lead to a change in plaque temperature, which can be measured by using arterial wall thermographic techniques to predict the severity of stenosis in the vessel without complicated surgery. This study aims to analyze the effect of plaque symmetricity with a similar degree of stenosis (DOS) on plaque surface temperature and blood heat transfer in a straight vessel. This analysis aims towards predicting the severity of stenosis in a straight blood vessel through plaque temperature as an indicator. Two cases are being analyzed here; case 1 and case 2 refer to having similar vessel dimensions and an overall degree of stenosis (DOS) of 70%, with the exception of case 1 having a symmetrically developed plaque while case 2 refers to an asymmetrically developed plaque. Euler-Euler multiphase method with the application of the granular model is being applied in this study. At peak systole (0.2 s into the 10th cardiac cycle) in a cardiac cycle, the increase in plaque surface temperature at exit is higher in case of a symmetrically developed stenosis compared to an asymmetric one but the reverse situation happens during end systole (0.5 s into the 10th cardiac cycle). Although the population of macrophages in a plaque is a deciding factor of the thermal signature of a plaque, the symmetricity variation also needs to be taken into consideration while plaque progression is being diagnosed through thermographic technique.
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Sotiriou M, Yiannakou M, Damianou C. Investigating atherosclerotic plaque phantoms for ultrasound therapy. J Ultrasound 2022; 25:709-720. [PMID: 35098435 PMCID: PMC9402861 DOI: 10.1007/s40477-022-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of the proposed study was to conduct a feasibility study using a flat rectangular (2 × 10 mm2) transducer operating at 4.0 MHz for creating thermal lesions in an arterial atherosclerotic plaque phantom. The proposed method can be used in the future for treating atherosclerotic plaques in human arteries. MATERIALS AND METHODS The flat rectangular transducer was firstly assessed in agar/silica evaporated milk phantom, polyacrylamide phantom and freshly excised turkeytissue phantom. Then, the same transducer was assessed in an arterial atherosclerotic plaque phantom which was created in the laboratory with a very low cost. The recipe of the atherosclerotic plaque phantom was 4% w/v agar, 1% w/v gypsum, 2% w/v butter and 93% water. The amount of plaque removal was evaluated visually and using an X-Ray system. RESULTS It was shown that the flat rectangular transducer can create thermal lesions on the agar/silica evaporated milk phantom, polyacrylamide phantom and in excised tissue. The size of the lesions matches the geometry of the transducer. Moreover, this transducer destroyed 27.1% of the atherosclerotic plaque phantom with 8 W acoustical power and 30 s duration. CONCLUSIONS This feasibility study demonstrated that atherosclerotic plaque can be destroyed using a very small flat rectangular (2 × 10 mm2) transducer in a very small time interval of 30 s. In future clinical trials the transducer will be incorporated in a catheter which will be inserted intravascular (1-3 mm) wide and can be used to treat atherosclerotic plaques in the coronary arteries.
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Affiliation(s)
- Michalis Sotiriou
- Electrical Engineering Department, Cyprus University of Technology, 30 Archbishop Kyprianos Street, 3036 Limassol, Cyprus
| | - Marinos Yiannakou
- Electrical Engineering Department, Cyprus University of Technology, 30 Archbishop Kyprianos Street, 3036 Limassol, Cyprus
| | - Christakis Damianou
- Electrical Engineering Department, Cyprus University of Technology, 30 Archbishop Kyprianos Street, 3036 Limassol, Cyprus
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Lin P, Ji HH, Li YJ, Guo SD. Macrophage Plasticity and Atherosclerosis Therapy. Front Mol Biosci 2021; 8:679797. [PMID: 34026849 PMCID: PMC8138136 DOI: 10.3389/fmolb.2021.679797] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/12/2021] [Indexed: 12/15/2022] Open
Abstract
Atherosclerosis is a chronic disease starting with the entry of monocytes into the subendothelium and the subsequent differentiation into macrophages. Macrophages are the major immune cells in atherosclerotic plaques and are involved in the dynamic progression of atherosclerotic plaques. The biological properties of atherosclerotic plaque macrophages determine lesion size, composition, and stability. The heterogenicity and plasticity of atherosclerotic macrophages have been a hotspot in recent years. Studies demonstrated that lipids, cytokines, chemokines, and other molecules in the atherosclerotic plaque microenvironment regulate macrophage phenotype, contributing to the switch of macrophages toward a pro- or anti-atherosclerosis state. Of note, M1/M2 classification is oversimplified and only represent two extreme states of macrophages. Moreover, M2 macrophages in atherosclerosis are not always protective. Understanding the phenotypic diversity and functions of macrophages can disclose their roles in atherosclerotic plaques. Given that lipid-lowering therapy cannot completely retard the progression of atherosclerosis, macrophages with high heterogeneity and plasticity raise the hope for atherosclerosis regression. This review will focus on the macrophage phenotypic diversity, its role in the progression of the dynamic atherosclerotic plaque, and finally discuss the possibility of treating atherosclerosis by targeting macrophage microenvironment.
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Affiliation(s)
- Ping Lin
- Institute of Lipid Metabolism and Atherosclerosis, Innovative Drug Research Centre, School of Pharmacy, Weifang Medical University, Weifang, China
| | - Hong-Hai Ji
- Institute of Lipid Metabolism and Atherosclerosis, Innovative Drug Research Centre, School of Pharmacy, Weifang Medical University, Weifang, China
| | - Yan-Jie Li
- Institute of Lipid Metabolism and Atherosclerosis, Innovative Drug Research Centre, School of Pharmacy, Weifang Medical University, Weifang, China
| | - Shou-Dong Guo
- Institute of Lipid Metabolism and Atherosclerosis, Innovative Drug Research Centre, School of Pharmacy, Weifang Medical University, Weifang, China
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Kim JH, Almuwaqqat Z, Hammadah M, Liu C, Ko YA, Lima B, Sullivan S, Alkhoder A, Abdulbaki R, Ward L, Bremner JD, Sheps DS, Raggi P, Sun YV, Shah AJ, Vaccarino V, Quyyumi AA. Peripheral Vasoconstriction During Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease. Circ Res 2019; 125:874-883. [PMID: 31550998 PMCID: PMC7134565 DOI: 10.1161/circresaha.119.315005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
RATIONALE Excessive vasoconstriction in response to mental stress may be a potential mechanism by which acute psychological stress leads to adverse cardiac events. OBJECTIVES We investigated whether excessive digital vasoconstriction during acute mental stress predicts adverse cardiovascular outcomes among patients with coronary artery disease. METHODS AND RESULTS Five hundred forty-nine patients with stable coronary artery disease (age 63±9, 76% male, 29% black) underwent mental stress testing with a standardized public speaking stressor and followed prospectively for cardiovascular end points. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during mental stress/baseline was calculated and dichotomized by the median value into low and high sPAT ratio groups. Upon 3-year follow-up, Fine and Gray's subdistribution hazard ratios were used to examine the association between sPAT ratio and the composite end point of cardiovascular death, myocardial infarction, revascularization, and hospitalization for heart failure. The median sPAT ratio was 0.68 (interquartile range, 0.48-0.88), indicating 32% vasoconstriction with mental stress. Men were more likely to have low sPAT ratio than women (odds ratio, 1.79; P=0.007) while those on β-blockers were less likely to have low sPAT ratio (odds ratio, 0.52; P=0.003). After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (subdistribution hazard ratio, 1.77 [95% CI, 1.12-2.80]). CONCLUSIONS Greater peripheral vasoconstriction with mental stress, denoted by a low sPAT ratio, is associated with a higher risk of adverse cardiovascular outcomes in patients with coronary artery disease.
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Affiliation(s)
- Jeong Hwan Kim
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Zakaria Almuwaqqat
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Chang Liu
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA.,Department of Biostatistics and Bioinformatics (C.L., Y.-A.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics (C.L., Y.-A.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Bruno Lima
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Samaah Sullivan
- Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ayman Alkhoder
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Rami Abdulbaki
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics (C.L., Y.-A.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA.,Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Decatur, Georgia (J.D.B., A.J.S.)
| | - David S Sheps
- Department of Epidemiology, University of Florida College of Medicine, Gainesville (D.S.S.)
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Yan V Sun
- Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA.,Atlanta VA Medical Center, Decatur, Georgia (J.D.B., A.J.S.)
| | - Viola Vaccarino
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology (S.S., L.W., Y.V.S., A.J.S., V.V.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Arshed A Quyyumi
- From the Division of Cardiology, Department of Medicine (J.H.K., Z.A., M.H., C.L., B.L., A.A., R.A., A.J.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA
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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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Joseph JP, Reyes E, Guzman J, O'Doherty J, McConkey H, Arri S, Kakkar R, Beckley N, Douiri A, Barrington SF, Redwood SR, Ferro A. CXCR2 Inhibition - a novel approach to treating CoronAry heart DiseAse (CICADA): study protocol for a randomised controlled trial. Trials 2017; 18:473. [PMID: 29020983 PMCID: PMC5637263 DOI: 10.1186/s13063-017-2210-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/25/2017] [Indexed: 02/02/2023] Open
Abstract
Background There is emerging evidence of the central role of neutrophils in both atherosclerotic plaque formation and rupture. Patients with lower neutrophil counts following acute coronary syndromes tend to have a greater coronary flow reserve, which is a strong predictor of long-term cardiovascular health. But so far, no data are available regarding the impact of neutrophil inhibition on cardiovascular clinical or surrogate endpoints. Therefore, the aim of this study is to investigate the effects of AZD5069, a cysteine-X-cysteine chemokine receptor 2 (CXCR2) inhibitor, on coronary flow reserve and coronary structure and function in patients with coronary artery disease. Methods/Design Ninety subjects with coronary artery disease undergoing percutaneous coronary intervention will be included in this investigator-driven, randomised, placebo-controlled, double-blind, phase IIa, single-centre study. Participants will be randomised to receive either AZD5069 (40 mg) administered orally twice daily or placebo for 24 weeks. Change in coronary flow reserve as determined by 13N-ammonia positron emission tomography-computed tomography will be the primary outcome. Change in the inflammatory component of coronary plaque structure and the backward expansion wave, an invasive coronary physiological measure of diastolic function, will be assessed as secondary outcomes. Discussion Cardiovascular surrogate parameters, such as coronary flow reserve, may provide insights into the potential mechanisms of the cardiovascular effects of CXCR2 inhibitors. Currently, ongoing trials do not specifically focus on neutrophil function as a target of intervention, and we therefore believe that our study will contribute to a better understanding of the role of neutrophil-mediated inflammation in coronary artery disease. Trial registration EudraCT, 2016-000775-24. Registered on 22 July 2016. International Standard Randomised Controlled Trial Number, ISRCTN48328178. Registered on 25 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2210-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jubin P Joseph
- British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, SE1 7EH, UK.
| | - Eliana Reyes
- PET Centre, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Josephine Guzman
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jim O'Doherty
- PET Centre, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Hannah McConkey
- British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Satpal Arri
- British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, SE1 7EH, UK
| | - Rahul Kakkar
- Scientific Partnering & Alliances, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Waltham, Massachusetts, 02451, USA
| | - Nicholas Beckley
- Department of Primary Care and Public Health Sciences, King's College London, London, SE1 1UL, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, King's College London, London, SE1 1UL, UK
| | - Sally F Barrington
- PET Centre, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Simon R Redwood
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Albert Ferro
- Cardiovascular Clinical Pharmacology, British Heart Foundation Centre of Research Excellence, Cardiovascular Division, King's College London, London, UK
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Dong N, Xie Z, Wang W, Dai J, Sun M, Pu Z, Tian J, Yu B. Comparison of coronary arterial lumen dimensions on angiography and plaque characteristics on optical coherence tomography images and their changes induced by statin. BMC Med Imaging 2016; 16:63. [PMID: 27871242 PMCID: PMC5118892 DOI: 10.1186/s12880-016-0166-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022] Open
Abstract
Background Coronary angiography (CAG) is widely used to assess lumen dimensions, and optical coherence tomography (OCT) is used to evaluate the characteristics of atherosclerotic plaque. This study was aimed to compare coronary lumen dimensions using CAG and plaque characteristics using OCT and their changes during statin therapy. Methods We identified 97 lipid-rich plaques from 69 statin-naïve patients, who received statin therapy in the following 12 months. CAG and OCT examinations were conducted at baseline and 12-month follow-up period. Results Lesion length, as measured by CAG, was closely correlated with lipid length by OCT (baseline: r = 0.754, p < 0.001; follow-up: r = 0.639, p < 0.001). However, no significant correlations were found between the other findings on OCT and data on CAG. With 12-month statin therapy, microstructures of lipid-rich plaques were significantly improved, but CAG-derived lumen dimensions were not improved. Moreover, we found no significant relationship between changes in OCT measurements and changes in CAG data over time. Conclusion Lipid length on OCT and lesion length on CAG were closely correlated. However, plaque microstructural characteristics on OCT showed no significantly statistically correlations with lumen dimensions on CAG, neither did their evolutionary changes induced by statin over time. A retrospectively registered study Clinical trial registry: ClinicalTrial.gov. Registered number: NCT01023607. Registered 1 December 2009.
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Affiliation(s)
- Nana Dong
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China.,Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, 150086, China
| | - Zulong Xie
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China
| | - Wei Wang
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China
| | - Jiannan Dai
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China
| | - Meng Sun
- Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, 150086, China
| | - Zhongyue Pu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China
| | - Jinwei Tian
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China.
| | - Bo Yu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, China. .,Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, 150086, China.
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Rather RA, Dhawan V. Genetic markers: Potential candidates for cardiovascular disease. Int J Cardiol 2016; 220:914-23. [PMID: 27416153 DOI: 10.1016/j.ijcard.2016.06.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/22/2016] [Accepted: 06/26/2016] [Indexed: 02/07/2023]
Abstract
The effective prevention of cardiovascular disease depends upon the ability to recognize the high-risk individuals at an early stage of the disease or long before the development of adverse events. Evolving technologies in the fields of proteomics, metabolomics, and genomics have played a significant role in the discovery of cardiovascular biomarkers, but so far these methods have achieved the modest success. Hence, there is a crucial need for more reliable, suitable, and lasting diagnostic and therapeutic markers to screen the disease well in time to start the clinical aid to the patients. Gene polymorphisms associated with the cardiovascular disease play a decisive role in the disease onset. Therefore, the genetic marker evaluation to classify high-risk patients from low-risk patients trends an effective approach to patient management and care. Currently, there are no genetic markers available for extensive adoption as risk factors for coronary vascular disease, yet, there are numerous promising, biologically acceptable candidates. Many of these gene biomarkers, alone or in combination, can play an essential role in the prediction of cardiovascular risk. The present review highlights some putative emerging genetic biomarkers that could facilitate more authentic and fast diagnosis of CVD. This review also briefly describes few technological approaches employed in the biomarker search.
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Affiliation(s)
- Riyaz Ahmad Rather
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Veena Dhawan
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, Franco OH, van der Lugt A, Wentzel JJ, Vernooij MW. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease. Stroke 2016; 47:1542-7. [DOI: 10.1161/strokeaha.116.012923] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mariana Selwaness
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Daniel Bos
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Quirijn van den Bouwhuijsen
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Marileen L.P. Portegies
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - M. Arfan Ikram
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Albert Hofman
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Oscar H. Franco
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Jolanda J. Wentzel
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Meike W. Vernooij
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
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11
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McDermott MM, Liu K, Green D, Greenland P, Tian L, Kibbe M, Tracy R, Shah S, Wilkins JT, Huffman M, Zhao L, Huang CC, Auerbach A, Liao Y, Skelly CL, McCarthy W, Lloyd Jones D. Changes in D-dimer and inflammatory biomarkers before ischemic events in patients with peripheral artery disease: The BRAVO Study. Vasc Med 2015; 21:12-20. [PMID: 26647446 DOI: 10.1177/1358863x15617541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Whether circulating biomarker levels increase shortly before an ischemic heart disease (IHD) event is unknown. We studied whether levels of D-dimer, C-reactive protein (CRP), and serum amyloid A (SAA) are higher within 2 months of an IHD event compared to time periods more than 2 months before the IHD event. We assembled 595 participants with peripheral artery disease (PAD) and followed them for up to 3 years. Blood samples were obtained every 2 months. The primary outcome was IHD events: myocardial infarctions, unstable angina, or IHD death. We used a nested case-control design. Fifty participants (cases) had events and were each matched by age, sex, duration in the study, and number of blood draws to two controls without events. Among cases, the mean D-dimer value of 1.105 obtained within 2 months of the event was higher than values obtained 10 months (0.68 mg/L, p<0.001), 12 months (0.71 mg/L, p=0.001), 16 months (0.65 mg/L, p=0.008), 20 months (p=0.032), 22 months (p=0.033), 26 months (p=0.038), and 32 months (p=0.04) before the event. Compared to controls, median D-dimer levels in cases were higher 4 months (p=0.017), 6 months (p=0.005), and 8 months (p=0.028) before the event. Values of CRP and SAA obtained within two months of an IHD event not consistently higher than values obtained during the prior months. In PAD participants with an IHD event, D-dimer was higher within 2 months of the event, compared to most values obtained 10 to 32 months previously. D-dimer was also higher in cases as compared to controls during most visits within 8 months of the IHD event.
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Affiliation(s)
- Mary McGrae McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Green
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Melina Kibbe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Russell Tracy
- Department of Pathology - Colchester Research Facility, University of Vermont College of Medicine, Colchester, VT, USA
| | - Sanjiv Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John T Wilkins
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiang-Ching Huang
- Joseph J Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Amanda Auerbach
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yihua Liao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Walter McCarthy
- Department of Surgery, Rush Medical Center, Chicago, IL, USA
| | - Donald Lloyd Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, McKenney JM, Grundy SM, Gill EA, Wild RA, Wilson DP, Brown WV. National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol 2015; 9:129-69. [PMID: 25911072 DOI: 10.1016/j.jacl.2015.02.003] [Citation(s) in RCA: 532] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 02/07/2023]
Abstract
The leadership of the National Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary. The major conclusions include (1) an elevated level of cholesterol carried by circulating apolipoprotein B-containing lipoproteins (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol [LDL-C], termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical atherosclerotic cardiovascular disease (ASCVD) events; (2) reducing elevated levels of atherogenic cholesterol will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies; (3) the intensity of risk-reduction therapy should generally be adjusted to the patient's absolute risk for an ASCVD event; (4) atherosclerosis is a process that often begins early in life and progresses for decades before resulting a clinical ASCVD event. Therefore, both intermediate-term and long-term or lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies; (5) for patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk; (6) nonlipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus; and (7) the measurement and monitoring of atherogenic cholesterol levels remain an important part of a comprehensive ASCVD prevention strategy.
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Affiliation(s)
- Terry A Jacobson
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Matthew K Ito
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, OR, USA
| | - Kevin C Maki
- Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL, USA
| | | | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | | | - James M McKenney
- Virginia Commonwealth University and National Clinical Research, Richmond, VA, USA
| | - Scott M Grundy
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward A Gill
- University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Robert A Wild
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Don P Wilson
- Cook Children's Medical Center, Fort Worth, TX, USA
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13
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Takeuchi H. Chest pain caused by pulmonary vein thrombi could be curable by dabigatran. BMJ Case Rep 2014; 2014:bcr-2013-203186. [PMID: 24626383 DOI: 10.1136/bcr-2013-203186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chest pain is a common clinical event that overwhelms many patients and is often a sign of coronary ischaemia. The comprehensive influence of pulmonary vein thrombosis (PVT) on coronary artery ischaemia is underappreciated. A 64-slice multidetector CT (64-MDCT) scan can detect pulmonary vein thrombi. A 68-year-old man was referred for the assessment of recent chest pain. A 64-MDCT scan was performed to assess his coronary artery. Although the scan did not show a coronary artery plaque, it did show a thrombus in the right lower pulmonary vein. After 3 months of dabigatran therapy, some parts of the thrombus had dissolved, and the image of the thrombus was more vague. The darkness of the thrombus was lost, indicating that the thrombus had loosened in structure and that the contrast enhancements were able to penetrate into the thrombus. PVT was identified as the likely aetiology for the cause of the chest pain.
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Kasraie N, Mah P, Keener CR, Clarke GD. Characterization of atherosclerotic plaque: a contrast-detail study using multidetector and cone-beam computed tomography. J Appl Clin Med Phys 2014; 15:4308. [PMID: 24423833 PMCID: PMC5711236 DOI: 10.1120/jacmp.v15i1.4308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 08/06/2013] [Accepted: 07/02/2013] [Indexed: 11/23/2022] Open
Abstract
A Hindmarsh-Rose model perceptibility phantom containing inserts with various in vitro atherosclerotic plaque compositions was constructed and imaged on a clinical 64 slice multidetector (MDCT) system using 80 and 120 kVp settings and two other cone-beam (CBCT) systems at 80 kVp. Perceptibility of the simulated lipid-fibrotic plaque solutions in the images was evaluated by six observers. The effective doses of the protocols employed were estimated using phantom CTDI-vol measurements placed at identical settings. The CBCT system allowed reduction in effective dose in comparison with the conventional MDCT system for imaging of the carotid plaque phantoms without degrading image quality. The CBCT dose was less than MDCT, with a mean dose of 1.14 ± 0.01 mSv and 1.11 ± 0.02 mSv for MDCT using two measuring techniques vs. 0.35 ± 0.01 mSv for CBCT. The image quality analysis showed no significant differences in the contrast-detail (C-D) curves of the best performing CBCT vs. clinical MDCT (p > 0.05) using a Mann-Whitney U test. Results indicate that low-tube-potential CBCT may produce comparable C-D resolution for phantom-based representations of soft plaque types with respect to MDCT systems. This study suggests that the utility of low kVp CT techniques for evaluating carotid vulnerable atherosclerotic plaque merits further study.
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Affiliation(s)
- Nima Kasraie
- The University of Texas Health Science Center at San Antonio.
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15
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Ginseng extracts restore high-glucose induced vascular dysfunctions by altering triglyceride metabolism and downregulation of atherosclerosis-related genes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:797310. [PMID: 24194784 PMCID: PMC3806155 DOI: 10.1155/2013/797310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/23/2013] [Accepted: 08/24/2013] [Indexed: 11/17/2022]
Abstract
The king of herbs, Panax ginseng, has been used widely as a therapeutic agent vis-à-vis its active pharmacological and physiological effects. Based on Chinese pharmacopeia Ben Cao Gang Mu and various pieces of literature, Panax ginseng was believed to exert active vascular protective effects through its antiobesity and anti-inflammation properties. We investigated the vascular protective effects of ginseng by administrating ginseng extracts to rats after the induction of diabetes. We found that Panax ginseng can restore diabetes-induced impaired vasorelaxation and can reduce serum triglyceride but not cholesterol level in the diabetic rats. The ginseng extracts also suppressed the expression of atherosclerosis-related genes and altered the expression of lipid-related genes. The results provide evidence that Panax ginseng improves vascular dysfunction induced by diabetes and the protective effects may possibly be due to the downregulation of atherosclerosis-related genes and altered lipid metabolism, which help to restore normal endothelium functions.
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Hagisawa K, Nishioka T, Suzuki R, Maruyama K, Takase B, Ishihara M, Kurita A, Yoshimoto N, Nishida Y, Iida K, Luo H, Siegel RJ. Thrombus-targeted perfluorocarbon-containing liposomal bubbles for enhancement of ultrasonic thrombolysis: in vitro and in vivo study. J Thromb Haemost 2013; 11:1565-73. [PMID: 23773778 DOI: 10.1111/jth.12321] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 06/09/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND External low-frequency ultrasound (USD) in combination with microbubbles has been reported to recanalize thrombotically occluded arteries in animal models. OBJECTIVE The purpose of this study was to examine the enhancing effect of thrombus-targeted bubble liposomes (BLs) developed for fresh thrombus imaging during ultrasonic thrombolysis. METHODS In vitro: after the administration of thrombus-targeted BLs or non-targeted BLs, the clot was exposed to low-frequency (27 kHz) USD for 5 min. In vivo: Rabbit iliofemoral arteries were thrombotically occluded, and an intravenous injection of either targeted BLs (n = 22) or non-targeted BLs (n = 22) was delivered. External low-frequency USD (low intensity, 1.4 W cm(-2) , to 12 arteries, and high intensity, 4.0 W cm(-2) , to 10 arteries, for both the targeted BL group and the non-targeted BL group) was applied to the thrombotically occluded arteries for 60 min. In another 10 rabbits, recombinant tissue-type plasminogen activator (rt-PA) was intravenously administered. RESULTS In vitro: the weight reduction rate of the clot with targeted BLs was significantly higher than that of the clot with non-targeted BLs. In vivo: TIMI grade 3 flow was present in a significantly higher number of rabbits with USD and targeted BLs than rabbits with USD and non-targeted BLs, or with rt-PA monotherapy. High-intensity USD exposure with targeted BLs achieved arterial recanalization in 90% of arteries, and the time to reperfusion was shorter than with rt-PA treatment (targeted BLs, 16.7 ± 5.0 min; rt-PA, 41.3 ± 14.4 min). CONCLUSIONS Thrombus-targeted BLs developed for USD thrombus imaging enhance ultrasonic disruption of thrombus both in vitro and in vivo.
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Affiliation(s)
- K Hagisawa
- Department of Physiology, National Defense Medical College, Tokorozawa, Japan
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Asrar Ul Haq M, Layland J, Mutha V, Barlis P. The invasive assessment of coronary atherosclerosis and stents using optical coherence tomography: a clinical update. HEART ASIA 2013; 5:154-161. [PMID: 24563666 PMCID: PMC3898547 DOI: 10.1136/heartasia-2013-010328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/21/2013] [Accepted: 06/30/2013] [Indexed: 01/12/2023]
Abstract
Ischaemic heart disease (IHD) remains one of the leading causes of death. Atherosclerosis has been intensely researched given the IHD prevalence and the financial impacts on healthcare systems. More recently, in vivo characterisation of coronary atherosclerotic plaque and tissue responses following stent implantation in a coronary artery has been made possible by a novel technology called optical coherence tomography (OCT). OCT is a light-based, invasive, intracoronary imaging modality long applied to the field of ophthalmology and now in clinical use worldwide. It gives a unique view of within the coronary artery using near-infrared light with a resolution of 15 microns, 10 times higher than other invasive coronary imaging techniques like intravascular ultrasound. The technology is being adopted to comprehensively detect features that make plaques 'vulnerable' (eg, large lipid pool, thin, fibrous-cap atheroma), whether stents are implanted optimally within the artery, and visualise the small layers of tissue that form over stent metal surfaces over time, which in turn may provide surrogate markers for long-term stent safety and help guide the optimal duration of dual antiplatelet therapy, a topic of big discussion at the current point of time.
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Affiliation(s)
- Muhammad Asrar Ul Haq
- Department of Medicine , University of Melbourne , Melbourne , Australia ; Department of Cardiology , The Northern Hospital , Melbourne , Australia
| | - Jamie Layland
- Department of Cardiology , St Vincent's Hospital , Melbourne , Australia
| | - Vivek Mutha
- Department of Medicine , University of Melbourne , Melbourne , Australia ; Department of Cardiology , The Northern Hospital , Melbourne , Australia
| | - Peter Barlis
- Department of Medicine , University of Melbourne , Melbourne , Australia ; Department of Cardiology , The Northern Hospital , Melbourne , Australia ; Department of Cardiology , St Vincent's Hospital , Melbourne , Australia
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18
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Comparison of coronary plaque subtypes in male and female patients using 320-row MDCTA. Atherosclerosis 2012; 226:428-32. [PMID: 23287639 DOI: 10.1016/j.atherosclerosis.2012.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 11/09/2012] [Accepted: 11/22/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Determine plaque subtype and volume difference in male and female patients with obstructive and non-obstructive CAD using 320-row MDCTA. MATERIALS AND METHODS 128 patients with suspected CAD underwent MDCTA. All studies were divided into two groups based on disease severity. 0-70% stenosis (non-obstructive CAD) & >70% (obstructive). All were compared for plaque quantity and subtypes by gender. Main arteries, RCA, LM, LAD and LCX were analyzed using Vitrea 5.2 software to quantify fatty, fibrous and calcified plaque. Thresholds for coronary plaque quantification (volume in mm(3)) were preset at 35 ± 12 HU for fatty, 90 ± 24 HU for fibrous and >130 HU for calcified/mixed plaque and analyzed using STATA software. RESULTS Total plaque burden in 118 patients [65M: 53F] was significantly higher in all arteries in males compared to females with non-obstructive disease. Total plaque volume for males vs. females was: RCA: 10.10 ± 5.02 mm(3) vs. 6.89 ± 2.75 mm(3), respectively, p = 0.001; LAD: 7.21 ± 3.38 mm(3) vs. 5.89 ± 1.93 mm(3), respectively, p = 0.04; LCX: 9.13 ± 3.27 mm(3) vs. 7.16 ± 1.73 mm(3), respectively, p = 0.002; LM 15.13 ± 4.51 mm(3) vs. 11.85 ± 4.03 mm(3), respectively, p = 0.001. In sub-analyses, males had significantly more fibrous and fatty plaque in LM, LAD & LCX than females. However in the RCA, only fibrous plaque was significantly greater in males. Calcified plaque volume was not significantly different in both genders. Only 8% of patients had obstructive CAD (>70% stenosis); there was no significant difference in plaque volume or subtypes. CONCLUSION In patients with non-obstructive CAD, males were found to have significantly higher total coronary plaque volume with predominance of fibrous and fatty subtypes compared to females of the same age and BMI. There was no significant difference in plaque subtype or volume in patients with obstructive disease.
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19
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Hyafil F, Feldman L, Le Guludec D, Fayad ZA. Evaluating Efficacy of Pharmaceutical Interventions in Atherosclerosis: Role of Magnetic Resonance Imaging and Positron Emission Tomography. ACTA ACUST UNITED AC 2012; 79:689-704. [DOI: 10.1002/msj.21349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kiani AN, Vogel-Claussen J, Arbab-Zadeh A, Magder LS, Lima J, Petri M. Semiquantified noncalcified coronary plaque in systemic lupus erythematosus. J Rheumatol 2012; 39:2286-93. [PMID: 23027889 DOI: 10.3899/jrheum.120197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE. METHODS Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software. RESULTS The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant. CONCLUSION Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.
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Affiliation(s)
- Adnan N Kiani
- Division of Rheumatology, Department of Radiology, and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Takeuchi H. Warfarin improved CT values of the coronary artery artherosclerotic plaque: evaluation by 64-MDCTA. BMJ Case Rep 2012; 2012:bcr.02.2012.5941. [PMID: 23008363 DOI: 10.1136/bcr.02.2012.5941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
64-multidetector CT angiography (MDCTA) can identify plaques and assess different plaque components (lipid, fibrous tissue and calcifications). The first patient was a 75-year-old-man with atrial fibrillation (AF). Axial 64-MDCTA image of a coronary artery atherosclerotic plaque was obtained, which included the plaque on the outer vessel wall. The authors measured the five points of CT values around the vague center of the plaque with almost equal interval, which was shown in figure 1. Max was 80 Hounsfield unit (HU), and min was 28 HU. After 3 months warfarin therapy (1.5 mg id), max increased to 100 HU, and min increased to 69 HU. The second patient was a 74-year-old-male with hypertension and AF. Max was 61 HU, and min was 37 HU. After 3 months warfarin therapy (2.5 mg id), max increased to 70 HU, and min increased to 50 HU. Warfarin increased CT values of the artherosclerotic plaques in two patients with AF.
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Affiliation(s)
- Hidekazu Takeuchi
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
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Boettcher MF, Heinig R, Schmeck C, Kohlsdorfer C, Ludwig M, Schaefer A, Gelfert-Peukert S, Wensing G, Weber O. Single dose pharmacokinetics, pharmacodynamics, tolerability and safety of BAY 60-5521, a potent inhibitor of cholesteryl ester transfer protein. Br J Clin Pharmacol 2012; 73:210-8. [PMID: 21838789 DOI: 10.1111/j.1365-2125.2011.04083.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS To determine pharmacokinetics (PK), pharmacodynamics (PD), tolerability and safety of BAY 60-5521, a potent inhibitor of cholesteryl ester transfer protein (CETP). METHODS The first in man (FIM) study investigated the safety, tolerability, pharmacodynamics and pharmacokinetics in healthy male subjects following administration of single oral doses. The study was performed using a randomized, single-blind, placebo-controlled, single dose-escalation design. Thirty-eight young healthy male subjects (aged 20-45 years) received an oral dose of 5, 12.5, 25 or 50 mg BAY 60-5521 (n= 28) or were treated with a placebo (n= 10). RESULTS In all four dose steps, only one adverse event (25 mg; mild skin rash) was considered drug related. Clinical laboratory parameters showed no clinically relevant changes. A clear dose-dependent CETP inhibition could be demonstrated starting at a dose of 5 mg. At a dose of 25 mg, a CETP inhibition >50% over 18 h was observed. After 50 mg, CETP inhibition >50% lasted more than 50 h. Twenty-four h after administration mean HDL-C-values showed a nearly dose-proportional increase. Following administration of 50 mg, a significant HDL-C increase of about 30% relative to baseline values was found. BAY 60-5521 was slowly absorbed reaching maximum concentrations in plasma after 4 to 6 h. The disposition in plasma was multi-exponential with an estimated mean terminal half-life of 76 to 144 h. CONCLUSIONS BAY 60-5521 was clinically safe and well tolerated. No effects on heart rate, blood pressure and ECG recordings were observed during the study. A clear pharmacodynamic effect on CETP inhibition and HDL could be demonstrated.
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Schiano V, Sirico G, Giugliano G, Laurenzano E, Brevetti L, Perrino C, Brevetti G, Esposito G. Femoral Plaque Echogenicity and Cardiovascular Risk in Claudicants. JACC Cardiovasc Imaging 2012; 5:348-57. [DOI: 10.1016/j.jcmg.2012.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/27/2011] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
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Chelliah MV, Chackalamannil S, Xia Y, Eagen K, Greenlee WJ, Ahn HS, Agans-Fantuzzi J, Boykow G, Hsieh Y, Bryant M, Chan TM, Chintala M. Discovery of nor-seco himbacine analogs as thrombin receptor antagonists. Bioorg Med Chem Lett 2012; 22:2544-9. [DOI: 10.1016/j.bmcl.2012.01.138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/31/2012] [Indexed: 12/22/2022]
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Duvall WL, Sealove B, Pungoti C, Katz D, Moreno P, Kim M. Angiographic investigation of the pathophysiology of perioperative myocardial infarction. Catheter Cardiovasc Interv 2012; 80:768-76. [DOI: 10.1002/ccd.23446] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 10/04/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022]
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Hutter R, Badimon JJ, Fuster V, Narula J. Coronary artery disease in aging women: a menopause of endothelial progenitor cells? Med Clin North Am 2012; 96:93-102. [PMID: 22391254 DOI: 10.1016/j.mcna.2012.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The cardiovascular protection provided to women during the reproductive age and the unique angiogenic properties of the female reproductive system provide insights into the complex regulatory network of female sex hormones, angiogenic growth factors, and stem cell regulatory molecules. The intricate and interwoven endometrial physiology of the female menstrual cycle shows that in order to harness the physiologic cardioprotection provided by nature to women of reproductive age, for better cardiovascular therapies in postmenopausal women and the population in general, a coherent and systematic approach is needed.
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Affiliation(s)
- Randolph Hutter
- Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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27
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Sawada T, Emoto T, Motoji Y, Hashimoto M, Kageyama H, Terashita D, Mizoguchi T, Mizuguchi T, Iwasaki M, Taira K, Okamoto H, Matsuo Y, Kim SK, Takarada A, Yokoyama M. Possible association between non-invasive parameter of flow-mediated dilatation in brachial artery and whole coronary plaque vulnerability in patients with coronary artery disease. Int J Cardiol 2011; 166:613-20. [PMID: 22172589 DOI: 10.1016/j.ijcard.2011.11.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 10/20/2011] [Accepted: 11/26/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Despite being a relatively widely-used non-invasive parameter of endothelial dysfunction, little is known regarding the relationship between flow-mediated dilatation (FMD) and coronary plaque vulnerability in patients with coronary artery disease (CAD). METHODS 111 CAD patients (age; 68.9 ± 9.3) who underwent both coronary intervention and FMD were enrolled. Spectral analyses of intravascular ultrasound radiofrequency data for both culprit and non-culprit lesions were performed using Virtual Histology software. Plaque burden was described based on fibrotic, fibro-fatty, dense calcium, and necrotic core (NC) components, and thin-cap fibroatheroma (TCFA) was defined as focal NC rich (> 10%) plaques touching the lumen with a percent-plaque volume exceeding 40%. RESULTS Averaged %FMD was 2.86 ± 2.03% (median 2.27%, 25th 1.40%, 75th 4.20%). NC volumes were negatively correlated with log%FMD for both culprit and non-culprit lesions (P = 0.001, r = 0.31 and P = 0.03, r = 0.21, respectively). We divided the patients into three tertiles according to %FMD; 38 were lower (≤ 1.75%), 41 were middle (> 1.75%, but ≤ 3.5%), and 32 were upper tertile (> 3.5%). The prevalence rate of TCFA increased with decreasing %FMD tertile and the incidence of major adverse cardiac events was significantly higher in lower %FMD tertile. Multivariate logistic regression analyses showed that the most powerful predictive factor for TCFA was log%FMD (P < 0.0001), and ROC curve analysis identified %FMD of < 2.81% (AUC = 0.82, sensitivity: 91.2%, specificity: 66.7%) as the optimal cut-off point for predicting the presence of TCFA. CONCLUSIONS Impaired endothelial function in brachial arteries may be associated with whole coronary plaque vulnerability and poor clinical outcome in patients with CAD.
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Affiliation(s)
- Takahiro Sawada
- Hyogo Prefectural Awaji Hospital, Division of Cardiovascular Medicine, Department of Internal Medicine, Japan.
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Mizuno Y, Jacob RF, Mason RP. Inflammation and the development of atherosclerosis. J Atheroscler Thromb 2011; 18:351-8. [PMID: 21427505 DOI: 10.5551/jat.7591] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Atherosclerosis is a progressive disease causally associated with multiple cardiovascular risk factors, including dyslipidemia. Without effective intervention, atherosclerosis becomes evidenced clinically as coronary artery and cerebrovascular disease, both of which remain the leading causes of death worldwide. Multiple lines of investigation indicate a central role for inflammation in atherosclerotic plaque progression, vulnerability and thrombogenicity. Randomized clinical trials have documented the benefit of lipid-lowering therapy for both primary and secondary prevention of cardiovascular events. Statins, a class of drugs that lower cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, have been shown to slow the progression of the atheroma and the frequency of associated clinical events to an extent that cannot be attributed solely to LDL reduction. The non-LDL or pleiotropic effects of statins are attributed to anti-inflammatory activity, enhanced endothelial function, and inhibition of oxidative stress. In this review, we discuss the role of inflammation in atherogenesis along with the effects of statins in slowing this process through LDL-dependent and -independent mechanisms.
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Affiliation(s)
- Yoshiko Mizuno
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
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29
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Elevated Levels of Oxidized Low-Density Lipoprotein Correlate Positively with C-Reactive Protein in Patients with Acute Coronary Syndrome. Cell Biochem Biophys 2011; 62:365-72. [DOI: 10.1007/s12013-011-9295-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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30
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Rautou PE, Vion AC, Amabile N, Chironi G, Simon A, Tedgui A, Boulanger CM. Microparticles, Vascular Function, and Atherothrombosis. Circ Res 2011; 109:593-606. [DOI: 10.1161/circresaha.110.233163] [Citation(s) in RCA: 291] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Membrane-shed submicron microparticles (MPs) are released after cell activation or apoptosis. High levels of MPs circulate in the blood of patients with atherothrombotic diseases, where they could serve as a useful biomarker of vascular injury and a potential predictor of cardiovascular mortality and major adverse cardiovascular events. Atherosclerotic lesions also accumulate large numbers of MPs of leukocyte, smooth muscle cell, endothelial, and erythrocyte origin. A large body of evidence supports the role of MPs at different steps of atherosclerosis development, progression, and complications. Circulating MPs impair the atheroprotective function of the vascular endothelium, at least partly, by decreased nitric oxide synthesis. Plaque MPs favor local inflammation by augmenting the expression of adhesion molecule, such as intercellular adhesion molecule -1 at the surface of endothelial cell, and monocyte recruitment within the lesion. In addition, plaque MPs stimulate angiogenesis, a key event in the transition from stable to unstable lesions. MPs also may promote local cell apoptosis, leading to the release and accumulation of new MPs, and thus creating a vicious circle. Furthermore, highly thrombogenic plaque MPs could increase thrombus formation at the time of rupture, together with circulating MPs released in this context by activated platelets and leukocytes. Finally, MPs also could participate in repairing the consequences of arterial occlusion and tissue ischemia by promoting postischemic neovascularization.
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Affiliation(s)
- Pierre-Emmanuel Rautou
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Clémence Vion
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas Amabile
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Chironi
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Simon
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Tedgui
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Chantal M. Boulanger
- From the INSERM (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité (P.E.R., A.C.V., N.A., G.C., A.S., A.T., C.M.B.), UMR-S970, Paris, France; Service de Cardiologie (N.A.), Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Centre de Médecine Préventive Cardiovasculaire (G.C., A.S.), AP-HP, Hôpital Européen Georges Pompidou, Paris, France
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Yamada M, Jinzaki M, Tanami Y, Matsumoto K, Ueno A, Nukui M, Imai Y, Ishihara Y, Nishide A, Sasaki K, Kuribayashi S. Detection of a coronary artery vessel wall: performance of 0.3 mm fine-cell detector computed tomography—a phantom study. Phys Med Biol 2011; 56:5235-47. [DOI: 10.1088/0031-9155/56/16/010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Liang M, Puri A, Devlin G. The vulnerable plaque: the real villain in acute coronary syndromes. Open Cardiovasc Med J 2011; 5:123-9. [PMID: 21673834 PMCID: PMC3111722 DOI: 10.2174/1874192401105010123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 04/09/2011] [Accepted: 04/12/2011] [Indexed: 01/13/2023] Open
Abstract
The term "vulnerable plaque" refers to a vascular lesion that is prone to rupture and may result in life-threatening events which include myocardial infarction. It consists of thin-cap fibroatheroma and a large lipid core which is highly thrombogenic. Acute coronary syndromes often result from rupture of vulnerable plaques which frequently are only moderately stenosed and not visible by conventional angiography. Several invasive and non-invasive strategies have been developed to assess the burden of vulnerable plaques. Intravascular ultrasound provides a two-dimensional cross-sectional image of the arterial wall and can help assess the plaque burden and composition. Optical coherent tomography offers superior resolution over intravascular ultrasound. High-resolution magnetic resonance imaging provides non-invasive imaging for visualizing fibrous cap thickness and rupture in plaques. In addition, it may be of value in assessing the effects of treatments, such as lipid-lowering therapy. Technical issues however limit its clinical applicability. The role of multi-slice computed tomography, a well established screening tool for coronary artery disease, remains to be determined. Fractional flow reserve (FFR) may provide physiological functional assessment of plaque vulnerability; however, its role in the management of vulnerable plaque requires further studies. Treatment of the vulnerable patient may involve systemic therapy which currently include statins, ACE inhibitors, beta-blockers, aspirin, and calcium-channel blockers and in the future local therapeutic options such as drug-eluting stents or photodynamic therapy.
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Affiliation(s)
- Michael Liang
- Department of Cardiology, Waikato Hospital, New Zealand
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Tardif JC, Lesage F, Harel F, Romeo P, Pressacco J. Imaging Biomarkers in Atherosclerosis Trials. Circ Cardiovasc Imaging 2011; 4:319-33. [DOI: 10.1161/circimaging.110.962001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jean-Claude Tardif
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Frédéric Lesage
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - François Harel
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Romeo
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Josephine Pressacco
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Abstract
Atherosclerosis and its thrombotic complications are the major cause of morbidity and mortality in the industrialized countries. Despite advances in our understanding of the pathophysiology, pathogenesis, and new treatment modalities, the absence of an adequate non-invasive imaging tool for early detection limits both the prevention and treatment of patients with various degrees and anatomical localizations of atherothrombotic disease. An ideal clinical imaging modality for atherosclerotic vascular disease should be safe, inexpensive, non-invasive or minimally invasive, accurate, and reproducible, and the results should correlate with the extent of atherosclerotic disease and have high predictive values for future clinical events. High-resolution magnetic resonance imaging (MRI) has emerged as the most promising technique for studying atherothrombotic disease in humans in vivo. Most importantly, MRI allows for the characterization of plaque composition, i.e. the discrimination of lipid core, fibrosis, calcification, and intraplaque haemorrhage deposits. Magnetic resonance imaging also allows for the detection of arterial thrombi and in defining thrombus age. Magnetic resonance imaging has been used to monitor plaque progression and regression in several animal models of atherosclerosis and in humans. Emerging MRI techniques capable of imaging biological processes, including inflammation, neovascularization, and mechanical forces, may aid in advancing our understanding of the atherothrombotic disease. Advances in diagnosis do prosper provided they march hand-in-hand with advances in treatment. We stand at the threshold of accurate non-invasive assessment of atherosclerosis. Thus, MRI opens new strategies ranging from screening of high-risk patients for early detection and treatment as well as monitoring of the target lesions for pharmacological intervention. Identification of subclinical atherosclerosis and early treatment initiation has the potential to surpass conventional risk factor assessment and management in terms of overall impact on cardiovascular morbidity and mortality. Such strategy is currently under clinical investigation.
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Affiliation(s)
- Roberto Corti
- Cardiology, Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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35
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Yoon YE, Chang SA, Choi SII, Chun EJ, Cho YS, Youn TJ, Chung WY, Chae IH, Choi DJ, Chang HJ. The absence of coronary artery calcification does not rule out the presence of significant coronary artery disease in Asian patients with acute chest pain. Int J Cardiovasc Imaging 2011; 28:389-98. [DOI: 10.1007/s10554-011-9819-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 01/24/2011] [Indexed: 01/17/2023]
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Ultrastructural changes in atherosclerotic plaques following the instillation of airborne particulate matter into the lungs of rabbits. Can J Cardiol 2010; 26:e258-69. [PMID: 20847974 DOI: 10.1016/s0828-282x(10)70422-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Epidemiological studies have established that cardiovascular events account for the greatest number of air pollution-related deaths. However, the underlying structural changes are still unknown. OBJECTIVE To investigate changes in the ultrastructure of atherosclerotic plaques in Watanabe heritable hyperlipidemic (WHHL) rabbits following the instillation of ambient particulate matter air pollution (particles smaller than 10 µm in diameter) into the lungs. METHODS WHHL rabbits (n=8) exposed to 5 mg of ambient particles (Environmental Health Centre - 1993 [EHC-93]; suspended in saline and instilled in the airway) twice per week for four weeks were compared with control WHHL rabbits (n=8) treated with saline alone. RESULTS All abdominal aortic plaques were examined using light and electron microscopy, which showed the following: increased accumulation of macrophage-derived foam cells immediately below the endothelial plaque surface (P=0.04); increased contact between these foam cells and the dense subendothelial extracellular matrix (P<0.005) with reduction (P<0.0001) and fragmentation (P<0.0001) of this matrix; and emigration of macrophage- derived foam cells from the plaques in exposed rabbits. In addition, immunohistochemistry verified the presence of type IV collagen in the thickened extracellular matrix material subtending the endothelium. CONCLUSIONS The ultrastructure of atherosclerotic plaques in EHC-93- instilled rabbits differed from the ultrastructure observed in rabbits that did not receive EHC-93. These ultrastructural differences are consistent with greater endothelial instability in the plaques of atherosclerosis-prone rabbits.
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Heitner JF, Bhumireddy GP, Cawley PJ, Klem I, Patel MR, Crowley AL, Weinsaft JW, Elliott M, Parker M, Brener S, Judd RM, Kim RJ. The aorta wall of patients presenting to the emergency department with acute myocardial infarction by cardiac magnetic resonance. Atherosclerosis 2010; 212:166-70. [PMID: 20579652 DOI: 10.1016/j.atherosclerosis.2010.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 04/27/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inflammation has been shown to be a major component in the pathophysiology of acute coronary syndrome (ACS). In patients presenting with acute myocardial infarction (AMI), a critical component of the ACS spectrum, multiple coronary arteries are involved during this inflammatory process. In addition to the coronary vasculature, the inflammatory cascade has also been shown to affect the carotid arteries and possibly the aorta. PURPOSE To assess the involvement of the aorta during AMI by cardiac magnetic resonance (CMR). METHODS We prospectively evaluated the aortic wall by CMR in 123 patients. 78 patients were enrolled from the emergency department (ED), who presented with chest pain and were classified as either: (1) AMI: elevated troponin levels and typical chest pain or (2) non-cardiac chest pain (CP): negative troponins and a normal stress test or normal cardiac catheterization. We compared these 2 groups to a group of 45 asymptomatic diabetic patients. The descending thoracic aortic wall area (AWA) and maximal aortic wall thickness (AWT) were measured using a double inversion recovery T-2 weighted, ECG-gated, spin echo sequence by CMR. RESULTS Patients with AMI were older, more likely to smoke, had a higher incidence of claudication, and had higher CRP levels. The AWA and maximal AWT were greater in patients who presented to the ED with ACS (2.11+/-0.17 mm(2), and 3.17+/-0.19 mm, respectively) than both patients presenting with non-cardiac CP (1.52+/-0.58 mm(2), p<0.001; and 2.57+/-0.10 mm, p<0.001) and the diabetic patients (1.38+/-0.58 mm(2), p<0.001; and 2.30+/-0.131 mm, p<0.001). The difference in the aortic wall characteristics remained significant after correcting for body mass index, hyperlipidemia, statins and C-reactive protein. There was no difference in maximal AWT or AWA between patients with non-cardiac CP and patients with diabetes. CONCLUSION Patients with AMI have a significantly greater maximal aortic wall thickness and area compared to patients with non-cardiac CP. Longitudinal studies are needed to assess whether this increase is due to inflammation or a higher atherosclerotic burden.
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Affiliation(s)
- John F Heitner
- Division of Cardiology, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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Foley CJ, Nichols L, Jeong K, Moore C, Ragni MV. Coronary atherosclerosis and cardiovascular mortality in hemophilia. J Thromb Haemost 2010; 8:208-11. [PMID: 19874455 PMCID: PMC2881951 DOI: 10.1111/j.1538-7836.2009.03669.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carolyn J. Foley
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA
- Hemophilia Center of Western Pennsylvania, Pittsburgh, PA
| | - Larry Nichols
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Kwonho Jeong
- Center for Healthcare Research, University of Pittsburgh, Pittsburgh, PA
| | - Charity Moore
- Center for Healthcare Research, University of Pittsburgh, Pittsburgh, PA
| | - Margaret V. Ragni
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA
- Hemophilia Center of Western Pennsylvania, Pittsburgh, PA
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de la Cuesta F, Alvarez-Llamas G, Gil-Dones F, Martin-Rojas T, Zubiri I, Pastor C, Barderas MG, Vivanco F. Tissue proteomics in atherosclerosis: elucidating the molecular mechanisms of cardiovascular diseases. Expert Rev Proteomics 2009; 6:395-409. [PMID: 19681675 DOI: 10.1586/epr.09.60] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerosis is a disease with higher levels of mortality in developed countries. Comprehension of the molecular mechanisms can yield very useful information in clinics for prevention, diagnosis and recovery monitoring. Proteomics represents an ideal methodology for this purpose, as proteins constitute the effectors of the different biological processes running during pathogenesis. To date, studies in atherosclerosis have been mainly focused on the search for plasma biomarkers. However, tissue proteomics allows going deeper into tissue secretomes, arterial layers or particular cells of interest, which, in turn, constitutes a more direct approximation to in vivo operating mechanisms. The aim of this review is to report latest advances in tissue proteomics in atherosclerosis and related diseases (e.g., aortic stenosis and ischemic injury).
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Affiliation(s)
- Fernando de la Cuesta
- Department of Immunology, Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain
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40
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Thrombin induces the expression of oncostatin M via AP-1 activation in human macrophages: a link between coagulation and inflammation. Blood 2009; 114:2812-8. [PMID: 19652200 DOI: 10.1182/blood-2009-01-200915] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Macrophages as inflammatory cells are involved in the pathogenesis of atherosclerosis that today is recognized as an inflammatory disease. Activation of coagulation leads to the late complication of atherosclerosis, namely atherothrombosis with its clinical manifestations stroke, unstable angina, myocardial infarction, and sudden cardiac death. Thus inflammation and coagulation play fundamental roles in the pathogenesis of atherosclerosis. We show that the coagulation enzyme thrombin up-regulates oncostatin M (OSM), a pleiotropic cytokine implicated in the pathophysiology of vascular disease, in human monocyte-derived macrophages (MDMs) up to 16.8-fold. A similar effect was seen in human peripheral blood monocytes and human plaque macrophages. In MDMs, the effect of thrombin on OSM was abolished by PPACK and mimicked by a PAR-1-specific peptide. Thrombin induced phosphorylation of ERK1/2 and p38 in MDMs. The ERK1/2 inhibitor PD98059 blocked the effect of thrombin on OSM production in MDMs, whereas the p38 inhibitor SB202190 had no effect. Thrombin induced translocation of c-fos and c-jun to the nucleus of MDMs. Using OSM promoter-luciferase reporter constructs transfected into MDMs, we show that a functional AP-1 site is required for promoter activation by thrombin. We present another link between coagulation and inflammation, which could impact on the pathogenesis of atherosclerosis.
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Riou LM, Broisat A, Dimastromatteo J, Pons G, Fagret D, Ghezzi C. Pre-clinical and clinical evaluation of nuclear tracers for the molecular imaging of vulnerable atherosclerosis: an overview. Curr Med Chem 2009; 16:1499-511. [PMID: 19355903 DOI: 10.2174/092986709787909596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Despite major advances in the treatment of CVD, a high proportion of CVD victims die suddenly while being apparently healthy, the great majority of these accidents being due to the rupture or erosion of a vulnerable coronary atherosclerotic plaque. A non-invasive imaging methodology allowing the early detection of vulnerable atherosclerotic plaques in selected individuals prior to the occurrence of any symptom would therefore be of great public health benefit. Nuclear imaging could allow the identification of vulnerable patients by non-invasive in vivo scintigraphic imaging following administration of a radiolabeled tracer. The purpose of this review is to provide an overview of radiotracers that have been recently evaluated for the detection of vulnerable plaques together with the biological rationale that initiated their development. Radiotracers targeted at the inflammatory process seem particularly relevant and promising. Recently, macrophage targeting allowed the experimental in vivo detection of atherosclerosis using either SPECT or PET. A few tracers have also been evaluated clinically. Targeting of apoptosis and macrophage metabolism both allowed the imaging of vulnerable plaques in carotid vessels of patients. However, nuclear imaging of vulnerable plaques at the level of coronary arteries remains challenging, mostly because of their small size and their vicinity with unbound circulating tracer. The experimental and pilot clinical studies reviewed in the present paper represent a fundamental step prior to the evaluation of the efficacy of any selected tracer for the early, non-invasive detection of vulnerable patients.
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Affiliation(s)
- L M Riou
- INSERM, U877, Radiopharmaceutiques Biocliniques, Faculté de Médecine de Grenoble, F-38700, La tronche, France.
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Low A, Kawase Y, Chan YH, Tearney G, Bouma B, Jang IK. In vivo characterisation of coronary plaques with conventional grey-scale intravascular ultrasound: correlation with optical coherence tomography. EUROINTERVENTION 2009; 4:626-32. [DOI: 10.4244/eijv4i5a105] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Roes SD, Westenberg JJM, Doornbos J, van der Geest RJ, Angelié E, de Roos A, Stuber M. Aortic vessel wall magnetic resonance imaging at 3.0 Tesla: a reproducibility study of respiratory navigator gated free-breathing 3D black blood magnetic resonance imaging. Magn Reson Med 2009; 61:35-44. [PMID: 19097222 DOI: 10.1002/mrm.21798] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to evaluate a free-breathing three-dimensional (3D) dual inversion-recovery (DIR) segmented k-space gradient-echo (turbo field echo [TFE]) imaging sequence at 3T for the quantification of aortic vessel wall dimensions. The effect of respiratory motion suppression on image quality was tested. Furthermore, the reproducibility of the aortic vessel wall measurements was investigated. Seven healthy subjects underwent 3D DIR TFE imaging of the aortic vessel wall with and without respiratory navigator. Subsequently, this sequence with respiratory navigator was performed twice in 10 healthy subjects to test its reproducibility. The signal-to-noise (SNR), contrast-to-noise ratio (CNR), vessel wall sharpness, and vessel wall volume (VWV) were assessed. Data were compared using the paired t-test, and the reproducibility of VWV measurements was evaluated using intraclass correlation coefficients (ICCs). SNR, CNR, and vessel wall sharpness were superior in scans performed with respiratory navigator compared to scans performed without. The ICCs concerning intraobserver, interobserver, and interscan reproducibility were excellent (0.99, 0.94, and 0.95, respectively). In conclusion, respiratory motion suppression substantially improves image quality of 3D DIR TFE imaging of the aortic vessel wall at 3T. Furthermore, this optimized technique with respiratory motion suppression enables assessment of aortic vessel wall dimensions with high reproducibility.
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Affiliation(s)
- Stijntje D Roes
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Coronary artery disease with acute coronary syndromes (ACS) is the leading cause of death worldwide in both men and women. ACS mostly occur as a result of rupture of "vulnerable plaque" with a superimposed thrombus formation, which ultimately leads to distal cessation of blood flow. Vulnerable plaque mostly occurs in mildly obstructive coronary lesions rather than severely stenosed (< 50%) lesions. Support for this conclusion comes from studies of patients with ACS who had a recent prior coronary angiogram; the artery involved in the subsequent ACS was usually only moderately diseased. Whether early treatment of these mildly obstructive lesions with percutaneous coronary interventions may lead to prevention of this deadly malady remains unknown. The long-term efficacy of percutaneous coronary intervention for mildly obstructive coronary narrowing is limited by the occurrence of restenosis, which limits the applicability of this therapy for these lesions. However, use of drug-eluting stents has significantly reduced the incidence of in-stent restenosis, yielding much better long-term outcomes. This article reviews the available data for possible early treatment of mildly obstructive coronary lesions with drug-eluting stents for prevention of ACS.
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Kim T, Ley O. Numerical analysis of the cooling effect of blood over inflamed atherosclerotic plaque. J Biomech Eng 2008; 130:031013. [PMID: 18532862 DOI: 10.1115/1.2913236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerotic plaques with high likelihood of rupture often show local temperature increase with respect to the surrounding arterial wall temperature. In this work, atherosclerotic plaque temperature was numerically determined during the different levels of blood flow reduction produced by the introduction of catheters at the vessel lumen. The temperature was calculated by solving the energy equation and the Navier-Stokes equations in 2D idealized arterial models. Arterial wall temperature depends on three basic factors: metabolic activity of the inflammatory cells embedded in the plaque, heat convection due to luminal blood flow, and heat conduction through the arterial wall and plaque. The calculations performed serve to simulate transient blood flow reduction produced by the presence of thermography catheters used to measure arterial wall temperature. The calculations estimate the spatial and temporal alterations in the cooling effect of blood flow and plaque temperature during the measurement process. The mathematical model developed provides a tool for analyzing the contribution of factors known to affect heat transfer at the plaque surface. Blood flow reduction leads to a nonuniform temperature increase ranging from 0.1 to 0.25 degrees Celsius in the plaque/lumen interface of the arterial geometries considered in this study. The temperature variation as well as the Nusselt number calculated along the plaque surface strongly depended on the arterial geometry and distribution of inflammatory cells. The calculations indicate that the minimum required time to obtain a steady temperature profile after arterial occlusion is 6 s. It was seen that in arteries with geometries involving bends, the temperature profiles appear asymmetrical and lean toward the downstream edge of the plaque.
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Affiliation(s)
- Taehong Kim
- Department of Mechanical Engineering, Texas A&M University, MS 3123, College Station, TX 77843-3123, USA.
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Measuring Noncalcified Coronary Atherosclerotic Plaque Using Voxel Analysis with MDCT Angiography: A Pilot Clinical Study. AJR Am J Roentgenol 2008; 190:1553-60. [DOI: 10.2214/ajr.07.2988] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nakayama M, Kudoh T, Kaikita K, Yoshimura M, Oshima S, Miyamoto Y, Takeya M, Ogawa H. Class A macrophage scavenger receptor gene expression levels in peripheral blood mononuclear cells specifically increase in patients with acute coronary syndrome. Atherosclerosis 2008; 198:426-33. [DOI: 10.1016/j.atherosclerosis.2007.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 08/28/2007] [Accepted: 09/06/2007] [Indexed: 11/29/2022]
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Suzuki H, Kusuyama T, Sato R, Yokota Y, Tsunoda F, Sato T, Shoji M, Iso Y, Koba S, Katagiri T. Elevation of matrix metalloproteinases and interleukin-6 in the culprit coronary artery of myocardial infarction. Eur J Clin Invest 2008; 38:166-73. [PMID: 18257779 DOI: 10.1111/j.1365-2362.2007.01919.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Interleukin-6 (IL-6) and metalloproteinases (MMPs) are involved in the instability of vulnerable plaque associated with the induction of acute myocardial infarction (AMI). We examined the regional changes of cytokines, MMPs and adhesion molecules in patients with AMI to elucidate how these factors are involved in the onset of AMI. MATERIALS AND METHODS One hundred and twenty-two patients with AMI were included. Blood was aspirated from the culprit coronary artery with a thrombectomy catheter, and was also sampled from peripheral veins during the coronary intervention. Control samples were obtained from the peripheral blood of age-matched patients. RESULTS The serum levels of IL-6 (P < 0.05), tumour necrosis factor-alpha (P < 0.005), MMP-1 (P < 0.001), MMP-13 (P < 0.001), soluble intercellular adhesion molecule-1 (P < 0.005), and soluble vascular cellular adhesion molecule-1 (P < 0.05) in peripheral blood were significantly higher in the AMI group than in the controls. Aspirated serum contained significantly higher levels of IL-6 (P < 0.001), MMP-1 (P < 0.001), and MMP-13 (P < 0.05) compared to the peripheral blood of AMI. Serum IL-6 levels were significantly higher in the aspirated than in the peripheral blood in the patients hospitalized within 6 h and 6-12 h, but were similar in the aspirated and peripheral blood of the patients hospitalized 12-24 h after the onset of AMI. There were no differences between the aspirated serum and peripheral blood in the levels of interleukin-1beta and MMP-2. CONCLUSIONS The levels of MMP-1, MMP-13 and IL-6 were higher in the culprit coronary artery than in the peripheral blood. These factors appear to be involved in the early stage of AMI.
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Affiliation(s)
- H Suzuki
- Third Department of Internal Medicine, Showa University School of Medicine, Hatanodai, Shinagawa-ku, Tokyo, Japan.
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Contemporary Approach to the Diagnosis and Management of Non–ST-Segment Elevation Acute Coronary Syndromes. Prog Cardiovasc Dis 2008; 50:311-51. [DOI: 10.1016/j.pcad.2007.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Díaz-Lobato S, Alises SM, Rodríguez EP. Current status of noninvasive ventilation in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2008; 1:129-35. [PMID: 18046890 PMCID: PMC2706610 DOI: 10.2147/copd.2006.1.2.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Noninvasive ventilation (NIV) has been one of the major advances in respiratory medicine in the last decade. NIV improves quality of life, prolongs survival, and improves gas exchange and sleep quality in restrictive patients, but evidence available now does not allow us to establish clear criteria for prescribing NIV in patients with chronic respiratory failure due to COPD. On the basis of the available studies, NIV should not be used as a treatment of choice for all patients with COPD, even when disease is severe. However, there is more evidence that NIV has an important effect in these patients. In fact, a selected group of patients may well benefit from domiciliary mechanical ventilation, and we need to be able to identify who they are. Moreover, NIV can be a new strategy to improve exercise tolerance in COPD patients.
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