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van den Hoogen IJ, van Rosendael AR, Lin FY, Gianni U, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Hyun Choi J, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic J, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Virmani R, Samady H, Stone PH, Narula J, Chang HJ, Min JK, Shaw LJ, Bax JJ. Measurement of compensatory arterial remodelling over time with serial coronary computed tomography angiography and 3D metrics. Eur Heart J Cardiovasc Imaging 2021; 23:1336-1344. [PMID: 34468717 DOI: 10.1093/ehjci/jeab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The magnitude of alterations in which coronary arteries remodel and narrow over time is not well understood. We aimed to examine changes in coronary arterial remodelling and luminal narrowing by three-dimensional (3D) metrics from serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicentre registry of patients with suspected coronary artery disease who underwent clinically indicated serial CCTA (median interscan interval = 3.3 years), we quantitatively measured coronary plaque, vessel, and lumen volumes on both scans. Primary outcome was the per-segment change in coronary vessel and lumen volume from a change in plaque volume, focusing on arterial remodelling. Multivariate generalized estimating equations including statins were calculated comparing associations between groups of baseline percent atheroma volume (PAV) and location within the coronary artery tree. From 1245 patients (mean age 61 ± 9 years, 39% women), a total of 5721 segments were analysed. For each 1.00 mm3 increase in plaque volume, the vessel volume increased by 0.71 mm3 [95% confidence interval (CI) 0.63 to 0.79 mm3, P < 0.001] with a corresponding reduction in lumen volume by 0.29 mm3 (95% CI -0.37 to -0.21 mm3, P < 0.001). Serial 3D arterial remodelling and luminal narrowing was similar in segments with low and high baseline PAV (P ≥ 0.496). No differences were observed between left main and non-left main segments, proximal and distal segments and side branch and non-side branch segments (P ≥ 0.281). CONCLUSIONS Over time, atherosclerotic coronary plaque reveals prominent outward arterial remodelling that co-occurs with modest luminal narrowing. These findings provide additional insight into the compensatory mechanisms involved in the progression of coronary atherosclerosis.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Ontact Health, Inc, Seoul, South Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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2
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van Rosendael AR, Lin FY, Ma X, van den Hoogen IJ, Gianni U, Al Hussein O, Al'Aref SJ, Peña JM, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Raff GL, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Virmani R, Samady H, Stone PH, Narula J, Bax JJ, Shaw LJ, Min JK, Chang HJ. Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study. J Cardiovasc Comput Tomogr 2020; 14:400-406. [PMID: 32063545 DOI: 10.1016/j.jcct.2020.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/05/2019] [Accepted: 01/29/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. METHODS The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. RESULTS The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex. CONCLUSIONS PAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Inge J van den Hoogen
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Umberto Gianni
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Omar Al Hussein
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Subhi J Al'Aref
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jessica M Peña
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Leslee J Shaw
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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3
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Xie Z, Dong N, Sun R, Liu X, Gu X, Sun Y, Du H, Dai J, Liu Y, Hou J, Tian J, Yu B. Relation between baseline plaque features and subsequent coronary artery remodeling determined by optical coherence tomography and intravascular ultrasound. Oncotarget 2017; 8:4234-4244. [PMID: 27992371 PMCID: PMC5354827 DOI: 10.18632/oncotarget.13959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Atherosclerosis often leads to myocardial infarction and stroke. We examined the influence of baseline plaque characteristics on subsequent vascular remodeling in response to changes in plaque size. Using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), we examined 213 plaques from 138 patients with acute coronary syndrome at baseline and repeated IVUS at the 12-month follow-up. The change in external elastic membrane (EEM) area for each 1 mm2 change in plaque area (i.e., the slope of the regression line) was calculated as a measure of vascular remodeling capacity. In plaques with static positive remodeling, the slope was smaller than in plaques without static positive remodeling. In addition, the slope of the regression line for lesions with a large plaque burden was much smaller than that for lesions with a small plaque burden. Multivariate linear regression analysis showed that diabetes, calcification and static positive remodeling were inversely and independently associated with the level of change in EEM area/change in plaque area. Lesions with a large plaque burden, calcifications or static positive remodeling had less remodeling capacity, and calcification and static positive remodeling were independent predictors of reduced subsequent remodeling. Therefore, calcifications and static positive remodeling could be used as morphological biomarkers to predict decreased subsequent arterial remodeling.
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Affiliation(s)
- Zulong Xie
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nana Dong
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Rong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xinxin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xia Gu
- Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, China
| | - Yong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Hongwei Du
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Youbin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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4
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Bi Y, Zhong H, Xu K, Qi X. Combination of Periaortic Elastase Incubation and Cholesterol-Rich Diet: A Novel Model of Atherosclerosis in Rabbit Abdominal Aorta. Cell Biochem Biophys 2013; 68:611-4. [DOI: 10.1007/s12013-013-9753-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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5
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Comparison of the vulnerability risk for positive versus negative atheroma plaque morphology. J Biomech 2013; 46:1248-54. [DOI: 10.1016/j.jbiomech.2013.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 01/11/2013] [Accepted: 02/24/2013] [Indexed: 11/24/2022]
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6
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A novel model of atherosclerosis in rabbits using injury to arterial walls induced by ferric chloride as evaluated by optical coherence tomography as well as intravascular ultrasound and histology. J Biomed Biotechnol 2012; 2012:121867. [PMID: 22665979 PMCID: PMC3361737 DOI: 10.1155/2012/121867] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/06/2012] [Accepted: 03/10/2012] [Indexed: 11/17/2022] Open
Abstract
This study aim was to develop a new model of atherosclerosis by FeCl3-induced injury to right common carotid arteries (CCAs) of rabbits. Right CCAs were induced in male New Zealand White rabbits (n = 15) by combination of a cholesterol-rich diet and FeCl3-induced injury to arterial walls. The right and left CCAs were evaluated by histology and in vivo intravascular ultrasound (IVUS) and optical coherence tomography (OCT) examinations of 24 hours (n = 3), 8 weeks (n = 6), and 12 weeks (n = 6) after injury. Each right CCA of the rabbits showed extensive white-yellow plaques. At eight and 12 weeks after injury, IVUS, OCT, and histological findings demonstrated that the right CCAs had evident eccentric plaques. Six plaques (50%) with evident positive remodeling were observed. Marked progression was clearly observed in the same plaque at 12 weeks after injury when it underwent repeat OCT and IVUS. We demonstrated, for the first time, a novel model of atherosclerosis induced by FeCl3. The model is simple, fast, inexpensive, and reproducible and has a high success rate. The eccentric plaques and remodeling of plaques were common in this model. We successfully carried out IVUS and OCT examinations twice in the same lesion within a relatively long period of time.
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7
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Papadopoulou SL, Neefjes LA, Garcia-Garcia HM, Flu WJ, Rossi A, Dharampal AS, Kitslaar PH, Mollet NR, Veldhof S, Nieman K, Stone GW, Serruys PW, Krestin GP, de Feyter PJ. Natural History of Coronary Atherosclerosis by Multislice Computed Tomography. JACC Cardiovasc Imaging 2012; 5:S28-37. [DOI: 10.1016/j.jcmg.2012.01.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/25/2022]
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8
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von Birgelen C, Hartmann M. Beyond the lumen border: on the use of intravascular ultrasound in the left main coronary artery. EUROINTERVENTION 2011; 7:300-2. [PMID: 21729830 DOI: 10.4244/eijv7i3a52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Hartmann M, Huisman J, Bose D, Jensen LO, Schoenhagen P, Mintz GS, Erbel R, von Birgelen C. Serial intravascular ultrasound assessment of changes in coronary atherosclerotic plaque dimensions and composition: an update. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:313-21. [DOI: 10.1093/ejechocard/jer017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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10
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Khuddus MA, Pepine CJ, Handberg EM, Bairey Merz CN, Sopko G, Bavry AA, Denardo SJ, McGorray SP, Smith KM, Sharaf BL, Nicholls SJ, Nissen SE, Anderson RD. An intravascular ultrasound analysis in women experiencing chest pain in the absence of obstructive coronary artery disease: a substudy from the National Heart, Lung and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation (WISE). J Interv Cardiol 2010; 23:511-9. [PMID: 21029178 PMCID: PMC3019081 DOI: 10.1111/j.1540-8183.2010.00598.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Using intravascular ultrasound (IVUS), we sought to characterize coronary morphology in women with chest pain without major epicardial obstructive coronary artery disease (CAD). We have previously observed an unexpectedly high rate of adverse outcomes among women with chest pain and normal or insignificant obstructive CAD. Information about the presence and characteristics of coronary atherosclerosis in these women could provide insight into the mechanisms related to increased risk, as well as improved diagnosis, prevention, and treatment. METHODS Women (n = 100) with suspected ischemia without obstructive CAD (>50% stenosis) underwent IVUS of a left coronary segment with measurements by a core lab masked to clinical and angiographic findings. RESULTS Angiograhic core lab analysis found 69.6% of patients had no (≤20%) and 30.4% had minimal (20-<50%) CAD. IVUS segmental images were interpretable by the core lab in 92 women, with 19 (21%) having no atherosclerosis (intimal-medial thickness <0.5 mm). In the remaining 73 women (79%), percent atheroma volume was 27 ± 8% and mean maximum plaque thickness was 0.53 ± 0.22 mm. Thirty-eight women with atherosclerosis (53%) had ≥30% of interrogated vessel involved. The average vessel involvement was 40%, and the maximum plaque thickness was 1.27 mm. The number of risk factors strongly correlated with percent atheroma volume (r = 0.53, P < 0.0001) and percent vessel involvement (r = 0.51, P < 0.0001), with the strongest independent predictor of both being age. Remodeling was assessed in 59/73 women (81%), and 73% had evidence of positive remodeling. CONCLUSIONS In symptomatic women without significant luminal obstructive CAD, we observed a high prevalence of atherosclerosis with positive remodeling and preserved lumen size. These findings may help explain increased risk and emphasize need for improved diagnostic and treatment options for women with concealed CAD.
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Affiliation(s)
- Matheen A Khuddus
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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11
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Wellnhofer E, Stypmann J, Bara CL, Stadlbauer T, Heidt MC, Kreider-Stempfle HU, Sohn HY, Zeh W, Comberg T, Eckert S, Dengler T, Ensminger SM, Hiemann NE. Angiographic assessment of cardiac allograft vasculopathy: results of a Consensus Conference of the Task Force for Thoracic Organ Transplantation of the German Cardiac Society. Transpl Int 2010; 23:1094-104. [DOI: 10.1111/j.1432-2277.2010.01096.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Thompson JB, Blaha M, Resar JR, Blumenthal RS, Desai MY. Strategies to reverse atherosclerosis: an imaging perspective. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 10:283-93. [PMID: 18647584 DOI: 10.1007/s11936-008-0049-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several treatment strategies, including lowering low-density lipoprotein cholesterol with intensive statin therapy, reducing triglycerides with fibrates, and raising high-density lipoprotein cholesterol with nicotinic acid, have the potential to induce atherosclerosis regression. Atherosclerosis imaging techniques including intravascular ultrasound, carotid ultrasound to measure carotid intima-media thickness, and cardiovascular MRI are established modalities for describing longitudinal changes in the quantity and quality of atherosclerotic plaque. An increasing number of clinical trials are using radiologic measures of subclinical atherosclerosis as surrogate end points in lieu of the traditional "hard" end points of myocardial infarction and death. This approach has great appeal, as improvements in atherosclerosis imaging now enable the characterization of early atheromas and positive remodeling within the vessel wall before the plaque becomes obstructive. Additional prospective data correlating these surrogate end points with hard outcomes are needed to determine whether atherosclerosis regression will be the major determinant of future treatment strategies.
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Affiliation(s)
- Jason B Thompson
- Division of Cardiology, The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA.
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13
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Hirohata A, Yamamoto K, Miyoshi T, Hatanaka K, Hirohata S, Yamawaki H, Komatsubara I, Murakami M, Hirose E, Sato S, Ohkawa K, Ishizawa M, Yamaji H, Kawamura H, Kusachi S, Murakami T, Hina K, Ohe T. Impact of olmesartan on progression of coronary atherosclerosis a serial volumetric intravascular ultrasound analysis from the OLIVUS (impact of OLmesarten on progression of coronary atherosclerosis: evaluation by intravascular ultrasound) trial. J Am Coll Cardiol 2010; 55:976-82. [PMID: 20202514 DOI: 10.1016/j.jacc.2009.09.062] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 08/10/2009] [Accepted: 09/14/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of olmesartan on progression of coronary atherosclerosis. BACKGROUND Prior intravascular ultrasound (IVUS) trial results suggest slowing of coronary atheroma progression with some medicines but have not shown convincing evidence of regression with angiotension-II receptor blocking agents. METHODS A prospective, randomized, multicenter trial-OLIVUS (Impact of OLmesartan on progression of coronary atherosclerosis: evaluation by IntraVascular UltraSound)-was performed in 247 stable angina pectoris patients with native coronary artery disease. When these patients underwent percutaneous coronary intervention for culprit lesions, IVUS was performed in their nonculprit vessels (without angiographically documented coronary stenosis [<50%]). Patients were randomly assigned to receive 10 to 40 mg of olmesartan or control and treated with a combination of beta-blockers, calcium channel blockers, diuretics, nitrates, glycemic control agents, and/or statins per physician's guidance. Serial IVUS examinations (baseline and 14-month follow-up) were performed to assess coronary atheroma volume. Volumetric IVUS analyses included lumen, plaque, vessel volume, percent atheroma volume (PAV), percent change in total atheroma volume (TAV) and PAV. RESULTS Patient characteristics and blood pressure control were identical between the 2 groups. However, follow-up IVUS showed significantly decreased TAV and percent change in PAV in the olmesartan group (5.4% vs. 0.6 % for TAV and 3.1% vs. -0.7% for percent change in PAV, control vs. olmesartan, p < 0.05 for all). CONCLUSIONS These observations suggest a positive role in a potentially lower rate of coronary atheroma progression through the administration of olmesartan, an angiotension-II receptor blocking agent, for patients with stable angina pectoris.
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Mintz GS, Maehara A. Serial Intravascular Ultrasound Assessment of Atherosclerosis Progression and Regression State-of-the-Art and Limitations. Circ J 2009; 73:1557-60. [DOI: 10.1253/circj.cj-09-0475] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sabeti S, Schlager O, Exner M, Mlekusch W, Amighi J, Dick P, Maurer G, Huber K, Koppensteiner R, Wagner O, Minar E, Schillinger M. Progression of Carotid Stenosis Detected by Duplex Ultrasonography Predicts Adverse Outcomes in Cardiovascular High-Risk Patients. Stroke 2007; 38:2887-94. [PMID: 17885257 DOI: 10.1161/strokeaha.107.488387] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The progression of carotid stenosis reflects the activity of atherosclerotic disease and may indicate a risk for systemic atherothrombotic complications. We investigated whether progressive carotid stenosis determined by duplex ultrasonography predicts adverse outcomes in cardiovascular high-risk patients. METHODS We prospectively studied 1065 of 1268 consecutive patients initially asymptomatic with respect to carotid disease. Carotid ultrasound investigations at baseline and after a median of 7.5 months (range, 6 to 9 months) were performed to identify patients with progressive stenosis as defined by Doppler velocity criteria. Patients were then followed up clinically for a median of 3.2 years for the occurrence of major adverse cardiovascular events (composite MACEs: myocardial infarction, percutaneous coronary or peripheral interventions, coronary or vascular surgery, amputation, stroke, and all-cause mortality). RESULTS We found progressive carotid stenosis in 93 patients (9%) by ultrasound and thereafter recorded 495 MACEs in 421 patients (40%) during clinical follow-up. Patients with progressive carotid stenosis had a significantly increased risk for cardiovascular events compared with patients with nonprogressive disease: adjusted hazard ratios and confidence intervals were 2.01 for composite MACEs (95% CI, 1.48 to 2.67, P<0.001), 2.38 for myocardial infarction (95% CI, 1.07 to 5.35, P=0.044), 1.59 for any coronary event (95% CI, 1.10 to 2.28, P=0.011), 2.00 for stroke (95% CI, 1.02 to 4.11, P=0.035), 2.42 for any peripheral vascular event (95% CI, 1.61 to 3.62, P<0.001), and 1.75 for cardiovascular death (95% CI, 1.03 to 2.97, P=0.039). CONCLUSIONS Progression of carotid stenosis within a 6- to 9-month interval detected by duplex ultrasound predicts midterm clinical adverse events of atherosclerosis in high-risk patients affecting the coronary, cerebrovascular, and peripheral circulations.
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Affiliation(s)
- Schila Sabeti
- Department of Angiology, Medical University Vienna, Vienna, Austria
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Rodriguez-Granillo GA, de Winter S, Bruining N, Ligthart JMR, García-García HM, Valgimigli M, de Feyter PJ. Effect of perindopril on coronary remodelling: insights from a multicentre, randomized study. Eur Heart J 2007; 28:2326-31. [PMID: 17766284 DOI: 10.1093/eurheartj/ehm255] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study sought to evaluate the effect of perindopril in coronary remodelling. METHODS AND RESULTS In this sub-study of a double-blind, multicentre trial, patients without clinical evidence of heart failure were randomized to perindopril 8 mg/day or placebo for at least 3 years and IVUS investigation was performed at both time-points. Positive and negative remodelling were defined as a relative increase (positive remodelling) or decrease (negative remodelling) of the mean vessel cross-sectional area (CSA)>2 SD of the mean intra-observer difference. A total of 118 matched evaluable IVUS (711 matched 5 mm segments) were available at follow-up. After a median follow-up of 3.0 (inter-quartile range 1.9, 4.1) years, there was no significant difference in the change of plaque CSA between perindopril (360 segments) and placebo (351 segments) groups, P=0.27. Conversely, the change in vessel CSA was significantly different between groups (perindopril -0.18+/-2.4 mm2 vs. placebo 0.19+/-2.4, P = 0.04). Negative remodelling occurred more frequently in the perindopril than in the placebo group (34 vs. 25%, P=0.01). In addition, the placebo group showed a larger, although not significant, mean remodelling index (RI) than the perindopril group (1.03+/-0.2 vs. 1.00+/-0.2, P=0.06). The temporal change in vessel dimensions assessed by the RI was significantly correlated with the change in plaque dimensions (r=0.48, P<0.0001). CONCLUSION In this sub-analysis of a multicentre, controlled study, long-term administration of perindopril was associated with a constrictive remodelling pattern without affecting the lumen.
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Suganuma E, Babaev VR, Motojima M, Zuo Y, Ayabe N, Fogo AB, Ichikawa I, Linton MF, Fazio S, Kon V. Angiotensin Inhibition Decreases Progression of Advanced Atherosclerosis and Stabilizes Established Atherosclerotic Plaques. J Am Soc Nephrol 2007; 18:2311-9. [PMID: 17634441 DOI: 10.1681/asn.2006090967] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although increased extracellular matrix (ECM) is pathogenic in a variety of chronic tissue injuries, reduced and/or disrupted ECM may be detrimental in atherosclerosis and rather destabilize existing atherosclerotic lesions. This study therefore assessed the effects of angiotensin II (AngII) antagonism on ECM components of advanced atherosclerosis. Twenty-four-week-old apolipoprotein E-deficient mice were treated with the AngII antagonist losartan for 12 wk. Controls received water or hydralazine. AngII antagonism significantly reduced progression of established atherosclerosis, whereas hydralazine showed no benefit despite similar decrease in BP. Although there was no difference in the macrophage component, AngII antagonism increased the relative collagen portion of the lesions; lessened elastin fragmentation, increased the total elastin content of the aorta; and reduced the mRNA and activity/protein of the elastolytic proteases, cathepsin S, and metalloproteinase-9. Extracellular elastin degradation by cultured smooth muscle cells (SMC) was reduced by losartan, as was SMC invasion through an elastin gel barrier. Thus, AngII antagonism lessens progression of atherosclerosis, increases collagen, and preserves elastin components of ECM within the vascular lesions, which, at least in part, is modulated by effects on SMC. These effects not only decrease further expansion of advanced lesions but also stabilize the established atherosclerotic plaques and may underlie the decreased incidence of acute cardiovascular events that are observed in patients in whom AngII antagonism is begun after atherosclerosis is already established.
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Affiliation(s)
- Eisuke Suganuma
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232-2584, USA
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Brown BG, Zhao XQ. Is intravascular ultrasound the gold standard surrogate for clinically relevant atherosclerosis progression? J Am Coll Cardiol 2007; 49:933-8. [PMID: 17336715 DOI: 10.1016/j.jacc.2006.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 08/26/2006] [Indexed: 11/24/2022]
Abstract
Are progressive changes in intravascular ultrasound (IVUS)-derived indexes of plaque size sufficiently predictive of in-trial or future cardiovascular event risk that IVUS can serve as an efficient surrogate for clinical events in coronary disease trials? This question remains unanswered by clinical trials reported to date. Indeed, the answer may well be "yes." Nevertheless, there are enough concerns about the physical limitations, the fundamental assumptions, and the interpretation of the IVUS measurements that the answer cannot be taken for granted. Here, we review the evidence to date, discuss some of the concerns, and compare IVUS results with those of quantitative arteriography.
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Affiliation(s)
- B Greg Brown
- Cardiology Division, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195-8855, USA.
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Abstract
Coronary events often result from thrombi that form because of physical disruption of the atherosclerotic plaque. The dynamic nature of the plaque offers the opportunity to intervene to modify plaque biology with lifestyle changes and, if needed, pharmacologic measures. Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (statins) reduce levels of serum cholesterol and decrease the incidence of coronary events, but some of the benefits of statins may not depend on their effects on circulating lipids. Indeed, increasing evidence suggests that statins may also enhance plaque stability. Such evidence includes results of preclinical studies with experimental atherosclerosis as well as imaging data and analyses of proinflammatory and prothrombotic mediators in clinical trials. Currently, however, no studies have demonstrated conclusively the mechanisms underlying the unexpected magnitude and rapidity of statin benefits. This article reviews the evolution of the concept of plaque stabilization and reexamines the evidence for the role of statins in that process.
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Affiliation(s)
- Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02135, USA.
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Klein LW. Atherosclerosis regression, vascular remodeling, and plaque stabilization. J Am Coll Cardiol 2006; 49:271-3. [PMID: 17222741 DOI: 10.1016/j.jacc.2006.10.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 10/16/2006] [Accepted: 10/17/2006] [Indexed: 11/29/2022]
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