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Bacigalupi E, Pizzicannella J, Rigatelli G, Scorpiglione L, Foglietta M, Rende G, Mantini C, Fiore FM, Pelliccia F, Zimarino M. Biomechanical factors and atherosclerosis localization: insights and clinical applications. Front Cardiovasc Med 2024; 11:1392702. [PMID: 39119184 PMCID: PMC11306036 DOI: 10.3389/fcvm.2024.1392702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Although the entire vascular bed is constantly exposed to the same risk factors, atherosclerosis manifests a distinct intra-individual pattern in localization and progression within the arterial vascular bed. Despite shared risk factors, the development of atherosclerotic plaques is influenced by physical principles, anatomic variations, metabolic functions, and genetic pathways. Biomechanical factors, particularly wall shear stress (WSS), play a crucial role in atherosclerosis and both low and high WSS are associated with plaque progression and heightened vulnerability. Low and oscillatory WSS contribute to plaque growth and arterial remodeling, while high WSS promotes vulnerable changes in obstructive coronary plaques. Axial plaque stress and plaque structural stress are proposed as biomechanical indicators of plaque vulnerability, representing hemodynamic stress on stenotic lesions and localized stress within growing plaques, respectively. Advancements in imaging and computational fluid dynamics techniques enable a comprehensive analysis of morphological and hemodynamic properties of atherosclerotic lesions and their role in plaque localization, evolution, and vulnerability. Understanding the impact of mechanical forces on blood vessels holds the potential for developing shear-regulated drugs, improving diagnostics, and informing clinical decision-making in coronary atherosclerosis management. Additionally, Computation Fluid Dynamic (CFD) finds clinical applications in comprehending stent-vessel dynamics, complexities of coronary bifurcations, and guiding assessments of coronary lesion severity. This review underscores the clinical significance of an integrated approach, concentrating on systemic, hemodynamic, and biomechanical factors in atherosclerosis and plaque vulnerability among patients with coronary artery disease.
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Affiliation(s)
- Elena Bacigalupi
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Engineering and Geology, University “G. d’ Annunzio” Chieti-Pescara, Pescara, Italy
| | | | - Luca Scorpiglione
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Cardiology Department, SS. Annunziata Hospital, Chieti, Italy
| | - Greta Rende
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Franco M. Fiore
- Division of Vascular Surgery, SS. Annunziata Hospital, Chieti, Italy
| | | | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Cardiology Department, SS. Annunziata Hospital, Chieti, Italy
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Ashrafee A, Yashfe SMS, Khan NS, Islam MT, Azam MG, Arafat MT. Design of experiment approach to identify the dominant geometrical feature of left coronary artery influencing atherosclerosis. Biomed Phys Eng Express 2024; 10:035008. [PMID: 38430572 DOI: 10.1088/2057-1976/ad2f59] [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: 09/06/2023] [Accepted: 03/01/2024] [Indexed: 03/04/2024]
Abstract
Background and Objective. Coronary artery geometry heavily influences local hemodynamics, potentially leading to atherosclerosis. Consequently, the unique geometrical configuration of an individual by birth can be associated with future risk of atherosclerosis. Although current researches focus on exploring the relationship between local hemodynamics and coronary artery geometry, this study aims to identify the order of influence of the geometrical features through systematic experiments, which can reveal the dominant geometrical feature for future risk assessment.Methods. According to Taguchi's method of design of experiment (DoE), the left main stem (LMS) length (lLMS), curvature (kLMS), diameter (dLMS) and the bifurcation angle between left anterior descending (LAD) and left circumflex (LCx) artery (αLAD-LCx) of two reconstructed patient-specific left coronary arteries (LCA) were varied in three levels to create L9 orthogonal array. Computational fluid dynamic (CFD) simulations with physiological boundary conditions were performed on the resulting eighteen LCA models. Average helicity intensity (h2) and relative atheroprone area (RAA) of near-wall hemodynamic descriptors were analyzed.Results. The proximal LAD (LADproximal) was identified to be the most atheroprone region of the left coronary artery due to higherh2,large RAA of time averaged wall shear stress (TAWSS < 0.4 Pa), oscillatory shear index (OSI ∼ 0.5) and relative residence time (RRT > 4.17 Pa-1). In both patient-specific cases, based onh2and TAWSS,dlmsis the dominant geometric parameter while based on OSI and RRT,αLAD-LCxis the dominant one influencing hemodynamic condition in proximal LAD (p< 0.05). Based on RRT, the rank of the geometrical factors is:αLAD-LCx>dLMS>lLMS>kLMS, indicating thatαLAD-LCxis the most dominant geometrical factor affecting hemodynamics at proximal LAD which may influence atherosclerosis.Conclusion. The proposed identification of the rank of geometrical features of LCA and the dominant feature may assist clinicians in predicting the possibility of atherosclerosis, of an individual, long before it will occur. This study can further be translated to be used to rank the influence of several arterial geometrical features at different arterial locations to explore detailed relationships between the arterial geometrical features and local hemodynamics.
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Affiliation(s)
- Adiba Ashrafee
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Syed Muiz Sadat Yashfe
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Nusrat S Khan
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
| | - Md Tariqul Islam
- Department of Radiology and Imaging, Sheikh Hasina National Institute of Burn & Plastic Surgery, Dhaka - 1205, Bangladesh
| | - M G Azam
- Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka - 1207, Bangladesh
| | - M Tarik Arafat
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
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3
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Peng T, Zhong Y, Lin X, Jiang B, Wang P, Jia Y. Analysis and numerical investigation of bile flow dynamics within the strictured biliary duct. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3790. [PMID: 37997039 DOI: 10.1002/cnm.3790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
The mechanics of bile flow in the biliary system plays an important role in studying bile stasis and gallstone formation. Bile duct stricture is an abnormal phenomenon that refers to the bile duct getting smaller or narrower. The main objective of this study is to study the influence of stricture on bile flow dynamics using numerical methods. We employed a numerical Computational Fluid Dynamics model of the bile flow within a strictured hepatic duct. We studied and compared the influence of stricture severity, stricture length, eccentricity, and bile flow property on the bile flow dynamics. The bile flow velocity, pressure distribution, pressure drop, and wall shear stress are provided in detail. The stricture alters the normal bile flow pattern and increases flow resistance. At the location upstream and downstream of the stricture, bile flow slows down. In the area of the stricture throat, bile flow is accelerated, and recirculation forms behind the stricture. The maximum pressure drop of the biliary system increases with the stricture length. The eccentricity makes the flow deflect away from the duct's centerline. The behavior of the deflected flow is significantly altered downstream of the stricture. Such bile flow behavior as deceleration and recirculation may lead to cholestasis. Stricture alters bile flow in the biliary tract, causing changes in biliary hydrodynamic indexes, which could potentially serve as an omen for gallstone formation and other related diseases. The consideration of the bile duct stricture could lead to better patient stratification.
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Affiliation(s)
- Tao Peng
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Yunlong Zhong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaodong Lin
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Bingyan Jiang
- State Key Laboratory of High Performance Complex Manufacturing, College of Mechanical and Electrical Engineering, Central South University, Hunan, China
| | - Ping Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanwei Jia
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
- State Key Laboratory of Analog and Mixed-Signal VLSI, Institute of Microelectronics, University of Macau, Macao, China
- Faculty of Science and Technology - Electrical and Computer Engineering, University of Macau, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Macau, China
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4
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Shakeri A, Wang Y, Zhao Y, Landau S, Perera K, Lee J, Radisic M. Engineering Organ-on-a-Chip Systems for Vascular Diseases. Arterioscler Thromb Vasc Biol 2023; 43:2241-2255. [PMID: 37823265 PMCID: PMC10842627 DOI: 10.1161/atvbaha.123.318233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
Vascular diseases, such as atherosclerosis and thrombosis, are major causes of morbidity and mortality worldwide. Traditional in vitro models for studying vascular diseases have limitations, as they do not fully recapitulate the complexity of the in vivo microenvironment. Organ-on-a-chip systems have emerged as a promising approach for modeling vascular diseases by incorporating multiple cell types, mechanical and biochemical cues, and fluid flow in a microscale platform. This review provides an overview of recent advancements in engineering organ-on-a-chip systems for modeling vascular diseases, including the use of microfluidic channels, ECM (extracellular matrix) scaffolds, and patient-specific cells. We also discuss the limitations and future perspectives of organ-on-a-chip for modeling vascular diseases.
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Affiliation(s)
- Amid Shakeri
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Ying Wang
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Yimu Zhao
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Shira Landau
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
| | - Kevin Perera
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jonguk Lee
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Milica Radisic
- Institute of Biomaterials Engineering; University of Toronto; Toronto; Ontario, M5S 3G9; Canada
- Toronto General Research Institute, Toronto; Ontario, M5G 2C4; Canada
- Department of Chemical Engineering and Applied Chemistry; University of Toronto; Toronto; Ontario, M5S 3E5; Canada
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5
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Ghorbannia A, LaDisa JF. Intravascular imaging of angioplasty balloon under-expansion during pre-dilation predicts hyperelastic behavior of coronary artery lesions. Front Bioeng Biotechnol 2023; 11:1192797. [PMID: 37284239 PMCID: PMC10240066 DOI: 10.3389/fbioe.2023.1192797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction: Stent-induced mechanical stimuli cause pathophysiological responses in the coronary artery post-treatment. These stimuli can be minimized through choice of stent, size, and deployment strategy. However, the lack of target lesion material characterization is a barrier to further personalizing treatment. A novel ex-vivo angioplasty-based intravascular imaging technique using optical coherence tomography (OCT) was developed to characterize local stiffness of the target lesion. Methods: After proper institutional oversight, atherosclerotic coronary arteries (n = 9) were dissected from human donor hearts for ex vivo material characterization <48 h post-mortem. Morphology was imaged at the diastolic blood pressure using common intravascular OCT protocols and at subsequent pressures using a specially fabricated perfusion balloon that accommodates the OCT imaging wire. Balloon under-expansion was quantified relative to the nominal balloon size at 8 ATM. Correlation to a constitutive hyperelastic model was empirically investigated (n = 13 plaques) using biaxial extension results fit to a mixed Neo-Hookean and Exponential constitutive model. Results and discussion: The average circumferential Cauchy stress was 66.5, 130.2, and 300.4 kPa for regions with <15, 15-30, and >30% balloon under-expansion at a 1.15 stretch ratio. Similarly, the average longitudinal Cauchy stress was 68.1, 172.6, and 412.7 kPa, respectively. Consequently, strong correlation coefficients >0.89 were observed between balloon under-expansion and stress-like constitutive parameters. These parameters allowed for visualization of stiffness and material heterogeneity for a range of atherosclerotic plaques. Balloon under-expansion is a strong predictor of target lesion stiffness. These findings are promising as stent deployment could now be further personalized via target lesion material characterization obtained pre-operatively.
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Affiliation(s)
- Arash Ghorbannia
- Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, WI, United States
| | - John F. LaDisa
- Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physiology, Milwaukee, WI, United States
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Zhou M, Yu Y, Chen R, Liu X, Hu Y, Ma Z, Gao L, Jian W, Wang L. Wall shear stress and its role in atherosclerosis. Front Cardiovasc Med 2023; 10:1083547. [PMID: 37077735 PMCID: PMC10106633 DOI: 10.3389/fcvm.2023.1083547] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Atherosclerosis (AS) is the major form of cardiovascular disease and the leading cause of morbidity and mortality in countries around the world. Atherosclerosis combines the interactions of systemic risk factors, haemodynamic factors, and biological factors, in which biomechanical and biochemical cues strongly regulate the process of atherosclerosis. The development of atherosclerosis is directly related to hemodynamic disorders and is the most important parameter in the biomechanics of atherosclerosis. The complex blood flow in arteries forms rich WSS vectorial features, including the newly proposed WSS topological skeleton to identify and classify the WSS fixed points and manifolds in complex vascular geometries. The onset of plaque usually occurs in the low WSS area, and the plaque development alters the local WSS topography. low WSS promotes atherosclerosis, while high WSS prevents atherosclerosis. Upon further progression of plaques, high WSS is associated with the formation of vulnerable plaque phenotype. Different types of shear stress can lead to focal differences in plaque composition and to spatial variations in the susceptibility to plaque rupture, atherosclerosis progression and thrombus formation. WSS can potentially gain insight into the initial lesions of AS and the vulnerable phenotype that gradually develops over time. The characteristics of WSS are studied through computational fluid dynamics (CFD) modeling. With the continuous improvement of computer performance-cost ratio, WSS as one of the effective parameters for early diagnosis of atherosclerosis has become a reality and will be worth actively promoting in clinical practice. The research on the pathogenesis of atherosclerosis based on WSS is gradually an academic consensus. This article will comprehensively review the systemic risk factors, hemodynamics and biological factors involved in the formation of atherosclerosis, and combine the application of CFD in hemodynamics, focusing on the mechanism of WSS and the complex interactions between WSS and plaque biological factors. It is expected to lay a foundation for revealing the pathophysiological mechanisms related to abnormal WSS in the progression and transformation of human atherosclerotic plaques.
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Affiliation(s)
- Manli Zhou
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yunfeng Yu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Ruiyi Chen
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Xingci Liu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yilei Hu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Zhiyan Ma
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Lingwei Gao
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Weixiong Jian
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- National Key Discipline of Traditional Chinese Medicine Diagnostics, Hunan Provincial Key Laboratory, Hunan University of Chinese Medicine, Changsha, China
- Correspondence: Weixiong Jian Liping Wang
| | - Liping Wang
- College of Rehabilitation Medicine and Health Care, Hunan University of Medicine, Huaihua, China
- Correspondence: Weixiong Jian Liping Wang
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Çap M, Torii R, Onuma Y, Krams R, Bennett MR, Stone PH, Serruys PW, Bourantas CV. Editorial: Computational modeling for assessing coronary artery pathophysiology. Front Cardiovasc Med 2023; 10:1113835. [PMID: 36733302 PMCID: PMC9887330 DOI: 10.3389/fcvm.2023.1113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Affiliation(s)
- Murat Çap
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, University of Health Sciences Diyarbakir Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Rob Krams
- Department of Molecular Bioengineering Engineering and Material Sciences, Queen Mary University of London, London, United Kingdom
| | - Martin R. Bennett
- Division of Cardiovascular Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter H. Stone
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Patrick W. Serruys
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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8
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Müller MB, Stihl C, Schmid A, Hirschberger S, Mitsigiorgi R, Holzer M, Patscheider M, Weiss BG, Reichel C, Hübner M, Uhl B. A novel OSA-related model of intermittent hypoxia in endothelial cells under flow reveals pronounced inflammatory pathway activation. Front Physiol 2023; 14:1108966. [PMID: 37123277 PMCID: PMC10133699 DOI: 10.3389/fphys.2023.1108966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent episodes of upper airway obstruction and subsequent hypoxia. In patients with OSA, severity and number of these hypoxic events positively correlate with the extent of associated cardiovascular pathology. The molecular mechanisms underlying intermittent hypoxia (IH)-driven cardiovascular disease in OSA, however, remain poorly understood-partly due to the lack of adequate experimental models. Here, we present a novel experimental approach that utilizes primary human endothelial cells cultivated under shear stress. Oxygen partial pressure dynamics were adopted in our in vitro model according to the desaturation-reoxygenation patterns identified in polysomnographic data of severe OSA patients (n = 10, with 892 severe desaturations, SpO2<80%). Using western blot analysis, we detected a robust activation of the two major inflammatory pathways ERK and NF-κB in endothelial cells, whereas no HIF1α and HIF2α protein stabilization was observed. In line with these findings, mRNA and protein expression of the pro-inflammatory adhesion and signaling molecule ICAM-1 and the chemokine CCL2 were significantly increased. Hence, we established a novel in vitro model for deciphering OSA-elicited effects on the vascular endothelium. First data obtained in this model point to the endothelial activation of pro-inflammatory rather than hypoxia-associated pathways in OSA. Future studies in this model might contribute to the development of targeted strategies against OSA-induced, secondary cardiovascular disease.
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Affiliation(s)
- Martin B. Müller
- Department of Anaesthesiology and Intensive Care Medicine, Research Unit Molecular Medicine, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- *Correspondence: Martin B. Müller,
| | - Clemens Stihl
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Annika Schmid
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Simon Hirschberger
- Department of Anaesthesiology and Intensive Care Medicine, Research Unit Molecular Medicine, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Rea Mitsigiorgi
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Martin Holzer
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Martin Patscheider
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Bernhard G. Weiss
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Christoph Reichel
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Max Hübner
- Department of Anaesthesiology and Intensive Care Medicine, Research Unit Molecular Medicine, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
| | - Bernd Uhl
- Walter Brendel Center of Experimental Medicine (WBex), Ludwig-Maximilians-University München (LMU), Munich, Germany
- Department of Otorhinolaryngology, LMU University Hospital, Ludwig-Maximilians-University München (LMU), Munich, Germany
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9
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Schultz J, van den Hoogen IJ, Kuneman JH, de Graaf MA, Kamperidis V, Broersen A, Jukema JW, Sakellarios A, Nikopoulos S, Tsarapatsani K, Naka K, Michalis L, Fotiadis DI, Maaniitty T, Saraste A, Bax JJ, Knuuti J. Coronary computed tomography angiography-based endothelial wall shear stress in normal coronary arteries. Int J Cardiovasc Imaging 2023; 39:441-450. [PMID: 36255544 PMCID: PMC9870961 DOI: 10.1007/s10554-022-02739-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
Endothelial wall shear stress (ESS) is a biomechanical force which plays a role in the formation and evolution of atherosclerotic lesions. The purpose of this study is to evaluate coronary computed tomography angiography (CCTA)-based ESS in coronary arteries without atherosclerosis, and to assess factors affecting ESS values. CCTA images from patients with suspected coronary artery disease were analyzed to identify coronary arteries without atherosclerosis. Minimal and maximal ESS values were calculated for 3-mm segments. Factors potentially affecting ESS values were examined, including sex, lumen diameter and distance from the ostium. Segments were categorized according to lumen diameter tertiles into small (< 2.6 mm), intermediate (2.6-3.2 mm) or large (≥ 3.2 mm) segments. A total of 349 normal vessels from 168 patients (mean age 59 ± 9 years, 39% men) were included. ESS was highest in the left anterior descending artery compared to the left circumflex artery and right coronary artery (minimal ESS 2.3 Pa vs. 1.9 Pa vs. 1.6 Pa, p < 0.001 and maximal ESS 3.7 Pa vs. 3.0 Pa vs. 2.5 Pa, p < 0.001). Men had lower ESS values than women, also after adjusting for lumen diameter (p < 0.001). ESS values were highest in small segments compared to intermediate or large segments (minimal ESS 3.8 Pa vs. 1.7 Pa vs. 1.2 Pa, p < 0.001 and maximal ESS 6.0 Pa vs. 2.6 Pa vs. 2.0 Pa, p < 0.001). A weak to strong correlation was found between ESS and distance from the ostium (ρ = 0.22-0.62, p < 0.001). CCTA-based ESS values increase rapidly and become widely scattered with decreasing lumen diameter. This needs to be taken into account when assessing the added value of ESS beyond lumen diameter in highly stenotic lesions.
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Affiliation(s)
- Jussi Schultz
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Inge J. van den Hoogen
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurrien H. Kuneman
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A. de Graaf
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vasileios Kamperidis
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexander Broersen
- grid.10419.3d0000000089452978Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Wouter Jukema
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.411737.7Netherlands Heart Institute, Utrecht, The Netherlands
| | - Antonis Sakellarios
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece ,grid.9594.10000 0001 2108 7481Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Sotirios Nikopoulos
- grid.9594.10000 0001 2108 7481Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Konstantina Tsarapatsani
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece ,grid.9594.10000 0001 2108 7481Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Katerina Naka
- grid.9594.10000 0001 2108 7481Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- grid.9594.10000 0001 2108 7481Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece ,grid.9594.10000 0001 2108 7481Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Teemu Maaniitty
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Antti Saraste
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland ,grid.410552.70000 0004 0628 215XHeart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeroen J. Bax
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.410552.70000 0004 0628 215XHeart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland ,grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci 2022; 23:12906. [PMID: 36361701 PMCID: PMC9658900 DOI: 10.3390/ijms232112906] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation. Recruited monocytes differentiate into macrophages which develop pro- or anti-inflammatory properties according to their microenvironment. Atheroma progression or healing is determined by the balance between these functional phenotypes. Macrophages and smooth muscle cells secrete inflammatory cytokines including interleukins IL-1β, IL-12, and IL-6. Within the arterial wall, low-density lipoprotein cholesterol undergoes an oxidation. Additionally, triglyceride-rich lipoproteins and remnant lipoproteins exert pro-inflammatory effects. Macrophages catabolize the oxidized lipoproteins and coalesce into a lipid-rich necrotic core, encapsulated by a collagen fibrous cap, leading to the formation of fibro-atheroma. In the conditions of chronic inflammation, macrophages exert a catabolic effect on the fibrous cap, resulting in a thin-cap fibro-atheroma which makes the plaque vulnerable. However, their morphology may change over time, shifting from high-risk lesions to more stable calcified plaques. In addition to conventional cardiovascular risk factors, an exposure to acute and chronic psychological stress may increase the risk of cardiovascular disease through inflammation mediated by an increased sympathetic output which results in the release of inflammatory cytokines. Inflammation is also the link between ageing and cardiovascular disease through increased clones of leukocytes in peripheral blood. Anti-inflammatory interventions specifically blocking the cytokine pathways reduce the risk of myocardial infarction and stroke, although they increase the risk of infections.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
- Molecular and Clinical Sciences Research Institute, St. George’s University, London UB8 3PH, UK
| | - Sergio Vancheri
- Interventional Neuroradiology Department, Besançon University Hospital, 25000 Besançon, France
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
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11
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Wang T, Pfeiffer T, Akyildiz A, van Beusekom HMM, Huber R, van der Steen AFW, van Soest G. Intravascular optical coherence elastography. BIOMEDICAL OPTICS EXPRESS 2022; 13:5418-5433. [PMID: 36425628 PMCID: PMC9664873 DOI: 10.1364/boe.470039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
Optical coherence elastography (OCE), a functional extension of optical coherence tomography (OCT), visualizes tissue strain to deduce the tissue's biomechanical properties. In this study, we demonstrate intravascular OCE using a 1.1 mm motorized catheter and a 1.6 MHz Fourier domain mode-locked OCT system. We induced an intraluminal pressure change by varying the infusion rate from the proximal end of the catheter. We analysed the pixel-matched phase change between two different frames to yield the radial strain. Imaging experiments were carried out in a phantom and in human coronary arteries in vitro. At an imaging speed of 3019 frames/s, we were able to capture the dynamic strain. Stiff inclusions in the phantom and calcification in atherosclerotic plaques are associated with low strain values and can be distinguished from the surrounding soft material, which exhibits elevated strain. For the first time, circumferential intravascular OCE images are provided side by side with conventional OCT images, simultaneously mapping both the tissue structure and stiffness.
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Affiliation(s)
- Tianshi Wang
- Thoraxcentre, Erasmus University Medical Centre, Rotterdam 3015 AA, The Netherlands
| | - Tom Pfeiffer
- Institut für Biomedizinische Optik, Universität zu Lübeck, Lübeck 23562, Germany
| | - Ali Akyildiz
- Thoraxcentre, Erasmus University Medical Centre, Rotterdam 3015 AA, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft 2600 AA, The Netherlands
| | | | - Robert Huber
- Institut für Biomedizinische Optik, Universität zu Lübeck, Lübeck 23562, Germany
| | - Antonius F. W. van der Steen
- Thoraxcentre, Erasmus University Medical Centre, Rotterdam 3015 AA, The Netherlands
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518005, China
- Department of Imaging Science and Technology, Delft University of Technology, Delft 2600 AA, The Netherlands
| | - Gijs van Soest
- Thoraxcentre, Erasmus University Medical Centre, Rotterdam 3015 AA, The Netherlands
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12
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Jin C, Torii R, Ramasamy A, Tufaro V, Little CD, Konstantinou K, Tan YY, Yap NAL, Cooper J, Crake T, O’Mahony C, Rakhit R, Egred M, Ahmed J, Karamasis G, Räber L, Baumbach A, Mathur A, Bourantas CV. Morphological and Physiological Characteristics of Ruptured Plaques in Native Arteries and Neoatherosclerotic Segments: An OCT-Based and Computational Fluid Dynamics Study. Front Cardiovasc Med 2022; 9:890799. [PMID: 35722127 PMCID: PMC9204481 DOI: 10.3389/fcvm.2022.890799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intravascular imaging has been used to assess the morphology of lesions causing an acute coronary syndrome (ACS) in native vessels (NV) and identify differences between plaques that ruptured (PR) and caused an event and those that ruptured without clinical manifestations. However, there is no data about the morphological and physiological characteristics of neoatherosclerotic plaques that ruptured (PR-NA) which constitute a common cause of stent failure. Methods We retrospectively analyzed data from patients admitted with an acute myocardial infarction that had optical coherence tomography (OCT) imaging of the culprit vessel before balloon pre-dilation. OCT pullbacks showing PR were segmented at every 0.4 mm. The extent of the formed cavity, lipid and calcific tissue, thrombus, and macrophages were measured, and the fibrous cap thickness (FCT) and the incidence of micro-channels and cholesterol crystals were reported. These data were used to reconstruct a representative model of the native and neoatherosclerotic lesion geometry that was processed with computational fluid dynamics (CFD) techniques to estimate the distribution of the endothelial shear stress and plaque structural stress. Result Eighty patients were included in the present analysis: 56 had PR in NV (PR-NV group) and 24 in NA segments (PR-NA group). The PR-NV group had a larger minimum lumen area (2.93 ± 2.03 vs. 2.00 ± 1.26 mm2, p = 0.015) but similar lesion length and area stenosis compared to PR-NA group. The mean FCT (186 ± 65 vs. 232 ± 80 μm, p = 0.009) and the lipid index was smaller (16.7 ± 13.8 vs. 25.9 ± 14.1, p = 0.008) while the of calcific index (8.3 ± 9.5 vs. 2.2 ± 1.6%, p = 0.002) and the incidence of micro-channels (41.4 vs. 12.5%, p = 0.013) was higher in the PR-NV group. Conversely, there was no difference in the incidence of cholesterol crystals, thrombus burden or the location of the rupture site between groups. CFD analysis revealed higher maximum endothelial shear stress (19.1 vs. 11.0 Pa) and lower maximum plaque structural stress (38.8 vs. 95.1 kPa) in the PR-NA compared to the PR-NV model. Conclusion We reported significant morphological and physiological differences between culprit ruptured plaques in native and stented segments. Further research is needed to better understand the causes of these differences and the mechanisms regulating neoatherosclerotic lesion destabilization.
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Affiliation(s)
- Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Callum D. Little
- Royal Free Hospital, University College London, London, United Kingdom
| | - Klio Konstantinou
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Yi Ying Tan
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Nathan A. L. Yap
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Jackie Cooper
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Tom Crake
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Constantinos O’Mahony
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Roby Rakhit
- Royal Free Hospital, University College London, London, United Kingdom
| | - Mohaned Egred
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Javed Ahmed
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grigoris Karamasis
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Lorenz Räber
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Yale University School of Medicine, New Haven, CT, United States
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- *Correspondence: Christos V. Bourantas,
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13
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Guo X, Maehara A, Yang M, Wang L, Zheng J, Samady H, Mintz GS, Giddens DP, Tang D. Predicting Coronary Stenosis Progression Using Plaque Fatigue From IVUS-Based Thin-Slice Models: A Machine Learning Random Forest Approach. Front Physiol 2022; 13:912447. [PMID: 35620594 PMCID: PMC9127388 DOI: 10.3389/fphys.2022.912447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Coronary stenosis due to atherosclerosis restricts blood flow. Stenosis progression would lead to increased clinical risk such as heart attack. Although many risk factors were found to contribute to atherosclerosis progression, factors associated with fatigue is underemphasized. Our goal is to investigate the relationship between fatigue and stenosis progression based on in vivo intravascular ultrasound (IVUS) images and finite element models. Methods: Baseline and follow-up in vivo IVUS and angiography data were acquired from seven patients using Institutional Review Board approved protocols with informed consent obtained. Three hundred and five paired slices at baseline and follow-up were matched and used for plaque modeling and analysis. IVUS-based thin-slice models were constructed to obtain the coronary biomechanics and stress/strain amplitudes (stress/strain variations in one cardiac cycle) were used as the measurement of fatigue. The change of lumen area (DLA) from baseline to follow-up were calculated to measure stenosis progression. Nineteen morphological and biomechanical factors were extracted from 305 slices at baseline. Correlation analyses of these factors with DLA were performed. Random forest (RF) method was used to fit morphological and biomechanical factors at baseline to predict stenosis progression during follow-up. Results: Significant correlations were found between stenosis progression and maximum stress amplitude, average stress amplitude and average strain amplitude (p < 0.05). After factors selection implemented by random forest (RF) method, eight morphological and biomechanical factors were selected for classification prediction of stenosis progression. Using eight factors including fatigue, the overall classification accuracy, sensitivity and specificity of stenosis progression prediction with RF method were 83.61%, 86.25% and 80.69%, respectively. Conclusion: Fatigue correlated positively with stenosis progression. Factors associated with fatigue could contribute to better prediction for atherosclerosis progression.
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Affiliation(s)
- Xiaoya Guo
- School of Science, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Mingming Yang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, United States
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Don P Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
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14
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He Y, Northrup H, Le H, Cheung AK, Berceli SA, Shiu YT. Medical Image-Based Computational Fluid Dynamics and Fluid-Structure Interaction Analysis in Vascular Diseases. Front Bioeng Biotechnol 2022; 10:855791. [PMID: 35573253 PMCID: PMC9091352 DOI: 10.3389/fbioe.2022.855791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 01/17/2023] Open
Abstract
Hemodynamic factors, induced by pulsatile blood flow, play a crucial role in vascular health and diseases, such as the initiation and progression of atherosclerosis. Computational fluid dynamics, finite element analysis, and fluid-structure interaction simulations have been widely used to quantify detailed hemodynamic forces based on vascular images commonly obtained from computed tomography angiography, magnetic resonance imaging, ultrasound, and optical coherence tomography. In this review, we focus on methods for obtaining accurate hemodynamic factors that regulate the structure and function of vascular endothelial and smooth muscle cells. We describe the multiple steps and recent advances in a typical patient-specific simulation pipeline, including medical imaging, image processing, spatial discretization to generate computational mesh, setting up boundary conditions and solver parameters, visualization and extraction of hemodynamic factors, and statistical analysis. These steps have not been standardized and thus have unavoidable uncertainties that should be thoroughly evaluated. We also discuss the recent development of combining patient-specific models with machine-learning methods to obtain hemodynamic factors faster and cheaper than conventional methods. These critical advances widen the use of biomechanical simulation tools in the research and potential personalized care of vascular diseases.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Hannah Northrup
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Yan Tin Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- *Correspondence: Yan Tin Shiu,
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15
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Endothelial Dysfunction in the Pathogenesis of Abdominal Aortic Aneurysm. Biomolecules 2022; 12:biom12040509. [PMID: 35454098 PMCID: PMC9030795 DOI: 10.3390/biom12040509] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 12/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA), defined as a focal dilation of the abdominal aorta beyond 50% of its normal diameter, is a common and potentially life-threatening vascular disease. The molecular and cellular mechanisms underlying AAA pathogenesis remain unclear. Healthy endothelial cells (ECs) play a critical role in maintaining vascular homeostasis by regulating vascular tone and maintaining an anti-inflammatory, anti-thrombotic local environment. Increasing evidence indicates that endothelial dysfunction is an early pathologic event in AAA formation, contributing to both oxidative stress and inflammation in the degenerating arterial wall. Recent studies utilizing single-cell RNA sequencing revealed heterogeneous EC sub-populations, as determined by their transcriptional profiles, in aortic aneurysm tissue. This review summarizes recent findings, including clinical evidence of endothelial dysfunction in AAA, the impact of biomechanical stress on EC in AAA, the role of endothelial nitric oxide synthase (eNOS) uncoupling in AAA, and EC heterogeneity in AAA. These studies help to improve our understanding of AAA pathogenesis and ultimately may lead to the generation of EC-targeted therapeutics to treat or prevent this deadly disease.
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16
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Huang J, Yang F, Gutiérrez-Chico JL, Xu T, Wu J, Wang L, Lv R, Lai Y, Liu X, Onuma Y, Tang D, Serruys PW, Wijns W, Tu S. Optical Coherence Tomography-Derived Changes in Plaque Structural Stress Over the Cardiac Cycle: A New Method for Plaque Biomechanical Assessment. Front Cardiovasc Med 2021; 8:715995. [PMID: 34805298 PMCID: PMC8600113 DOI: 10.3389/fcvm.2021.715995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Cyclic plaque structural stress has been hypothesized as a mechanism for plaque fatigue and eventually plaque rupture. A novel approach to derive cyclic plaque stress in vivo from optical coherence tomography (OCT) is hereby developed. Materials and Methods: All intermediate lesions from a previous OCT study were enrolled. OCT cross-sections at representative positions within each lesion were selected for plaque stress analysis. Detailed plaque morphology, including plaque composition, lumen and internal elastic lamina contours, were automatically delineated. OCT-derived vessel and plaque morphology were included in a 2-dimensional finite element analysis, loaded with patient-specific intracoronary pressure tracing data, to calculate the changes in plaque structural stress (ΔPSS) on vessel wall over the cardiac cycle. Results: A total of 50 lesions from 41 vessels were analyzed. A significant ΔPSS gradient was observed across the plaque, being maximal at the proximal shoulder (45.7 [32.3, 78.6] kPa), intermediate at minimal lumen area (MLA) (39.0 [30.8, 69.1] kPa) and minimal at the distal shoulder (35.1 [28.2, 72.3] kPa; p = 0.046). The presence of lipidic plaques were observed in 82% of the diseased segments. Larger relative lumen deformation and ΔPSS were observed in diseased segments, compared with normal segments (percent diameter change: 8.2 ± 4.2% vs. 6.3 ± 2.3%, p = 0.04; ΔPSS: 59.3 ± 48.2 kPa vs. 27.5 ± 8.2 kPa, p < 0.001). ΔPSS was positively correlated with plaque burden (r = 0.37, p < 0.001) and negatively correlated with fibrous cap thickness (r = -0.25, p = 0.004). Conclusions: ΔPSS provides a feasible method for assessing plaque biomechanics in vivo from OCT images, consistent with previous biomechanical and clinical studies based on different methodologies. Larger ΔPSS at proximal shoulder and MLA indicates the critical sites for future biomechanical assessment.
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Affiliation(s)
- Jiayue Huang
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China.,The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - Fan Yang
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Luis Gutiérrez-Chico
- Cardiology Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianxiao Xu
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jigang Wu
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Rui Lv
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Yan Lai
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yoshinobu Onuma
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Patrick W Serruys
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
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17
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Zhu Z, Chen L, Liu W, Wu Y, Zou C, Zhang X, He S, Wang Y, Shen B, Ma X, Gao H, Luan Y, Huang H. Carotid stiffening predicts cardiovascular risk stratification in mid-life: non-invasive quantification with ultrafast ultrasound imaging. Ultrasonography 2021; 41:462-472. [PMID: 35589550 PMCID: PMC9262672 DOI: 10.14366/usg.21197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The present study investigated the association between Systematic COronary Risk Evaluation (SCORE)-estimated cardiovascular risk and carotid stiffening in a middle-aged population using ultrafast pulse wave velocity (ufPWV). METHODS This study enrolled 683 participants without known cardiovascular disease or diabetes mellitus who underwent ufPWV measurements. Clinical interviews, physical examinations, laboratory findings, carotid intima-media thickness (cIMT), pulse wave velocity (PWV) at the beginning of systole (PWV-BS), and PWV at the end of systole (PWV-ES) were assessed. Each participant underwent an assessment of SCORE risk based on major cardiovascular risk factors (CVRFs), including age, sex, smoking, systolic blood pressure (SBP), and total cholesterol (TC). Crude and adjusted odds ratios (ORs) with 95% confidence intervals and ordinal logistic regression were used. Overall CVRFs were adjusted to assess ORs. RESULTS cIMT and carotid stiffening in PWV-BS and PWV-ES were significantly different between sex subgroups (all P<0.05), but only PWV-ES increased gradually in age and SCORE-estimated risk subgroups (all P<0.05). Compared with cIMT (r=0.388, P<0.001) and PWV-BS (r=0.159, P<0.001), PWV-ES was more strongly correlated with SCORE categories (r=0.405, P<0.001). Higher PWV-ES values were associated with SCORE categories independently of sex, SBP, TC, and smoking in moderate-risk and high-risk subgroups (OR, 1.63; P<0.001 and OR, 2.12; P=0.024, respectively), but were not independent of age in all risk subgroups (all P>0.05). CONCLUSION Carotid stiffening quantified by ufPWV is linked to SCORE categories, and elevated PWV-ES may aid in cardiovascular risk stratification.
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Affiliation(s)
- Zhengqiu Zhu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Lingshan Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Wenjun Liu
- School of Mathematics and Statistics, Nanjing University of Information Science and Technology, Nanjing, China
| | - Yiyun Wu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Chong Zou
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.,Center of Good Clinical Practice, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xinyi Zhang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Shanshan He
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yinping Wang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Bixiao Shen
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xuehui Ma
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Hui Gao
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yun Luan
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Hui Huang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
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18
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Yang S, Choi G, Zhang J, Lee JM, Hwang D, Doh JH, Nam CW, Shin ES, Cho YS, Choi SY, Chun EJ, Nørgaard BL, Nieman K, Otake H, Penicka M, Bruyne BD, Kubo T, Akasaka T, Taylor CA, Koo BK. Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:713835. [PMID: 34589527 PMCID: PMC8475759 DOI: 10.3389/fcvm.2021.713835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated. Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFRCT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFRCT across the lesion (ΔFFRCT) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared. Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFRCT were strongly correlated with each other (all p < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFRCT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFRCT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFRCT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFRCT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT had a similar or superior discrimination ability to that with FFRCT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFRCT did not improve the model performance. Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFRCT.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea
| | - Gilwoo Choi
- HeartFlow Inc., Redwood City, CA, United States
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Chang-Wook Nam
- Department of Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Hospital, Ulsan, South Korea
| | - Young-Seok Cho
- Cardiovascular Center, Sejong General Hospital, Incheon, South Korea
| | - Su-Yeon Choi
- Department of Medicine, Healthcare System Gangnam Center, Seoul National University, Seoul, South Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Koen Nieman
- School of Medicine, Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Hiromasa Otake
- Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | | | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Charles A Taylor
- HeartFlow Inc., Redwood City, CA, United States.,Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea.,Institute on Aging, Seoul National University, Seoul, South Korea
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19
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Wang Y, Fang C, Zhang S, Li L, Wang J, Yin Y, Wang Y, Yu H, Wei G, Zhang X, Guo J, Jiang S, Lei F, Lu J, Tu Y, Hou J, Dai J, Yu B. Predictors of Coronary Plaque Erosion in Current and Non-Current Smokers With ST-Segment Elevation Myocardial Infarction - An Optical Coherence Tomography Study. Circ J 2021; 85:1814-1822. [PMID: 33504712 DOI: 10.1253/circj.cj-20-0890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking is an important risk factor of plaque erosion. This study aimed to investigate the predictors of plaque erosion in current and non-current smokers presenting with ST-segment elevation myocardial infarction (STEMI).Methods and Results:A total of 1,320 STEMI patients with culprit plaque rupture or plaque erosion detected by pre-intervention optical coherence tomography were divided into a current smoking group (n=715) and non-current smoking group (n=605). Plaque erosion accounted for 30.8% (220/715) of culprit lesions in the current smokers and 21.2% (128/605) in the non-current smokers. Multivariable analysis showed age <50 years, single-vessel disease and the absence of dyslipidemia were independently associated with plaque erosion rather than plaque rupture, regardless of smoking status. In current smokers, diabetes mellitus (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.10-0.83; P=0.021) was negatively associated with plaque erosion as compared with plaque rupture. In non-current smokers, minimal lumen area (MLA, OR: 1.37; 95% CI: 1.16-1.62; P<0.001) and nearby bifurcation (OR: 3.20; 95% CI: 1.98-5.16; P<0.001) were positively related to plaque erosion, but not plaque rupture. CONCLUSIONS In patients with STEMI, the presence of diabetes mellitus significantly increased the risk of rupture-based STEMI but may not have reduced the risk of plaque erosion-based STEMI in current smokers. Nearby bifurcation and larger MLA were associated with plaque erosion in non-current smokers.
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Affiliation(s)
- Yidan Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Fang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Shaotao Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Lulu Li
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jifei Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yanwei Yin
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yini Wang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Huai Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Guo Wei
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Xiling Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Junchen Guo
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Senqing Jiang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Fangmeng Lei
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jia Lu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yingfeng Tu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jingbo Hou
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jiannan Dai
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
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20
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Tian S, Pan W, Peng J, Wang H, Deng B, Liang Y, Li X, Liu H, Wang Y, Luo B, Du J. Hemodynamic Responses in Carotid Bifurcation Induced by Enhanced External Counterpulsation Stimulation in Healthy Controls and Patients With Neurological Disorders. Front Physiol 2021; 12:717080. [PMID: 34531762 PMCID: PMC8438206 DOI: 10.3389/fphys.2021.717080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022] Open
Abstract
Enhanced external counterpulsation is a Food and Drug Administration–approved, non-invasive, assisted circulation therapy for ischemic cardiovascular and cerebrovascular diseases. Previous studies have confirmed that EECP stimulation induces largely different cerebral hemodynamic responses in patients with ischemic stroke and healthy controls. However, the underlying mechanisms remain uncertain. We hypothesize that different blood redistributions at the carotid bifurcation may play a key role. Ten subjects were enrolled in this study, namely, five patients with neurological disorders and five young healthy volunteers as controls. Magnetic resonance angiography (MRA) was performed on the carotid artery. All the subjects received a single session of EECP treatment, with external cuff pressures ranging from 20 to 40 kPa. Vascular ultrasound measurements were taken in the common carotid artery (CCA), external carotid artery (ECA) and internal carotid artery (ICA). Three-dimensional patient-specific numerical models were developed to calculate the WSS-derived hemodynamic factors. The results indicated that EECP increased CCA and ECA blood flow in both groups. The ICA blood flow in the patient group exhibited a mean increase of 6.67% during EECP treatment compared with the pre-EECP condition; a mean decrease of 9.2% was observed in the healthy control group. EECP increased the averaged wall shear stress (AWSS) throughout the carotid bifurcation in the patient group; the ICA AWSS of the healthy group decreased during EECP. In both groups, the oscillatory shear index (OSI) in the ICA increased proportionally with external cuff pressure. In addition, the relative resident time (RRT) was constant or slightly decreased in the CCA and ECA in both groups but increased in the ICA. We suggest that the benefits of EECP to patients with neurological disorders may partly result from blood flow promotion in the ICA and increase in WSS at the carotid bifurcation. In the healthy subjects, the ICA blood flow remained constant during EECP, although the CCA blood flow increased significantly. A relatively low external cuff pressure (20 kPa) is recommended as the optimal treatment pressure for better hemodynamic effects. This study may play an important role in the translation of physiological benefits of EECP treatment in populations with or without neurological disorders.
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Affiliation(s)
- Shuai Tian
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Wei Pan
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Junping Peng
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- Department of Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bin Deng
- Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Yi Liang
- Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Xinghua Li
- Medical Imaging Center, Chongming Medical Technology Company, Shenzhen, China
| | - Huahui Liu
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yujia Wang
- Department of Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jianhang Du
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China.,National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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21
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Leistner DM, Kränkel N, Meteva D, Abdelwahed YS, Seppelt C, Stähli BE, Rai H, Skurk C, Lauten A, Mochmann HC, Fröhlich G, Rauch-Kröhnert U, Flores E, Riedel M, Sieronski L, Kia S, Strässler E, Haghikia A, Dirks F, Steiner JK, Mueller DN, Volk HD, Klotsche J, Joner M, Libby P, Landmesser U. Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap: results from the prospective translational OPTICO-ACS study. Eur Heart J 2021; 41:3549-3560. [PMID: 33080003 DOI: 10.1093/eurheartj/ehaa703] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Acute coronary syndromes with intact fibrous cap (IFC-ACS), i.e. caused by coronary plaque erosion, account for approximately one-third of ACS. However, the underlying pathophysiological mechanisms as compared with ACS caused by plaque rupture (RFC-ACS) remain largely undefined. The prospective translational OPTICO-ACS study programme investigates for the first time the microenvironment of ACS-causing culprit lesions (CL) with intact fibrous cap by molecular high-resolution intracoronary imaging and simultaneous local immunological phenotyping. METHODS AND RESULTS The CL of 170 consecutive ACS patients were investigated by optical coherence tomography (OCT) and simultaneous immunophenotyping by flow cytometric analysis as well as by effector molecule concentration measurements across the culprit lesion gradient (ratio local/systemic levels). Within the study cohort, IFC caused 24.6% of ACS while RFC-ACS caused 75.4% as determined and validated by two independent OCT core laboratories. The IFC-CL were characterized by lower lipid content, less calcification, a thicker overlying fibrous cap, and largely localized near a coronary bifurcation as compared with RFC-CL. The microenvironment of IFC-ACS lesions demonstrated selective enrichment in both CD4+ and CD8+ T-lymphocytes (+8.1% and +11.2%, respectively, both P < 0.05) as compared with RFC-ACS lesions. T-cell-associated extracellular circulating microvesicles (MV) were more pronounced in IFC-ACS lesions and a significantly higher amount of CD8+ T-lymphocytes was detectable in thrombi aspirated from IFC-culprit sites. Furthermore, IFC-ACS lesions showed increased levels of the T-cell effector molecules granzyme A (+22.4%), perforin (+58.8%), and granulysin (+75.4%) as compared with RFC plaques (P < 0.005). Endothelial cells subjected to culture in disturbed laminar flow conditions, i.e. to simulate coronary flow near a bifurcation, demonstrated an enhanced adhesion of CD8+T cells. Finally, both CD8+T cells and their cytotoxic effector molecules caused endothelial cell death, a key potential pathophysiological mechanism in IFC-ACS. CONCLUSIONS The OPTICO-ACS study emphasizes a novel mechanism in the pathogenesis of IFC-ACS, favouring participation of the adaptive immune system, particularly CD4+ and CD8+ T-cells and their effector molecules. The different immune signatures identified in this study advance the understanding of coronary plaque progression and may provide a basis for future development of personalized therapeutic approaches to ACS with IFC. TRIAL REGISTRATION The study was registered at clinicalTrials.gov (NCT03129503).
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Affiliation(s)
- David M Leistner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Nicolle Kränkel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Denitsa Meteva
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Claudio Seppelt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Himanshu Rai
- DZHK (German Centre for Cardiovascular Research) Partner Site Munch, Munich, 80636, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Alexander Lauten
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Hans-Christian Mochmann
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany
| | - Georg Fröhlich
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Eduardo Flores
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany
| | - Matthias Riedel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Lara Sieronski
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Sylvia Kia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Elisabeth Strässler
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Arash Haghikia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Fabian Dirks
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
| | - Julia K Steiner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany
| | - Dominik N Mueller
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany.,Experimental and Clinical Research Centre (ECRC), a cooperation of Charité University Medicine Berlin and Max Delbruck Centre for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany.,Max Delbruck Centre for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
| | - Hans-Dieter Volk
- Berlin Institute of Health (BIH), Berlin 10117, Germany.,Institute for Medical Immunology and BIH Centre for Regenerative Therapies (BCRT), and Berlin Centre for Advanced Therapies (BeCAT), Charité University Medicine Berlin, Berlin 13353, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, and Institute for Social Medicine, Epidemiology und Heath Economy, Charité University Medicine Berlin, Campus Charité Mitte, Berlin 10117, Germany
| | - Michael Joner
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Munich, 80636, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Munch, Munich, 80636, Germany
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave Louis Pasteur, Boston, MA 02115, USA
| | - Ulf Landmesser
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Hindenburgdamm 30, Berlin D-12203, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin 12203, Germany.,Berlin Institute of Health (BIH), Berlin 10117, Germany
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22
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Hajjarian Z, Toussaint JD, Guerrero JL, Nadkarni SK. In-vivo mechanical characterization of coronary atherosclerotic plaques in living swine using intravascular laser speckle imaging. BIOMEDICAL OPTICS EXPRESS 2021; 12:2064-2078. [PMID: 33996217 PMCID: PMC8086462 DOI: 10.1364/boe.418939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 05/13/2023]
Abstract
The ability to evaluate the viscoelastic properties of coronary arteries is crucial for identifying mechanically unstable atherosclerotic plaques. Here, we demonstrate for the first time in living swine, the capability of intravascular laser speckle imaging (ILSI) to measure an index of coronary plaque viscoelasticity, τ, using a human coronary to swine xenograft model. Cardiac motion effects are evaluated by comparing the EKG-non-gated τ ¯ N G , and EKG-gated τ ¯ G among different plaque types. Results show that both τ ¯ N G and τ ¯ G are significantly lower in necrotic-core plaques compared with stable lesions. Discrete-point pullback measurements demonstrate the capability of ILSI for rapid mechanical characterization of coronary segments under physiological conditions, in-vivo.
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Affiliation(s)
- Zeinab Hajjarian
- Wellman Center for Photomedicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- Authors contributed equally to the manuscript
| | - Jimmy D. Toussaint
- Wellman Center for Photomedicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- Authors contributed equally to the manuscript
| | - J. Luis Guerrero
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Seemantini K. Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
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23
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Andelovic K, Winter P, Jakob PM, Bauer WR, Herold V, Zernecke A. Evaluation of Plaque Characteristics and Inflammation Using Magnetic Resonance Imaging. Biomedicines 2021; 9:185. [PMID: 33673124 PMCID: PMC7917750 DOI: 10.3390/biomedicines9020185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Atherosclerosis is an inflammatory disease of large and medium-sized arteries, characterized by the growth of atherosclerotic lesions (plaques). These plaques often develop at inner curvatures of arteries, branchpoints, and bifurcations, where the endothelial wall shear stress is low and oscillatory. In conjunction with other processes such as lipid deposition, biomechanical factors lead to local vascular inflammation and plaque growth. There is also evidence that low and oscillatory shear stress contribute to arterial remodeling, entailing a loss in arterial elasticity and, therefore, an increased pulse-wave velocity. Although altered shear stress profiles, elasticity and inflammation are closely intertwined and critical for plaque growth, preclinical and clinical investigations for atherosclerosis mostly focus on the investigation of one of these parameters only due to the experimental limitations. However, cardiovascular magnetic resonance imaging (MRI) has been demonstrated to be a potent tool which can be used to provide insights into a large range of biological parameters in one experimental session. It enables the evaluation of the dynamic process of atherosclerotic lesion formation without the need for harmful radiation. Flow-sensitive MRI provides the assessment of hemodynamic parameters such as wall shear stress and pulse wave velocity which may replace invasive and radiation-based techniques for imaging of the vascular function and the characterization of early plaque development. In combination with inflammation imaging, the analyses and correlations of these parameters could not only significantly advance basic preclinical investigations of atherosclerotic lesion formation and progression, but also the diagnostic clinical evaluation for early identification of high-risk plaques, which are prone to rupture. In this review, we summarize the key applications of magnetic resonance imaging for the evaluation of plaque characteristics through flow sensitive and morphological measurements. The simultaneous measurements of functional and structural parameters will further preclinical research on atherosclerosis and has the potential to fundamentally improve the detection of inflammation and vulnerable plaques in patients.
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Affiliation(s)
- Kristina Andelovic
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
| | - Patrick Winter
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
- Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Peter Michael Jakob
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
| | - Wolfgang Rudolf Bauer
- Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Volker Herold
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany
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24
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Eslami P, Thondapu V, Karady J, Hartman EMJ, Jin Z, Albaghdadi M, Lu M, Wentzel JJ, Hoffmann U. Physiology and coronary artery disease: emerging insights from computed tomography imaging based computational modeling. Int J Cardiovasc Imaging 2020; 36:2319-2333. [PMID: 32779078 PMCID: PMC8323761 DOI: 10.1007/s10554-020-01954-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
Improvements in spatial and temporal resolution now permit robust high quality characterization of presence, morphology and composition of coronary atherosclerosis in computed tomography (CT). These characteristics include high risk features such as large plaque volume, low CT attenuation, napkin-ring sign, spotty calcification and positive remodeling. Because of the high image quality, principles of patient-specific computational fluid dynamics modeling of blood flow through the coronary arteries can now be applied to CT and allow the calculation of local lesion-specific hemodynamics such as endothelial shear stress, fractional flow reserve and axial plaque stress. This review examines recent advances in coronary CT image-based computational modeling and discusses the opportunity to identify lesions at risk for rupture much earlier than today through the combination of anatomic and hemodynamic information.
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Affiliation(s)
- Parastou Eslami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Vikas Thondapu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia Karady
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eline M J Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Zexi Jin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mazen Albaghdadi
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Lu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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25
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Carrizzo A, Izzo C, Forte M, Sommella E, Di Pietro P, Venturini E, Ciccarelli M, Galasso G, Rubattu S, Campiglia P, Sciarretta S, Frati G, Vecchione C. A Novel Promising Frontier for Human Health: The Beneficial Effects of Nutraceuticals in Cardiovascular Diseases. Int J Mol Sci 2020; 21:E8706. [PMID: 33218062 PMCID: PMC7698807 DOI: 10.3390/ijms21228706] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) such as hypertension, atherosclerosis, myocardial infarction, and diabetes are a significant public health problem worldwide. Although several novel pharmacological treatments to reduce the progression of CVDs have been discovered during the last 20 years, the better way to contain the onset of CVDs remains prevention. In this regard, nutraceuticals seem to own a great potential in maintaining human health, exerting important protective cardiovascular effects. In the last years, there has been increased focus on identifying natural compounds with cardiovascular health-promoting effects and also to characterize the molecular mechanisms involved. Although many review articles have focused on the individual natural compound impact on cardiovascular diseases, the aim of this manuscript was to examine the role of the most studied nutraceuticals, such as resveratrol, cocoa, quercetin, curcumin, brassica, berberine and Spirulina platensis, on different CVDs.
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Affiliation(s)
- Albino Carrizzo
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
| | - Carmine Izzo
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
| | - Maurizio Forte
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
| | - Eduardo Sommella
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy;
| | - Paola Di Pietro
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
| | - Eleonora Venturini
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
| | - Michele Ciccarelli
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
| | - Gennaro Galasso
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
| | - Speranza Rubattu
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S.Andrea, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Petro Campiglia
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
| | - Sebastiano Sciarretta
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy
| | - Giacomo Frati
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy
| | - Carmine Vecchione
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (M.F.); (E.V.); (S.R.); (S.S.); (G.F.)
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy; (C.I.); (P.D.P.); (M.C.); (G.G.); (P.C.)
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26
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McCallinhart PE, Scandling BW, Trask AJ. Coronary remodeling and biomechanics: Are we going with the flow in 2020? Am J Physiol Heart Circ Physiol 2020; 320:H584-H592. [PMID: 33185115 DOI: 10.1152/ajpheart.00634.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Under normal conditions, coronary blood flow (CBF) provides critical blood supply to the myocardium so that it can appropriately meet the metabolic demands of the body. Dogmatically, there exist several known regulators and modulators of CBF that include local metabolites and neurohormonal factors that can influence the function of the coronary circulation. In disease states such as diabetes and myocardial ischemia, these regulators are impaired or shifted such that CBF is reduced. Although functional considerations have been and continued to be well studied, more recent evidence builds upon established studies that collectively suggest that the relative roles of coronary structure, biomechanics, and the influence of cardiac biomechanics via extravascular compression may also play a significant role in dictating CBF. In this mini review, we discuss these regulators of CBF under normal and pathophysiological conditions and their potential influence on the control of CBF.
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Affiliation(s)
- Patricia E McCallinhart
- Center for Cardiovascular Research, The Heart Center, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Benjamin W Scandling
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio.,Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Aaron J Trask
- Center for Cardiovascular Research, The Heart Center, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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27
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Babaniamansour P, Mohammadi M, Babaniamansour S, Aliniagerdroudbari E. The Relation between Atherosclerosis Plaque Composition and Plaque Rupture. JOURNAL OF MEDICAL SIGNALS & SENSORS 2020; 10:267-273. [PMID: 33575199 PMCID: PMC7866947 DOI: 10.4103/jmss.jmss_48_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/11/2020] [Accepted: 07/19/2020] [Indexed: 11/13/2022]
Abstract
Background: Intima, media, and adventitia are three layers of arteries. They have different structures and different mechanical properties. Damage to intima layer of arteries leads to an inflammatory response, which is usually the reason for atherosclerosis plaque formation. Atherosclerosis plaques mainly consist of smooth muscle cells and calcium. However, plaque geometry and mechanical properties change during time. Blood flow is the source of biomechanical stress to the plaques. Maximum stress that atherosclerosis plaque can burden before its rupture depends on fibrous cap thickness, lipid core, calcification, and artery stenosis. When atherosclerotic plaque ruptures, the blood would be in contact with coagulation factors. That is why plaque rupture is one of the main causes of fatality. Method: In this article, the coronary artery was modeled by ANSYS. First, fibrous cap thickness was increased from 40 μm to 250 μm by keeping other parameters constant. Then, the lipid pool percentage was incremented from 10% to 90% by keeping other parameters unchanged. Furthermore, for investigating the influence of calcium in plaque vulnerability, calcium was modeled in both agglomerated and microcalcium form. Results: It is proved that atherosclerosis plaque stress decreases exponentially as cap thickness increases. Larger lipid pool leads to more vulnerable plaques. In addition, the analysis showed maximum plaque stress usually increases in calcified plaque as compared with noncalcified plaque. Conclusion: The plaque stress is dependent on whether calcium is agglomerated near the lumen or far from it. However, in both cases, the deposition of more calcium in calcified plaque reduces maximum plaque stress.
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Affiliation(s)
- Parto Babaniamansour
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Maryam Mohammadi
- Department of Biomedical Engineering, University of Isfahan, Isfahan
| | - Sepideh Babaniamansour
- Department of Internal Medicine, School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Ehsan Aliniagerdroudbari
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Chen X, Gao X, Kan J, Shrestha R, Han L, Lu S, Qian X, Gogas BD, Zhang J, Chen SL. Overlapping Drug-Eluting Stent Is Associated with Increased Definite Stent Thrombosis and Revascularization: Results from 15,561 Patients in the AUTHENTIC Study. Cardiovasc Drugs Ther 2020; 35:331-341. [PMID: 33085027 DOI: 10.1007/s10557-020-07094-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was to analyze the incidence of definite stent thrombosis (ST) after the implantation of drug-eluting stents (DESs) and cutoff value of overlapping length for predicting definite ST. An overlapping stent is associated with a high rate of clinical events after DES implantation compared with a non-overlapping stent. However, the rates of definite ST and clinical outcomes from a large patient population remain underreported. METHODS A total of 15,561 patients with 24,183 lesions who underwent DES implantation from January 2005 to February 2017 were retrospectively included in 5 tertiary hospitals in China. The main endpoint was the incidence of definite ST after procedures. RESULTS With a median of 1932 (IQR = 1194-2929) days, clinical follow-up was available in 7484 patients in the overlap group and in 8077 patients in the non-overlap group. The rates of definite ST were 3.1% in the overlap group and 1.2% in the non-overlap group (HR: 2.67 (95% CI: 2.11-3.38), p < 0.001). Of the 24,183 treated lesions, the incidences of definite ST were 2.4% in the overlap group and 0.9% in the non-overlap group (HR: 2.96 (95% CI: 2.38-3.69), p < 0.001). Stent overlap was associated with a higher rate of target lesion revascularization (TLR) (9.4%) compared with stent non-overlap (6.4%, p < 0.001). The length of overlapping stent ≥ 2.93 mm strongly correlated with definite ST. CONCLUSION The present study shows that overlapping DES increases definite ST and revascularization in patients during long-term follow-up. In addition, the longer overlapping zone was associated with worse clinical outcomes.
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Affiliation(s)
- Xiang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Jinshan Road 2999#, Xiamen, China
| | - Xiaofei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China
| | - Jing Kan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China
| | - Rajiv Shrestha
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China
| | - Leng Han
- Department of Cardiology, Changshu NO.1 People's Hospital, Changshu, China
| | - Shu Lu
- Department of Cardiology, The First People's Hospital of Taicang, Taicang, China
| | - Xuesong Qian
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Zhangjiagang, China
- Department of Cardiology, Emory University Hospital, Atlanta, GA, USA
| | - Bill D Gogas
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Zhangjiagang, China
- Department of Cardiology, Emory University Hospital, Atlanta, GA, USA
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China.
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China.
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29
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Gijsen F, Katagiri Y, Barlis P, Bourantas C, Collet C, Coskun U, Daemen J, Dijkstra J, Edelman E, Evans P, van der Heiden K, Hose R, Koo BK, Krams R, Marsden A, Migliavacca F, Onuma Y, Ooi A, Poon E, Samady H, Stone P, Takahashi K, Tang D, Thondapu V, Tenekecioglu E, Timmins L, Torii R, Wentzel J, Serruys P. Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications. Eur Heart J 2020; 40:3421-3433. [PMID: 31566246 PMCID: PMC6823616 DOI: 10.1093/eurheartj/ehz551] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/09/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Frank Gijsen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yuki Katagiri
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter Barlis
- Department of Medicine and Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Cardiology, Northern Hospital, 185 Cooper Street, Epping, Australia.,St Vincent's Heart Centre, Building C, 41 Victoria Parade, Fitzroy, Australia
| | - Christos Bourantas
- Institute of Cardiovascular Sciences, University College of London, London, UK.,Department of Cardiology, Barts Heart Centre, London, UK.,School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Carlos Collet
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Umit Coskun
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jouke Dijkstra
- LKEB-Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Elazer Edelman
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.,Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA
| | - Paul Evans
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - Kim van der Heiden
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rod Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK.,Department of Circulation and Imaging, NTNU, Trondheim, Norway
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.,Institute of Aging, Seoul National University, Seoul, Korea
| | - Rob Krams
- School of Engineering and Materials Science Queen Mary University of London, London, UK
| | - Alison Marsden
- Departments of Bioengineering and Pediatrics, Institute of Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Yoshinobu Onuma
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrew Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Poon
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kuniaki Takahashi
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Dalin Tang
- Department of Mathematics, Southeast University, Nanjing, China; Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Vikas Thondapu
- Department of Medicine and Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia.,Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erhan Tenekecioglu
- Department of Interventional Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Lucas Timmins
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, UK
| | - Jolanda Wentzel
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick Serruys
- Erasmus University Medical Center, Rotterdam, the Netherlands.,Imperial College London, London, UK.,Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
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Hirai K, Imamura S, Hirai A, Ookawara S, Morishita Y. Effect of Evolocumab on Vulnerable Coronary Plaques: A Serial Coronary Computed Tomography Angiography Study. J Clin Med 2020; 9:jcm9103338. [PMID: 33080961 PMCID: PMC7603278 DOI: 10.3390/jcm9103338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023] Open
Abstract
This study investigated the effects of evolocumab on vulnerable coronary plaques and factors associated with the change in stability and size of plaques in patients taking statins. Vulnerable coronary plaques were defined using coronary computed tomography (CT) angiography as having a density of <50 HU within the region of interest and a remodeling index ≥1.1. The changes in minimum CT density, remodeling index, and percent stenosis of vulnerable coronary plaques after six months of evolocumab administration were retrospectively analyzed in 136 vulnerable coronary plaques from 98 patients (68 men and 30 women; mean age: 72.9 ± 8.7 years) treated with a statin. The administration of evolocumab significantly increased the minimum CT density (39.1 ± 8.1 HU to 84.9 ± 31.4 HU, p < 0.001), reduced the remodeling index (1.29 ± 0.11 to 1.19 ± 0.10, p < 0.001), and decreased the percent stenosis (27.0 ± 10.4% to 21.2 ± 9.8%, p < 0.001). Multiple linear regression analysis revealed that baseline percent stenosis (standard coefficient (β) = -0.391, p = 0.002) independently correlated with the change in minimum CT density, whereas the baseline remodeling index (β = -0.368, p < 0.001) independently correlated with a change in the remodeling index. Evolocumab stabilized vulnerable coronary plaques and reduced their size. These results suggest that evolocumab protects against coronary artery disease progression in patients taking statins.
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Affiliation(s)
- Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken 330-8503, Japan; (S.O.); (Y.M.)
- Correspondence: ; Tel.: +81-48-647-2111; Fax: +81-48-647-6831
| | - Shigeki Imamura
- Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara-shi, Chiba-ken 290-0512, Japan; (S.I.); (A.H.)
| | - Aizan Hirai
- Department of Internal Medicine, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara-shi, Chiba-ken 290-0512, Japan; (S.I.); (A.H.)
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken 330-8503, Japan; (S.O.); (Y.M.)
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken 330-8503, Japan; (S.O.); (Y.M.)
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31
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Sterpetti AV. Inflammatory Cytokines and Atherosclerotic Plaque Progression. Therapeutic Implications. Curr Atheroscler Rep 2020; 22:75. [PMID: 33025148 PMCID: PMC7538409 DOI: 10.1007/s11883-020-00891-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF THE REVIEW Inflammatory cytokines play a major role in atherosclerotic plaque progression. This review summarizes the rationale for personalized anti-inflammatory therapy. RECENT FINDINGS Systemic inflammatory parameters may be used to follow the clinical outcome in primary and secondary prevention. Medical therapy, both in patients with stable cardiovascular disease, or with acute events, may be tailored taking into consideration the level and course of systemic inflammatory mediators. There is significant space for improvement in primary prevention and in the treatment of patients who have suffered from severe cardiovascular events, paying attention to not only blood pressure and cholesterol levels but also including inflammatory parameters in our clinical analysis. The potential exists to alter the course of atherosclerosis with anti-inflammatory drugs. With increased understanding of the specific mechanisms that regulate the relationship between inflammation and atherosclerosis, new, more effective and specific anti-inflammatory treatment may become available.
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Affiliation(s)
- Antonio V Sterpetti
- University of Rome Sapienza, Rome, Italy.
- AV Sterpetti- Policlinico Umberto I, Viale del Policlinico, 00167, Rome, Italy.
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32
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Tyson J, Bundy K, Roach C, Douglas H, Ventura V, Segars MF, Schwartz O, Simpson CL. Mechanisms of the Osteogenic Switch of Smooth Muscle Cells in Vascular Calcification: WNT Signaling, BMPs, Mechanotransduction, and EndMT. Bioengineering (Basel) 2020; 7:bioengineering7030088. [PMID: 32781528 PMCID: PMC7552614 DOI: 10.3390/bioengineering7030088] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 12/16/2022] Open
Abstract
Characterized by the hardening of arteries, vascular calcification is the deposition of hydroxyapatite crystals in the arterial tissue. Calcification is now understood to be a cell-regulated process involving the phenotypic transition of vascular smooth muscle cells into osteoblast-like cells. There are various pathways of initiation and mechanisms behind vascular calcification, but this literature review highlights the wingless-related integration site (WNT) pathway, along with bone morphogenic proteins (BMPs) and mechanical strain. The process mirrors that of bone formation and remodeling, as an increase in mechanical stress causes osteogenesis. Observing the similarities between the two may aid in the development of a deeper understanding of calcification. Both are thought to be regulated by the WNT signaling cascade and bone morphogenetic protein signaling and can also be activated in response to stress. In a pro-calcific environment, integrins and cadherins of vascular smooth muscle cells respond to a mechanical stimulus, activating cellular signaling pathways, ultimately resulting in gene regulation that promotes calcification of the vascular extracellular matrix (ECM). The endothelium is also thought to contribute to vascular calcification via endothelial to mesenchymal transition, creating greater cell plasticity. Each of these factors contributes to calcification, leading to increased cardiovascular mortality in patients, especially those suffering from other conditions, such as diabetes and kidney failure. Developing a better understanding of the mechanisms behind calcification may lead to the development of a potential treatment in the future.
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33
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Kolpakova AF, Sharipov RN, Volkova OA, Kolpakov FA. Role of air pollution by particulate matter in the pathogenesis of cardiovascular diseases. Prevention measures. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review highlights contemporary concepts about the role of atmospheric air pollution by particulate matter (PM) in pathogenesis of cardiovascular diseases (CVD). We used publications from the PubMed and Russian Science Citation Index databases. The influence of PM on the development and progression of CVD is considered depending on size, origin, chemical composition, concentration in air. PM with an aerodynamic diameter of ≤2,5 μm (PM2,5) are recognized as the most dangerous. Epidemiological studies have established a dose-dependent effect PM. Oxidative stress, damage of genome of cell and epigenetic changes associated with PM effect are the important component of CVD pathogenesis. Systematization of scientific data through a formalized description helps to understand the pathogenesis of CVD and facilitates its practical use for assessing the risk of occurrence, early diagnosing, prognostication, increasing the effectiveness of treatment, and developing preventive measures.
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Affiliation(s)
- A. F. Kolpakova
- Institute of Computational Technologies, Siberian Branch of the Russian Academy of Sciences
| | | | - O. A. Volkova
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences
| | - F. A. Kolpakov
- Institute of Computational Technologies, Siberian Branch of the Russian Academy of Sciences;
LLC BIOSOFT.RU
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34
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Kurihara O, Takano M, Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Yan BP, Crea F, Higuma T, Kimura S, Minami Y, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, Thondapu V, Kim HO, Russo M, Sugiyama T, Fracassi F, Lee H, Mizuno K, Jang IK. Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes. J Am Heart Assoc 2020; 9:e015579. [PMID: 32611221 PMCID: PMC7670515 DOI: 10.1161/jaha.119.015579] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (P=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; P=0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; P=0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (P=0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03479723.
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Affiliation(s)
- Osamu Kurihara
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Masamichi Takano
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai, Chiba Japan
| | - Erika Yamamoto
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Taishi Yonetsu
- Department of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine Nara Medical University Nara Japan
| | - Bryan P Yan
- Division of Cardiology Department of Medicine and Therapeutics Prince of Wales Hospital Chinese University of Hong Kong Hong Kong SAR China
| | - Filippo Crea
- Fondazione Policlinico Universitario A Gemelli IRCCS Roma Italy
| | - Takumi Higuma
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Kanagawa Japan
| | - Shigeki Kimura
- Division of Cardiology Kameda Medical Center Chiba Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine University Hospitals Leuven Leuven Belgium
| | | | - Holger M Nef
- Department of Cardiology University of Giessen Germany
| | - Chong Jin Kim
- Department of Cardiology Kyung Hee University Hospital Seoul Korea
| | - Vikas Thondapu
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Hyung Oh Kim
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Michele Russo
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Tomoyo Sugiyama
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Francesco Fracassi
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital Harvard Medical School Boston MA
| | | | - Ik-Kyung Jang
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.,Department of Cardiology Kyung Hee University Hospital Seoul Korea
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35
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Dominic A, Banerjee P, Hamilton DJ, Le NT, Abe JI. Time-dependent replicative senescence vs. disturbed flow-induced pre-mature aging in atherosclerosis. Redox Biol 2020; 37:101614. [PMID: 32863187 PMCID: PMC7767754 DOI: 10.1016/j.redox.2020.101614] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 12/19/2022] Open
Abstract
Accumulation of senescent cells has a causative role in the pathology of age-related disorders including atherosclerosis (AS) and cardiovascular diseases (CVDs). However, the concept of senescence is now drastically changing, and the new concept of senescence-associated reprogramming/stemness has emerged, suggesting that senescence is not merely related to “cell cycle arrest” or halting various cellular functions. It is well known that disturbed flow (D-flow) accelerates pre-mature aging and plays a significant role in the development of AS. We will discuss in this review that pre-mature aging induced by D-flow is not comparable to time-dependent aging, particularly with a focus on the possible involvement of senescence-associated secretory phenotype (SASP) in senescence-associated reprogramming/stemness, or increasing cell numbers. We will also present our outlook of nicotinamide adenine dinucleotides (NAD)+ deficiency-induced mitochondrial reactive oxygen species (mtROS) in evoking SASP by activating DNA damage response (DDR). MtROS plays a key role in developing cross-talk between nuclear-mitochondria, SASP, and ultimately atherosclerosis formation. Although senescence induced by time and various stress factors is a classical concept, we wish that the readers will see the undergoing Copernican-like change in this concept, as well as to recognize the significant contrast between pre-mature aging induced by D-flow and time-dependent aging.
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Affiliation(s)
- Abishai Dominic
- Department of Molecular and Cellular Biology Texas A&M Health Science Center, USA; Department of Cardio-Vascular Regeneration, Houston Methodist Research Institute, Texas, USA
| | - Priyanka Banerjee
- Department of Cardio-Vascular Regeneration, Houston Methodist Research Institute, Texas, USA
| | - Dale J Hamilton
- Department of Medicine, Center for Bioenergetics Houston Methodist Research Institute, Texas, USA
| | - Nhat-Tu Le
- Department of Cardio-Vascular Regeneration, Houston Methodist Research Institute, Texas, USA.
| | - Jun-Ichi Abe
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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36
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Kilic Y, Safi H, Bajaj R, Serruys PW, Kitslaar P, Ramasamy A, Tufaro V, Onuma Y, Mathur A, Torii R, Baumbach A, Bourantas CV. The Evolution of Data Fusion Methodologies Developed to Reconstruct Coronary Artery Geometry From Intravascular Imaging and Coronary Angiography Data: A Comprehensive Review. Front Cardiovasc Med 2020; 7:33. [PMID: 32296713 PMCID: PMC7136420 DOI: 10.3389/fcvm.2020.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/21/2020] [Indexed: 12/01/2022] Open
Abstract
Understanding the mechanisms that regulate atherosclerotic plaque formation and evolution is a crucial step for developing treatment strategies that will prevent plaque progression and reduce cardiovascular events. Advances in signal processing and the miniaturization of medical devices have enabled the design of multimodality intravascular imaging catheters that allow complete and detailed assessment of plaque morphology and biology. However, a significant limitation of these novel imaging catheters is that they provide two-dimensional (2D) visualization of the lumen and vessel wall and thus they cannot portray vessel geometry and 3D lesion architecture. To address this limitation computer-based methodologies and user-friendly software have been developed. These are able to off-line process and fuse intravascular imaging data with X-ray or computed tomography coronary angiography (CTCA) to reconstruct coronary artery anatomy. The aim of this review article is to summarize the evolution in the field of coronary artery modeling; we thus present the first methodologies that were developed to model vessel geometry, highlight the modifications introduced in revised methods to overcome the limitations of the first approaches and discuss the challenges that need to be addressed, so these techniques can have broad application in clinical practice and research.
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Affiliation(s)
- Yakup Kilic
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Hannah Safi
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Pieter Kitslaar
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Vincenzo Tufaro
- Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | | | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, London, United Kingdom.,Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
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37
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Feng Y, Liu J, Fan T, Zhang W, Yin X, E Y, Tan W, Huo Y. Vertebral Artery Stenoses Contribute to the Development of Diffuse Plaques in the Basilar Artery. Front Bioeng Biotechnol 2020; 8:168. [PMID: 32211395 PMCID: PMC7068210 DOI: 10.3389/fbioe.2020.00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/19/2020] [Indexed: 12/19/2022] Open
Abstract
Vertebral artery (VA) stenosis is relevant to a high early risk of recurrent stroke and basilar artery (BA) is the most common intracranial site of atherosclerotic lesions. It is important to show predictive risk factors for transient ischemic attack (TIA) or posterior infarctions. The aim of the study is to investigate morphometry and hemodynamics in intracranial vertebral and basilar arteries of health and diseased patients to enhance the risk assessment. Based on the geometrical model reconstructed from CTA images in 343 patients, a transient three-dimensional computational model was used to determine the hemodynamics. Patients were classified in symmetric, asymmetric, hypoplastic, and stenotic groups while patients in the stenotic group were divided into unilateral, bilateral, bifurcation, and tandem stenotic sub-groups. Patients in bilateral, bifurcation, and tandem stenotic sub-groups had significantly lower basilar artery diameters than other groups. Patients in the stenotic group had significantly higher surface area ratio (SAR) of high time-averaged wall shear stress gradient (TAWSSG) and higher incidence of TIAs or posterior infarctions than other groups while patients in the tandem stenotic sub-group had the highest values (SAR-TAWSSG of 57 ± 22% and TIAs or posterior infarction incidence of 54%). The high SAR-TAWSSG is predisposed to induce TIAs or posterior infarction.
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Affiliation(s)
- Yundi Feng
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Tingting Fan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Wenxi Zhang
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Xiaoping Yin
- Department of Radiology, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Yajun E
- Department of Neurology, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.,Shenzhen Graduate School, Peking University, Shenzhen, China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.,Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
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38
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Becher T, Riascos-Bernal DF, Kramer DJ, Almonte VM, Chi J, Tong T, Oliveira-Paula GH, Koleilat I, Chen W, Cohen P, Sibinga NES. Three-Dimensional Imaging Provides Detailed Atherosclerotic Plaque Morphology and Reveals Angiogenesis After Carotid Artery Ligation. Circ Res 2020; 126:619-632. [PMID: 31914850 DOI: 10.1161/circresaha.119.315804] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
RATIONALE Remodeling of the vessel wall and the formation of vascular networks are dynamic processes that occur during mammalian embryonic development and in adulthood. Plaque development and excessive neointima formation are hallmarks of atherosclerosis and vascular injury. As our understanding of these complex processes evolves, there is a need to develop new imaging techniques to study underlying mechanisms. OBJECTIVE We used tissue clearing and light-sheet microscopy for 3-dimensional (3D) profiling of the vascular response to carotid artery ligation and induction of atherosclerosis in mouse models. METHODS AND RESULTS Adipo-Clear and immunolabeling in combination with light-sheet microscopy were applied to image carotid arteries and brachiocephalic arteries, allowing for 3D reconstruction of vessel architecture. Entire 3D neointima formations with different geometries were observed within the carotid artery and scored by volumetric analysis. Additionally, we identified a CD31-positive adventitial plexus after ligation of the carotid artery that evolved and matured over time. We also used this method to characterize plaque extent and composition in the brachiocephalic arteries of ApoE-deficient mice on high-fat diet. The plaques exhibited inter-animal differences in terms of plaque volume, geometry, and ratio of acellular core to plaque volume. A 3D reconstruction of the endothelium overlying the plaque was also generated. CONCLUSIONS We present a novel approach to characterize vascular remodeling in adult mice using Adipo-Clear in combination with light-sheet microscopy. Our method reconstructs 3D neointima formation after arterial injury and allows for volumetric analysis of remodeling, in addition to revealing angiogenesis and maturation of a plexus surrounding the carotid artery. This method generates complete 3D reconstructions of atherosclerotic plaques and uncovers their volume, geometry, acellular component, surface, and spatial position within the brachiocephalic arteries. Our approach may be used in a number of mouse models of cardiovascular disease to assess vessel geometry and volume. Visual Overview: An online visual overview is available for this article.
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Affiliation(s)
- Tobias Becher
- From the Laboratory of Molecular Metabolism (T.B., D.J.K., J.C., P.C.), The Rockefeller University, NY.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany (T.B.).,First Department of Medicine (Division of Cardiology), University Medical Center Mannheim, Germany (T.B.)
| | - Dario F Riascos-Bernal
- (Cardiology Division) Department of Medicine, Department of Developmental and Molecular Biology, Wilf Family Cardiovascular Research Institute (D.F.R.-B., V.M.A., G.H.O.-P., N.E.S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J Kramer
- From the Laboratory of Molecular Metabolism (T.B., D.J.K., J.C., P.C.), The Rockefeller University, NY
| | - Vanessa M Almonte
- (Cardiology Division) Department of Medicine, Department of Developmental and Molecular Biology, Wilf Family Cardiovascular Research Institute (D.F.R.-B., V.M.A., G.H.O.-P., N.E.S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Jingy Chi
- From the Laboratory of Molecular Metabolism (T.B., D.J.K., J.C., P.C.), The Rockefeller University, NY
| | - Tao Tong
- Bio-Imaging Resource Center (T.T.), The Rockefeller University, NY
| | - Gustavo H Oliveira-Paula
- (Cardiology Division) Department of Medicine, Department of Developmental and Molecular Biology, Wilf Family Cardiovascular Research Institute (D.F.R.-B., V.M.A., G.H.O.-P., N.E.S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Issam Koleilat
- Department of Cardiothoracic and Vascular Surgery (Division of Vascular Surgery), Montefiore Medical Center, Bronx, NY (I.K.)
| | - Wei Chen
- Department of Medicine (Nephrology Division) (W.C.), Albert Einstein College of Medicine, Bronx, NY.,Department of Medicine, University of Rochester School of Medicine and Dentistry, NY (W.C.)
| | - Paul Cohen
- From the Laboratory of Molecular Metabolism (T.B., D.J.K., J.C., P.C.), The Rockefeller University, NY
| | - Nicholas E S Sibinga
- (Cardiology Division) Department of Medicine, Department of Developmental and Molecular Biology, Wilf Family Cardiovascular Research Institute (D.F.R.-B., V.M.A., G.H.O.-P., N.E.S.S.), Albert Einstein College of Medicine, Bronx, NY
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39
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Kay FU, Canan A, Abbara S. Future Directions in Coronary CT Angiography: CT-Fractional Flow Reserve, Plaque Vulnerability, and Quantitative Plaque Assessment. Korean Circ J 2019; 50:185-202. [PMID: 31960635 PMCID: PMC7043962 DOI: 10.4070/kcj.2019.0315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/08/2019] [Indexed: 01/12/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is a well-validated and noninvasive imaging modality for the assessment of coronary artery disease (CAD) in patients with stable ischemic heart disease and acute coronary syndromes (ACSs). CCTA not only delineates the anatomy of the heart and coronary arteries in detail, but also allows for intra- and extraluminal imaging of coronary arteries. Emerging technologies have promoted new CCTA applications, resulting in a comprehensive assessment of coronary plaques and their clinical significance. The application of computational fluid dynamics to CCTA resulted in a robust tool for noninvasive assessment of coronary blood flow hemodynamics and determination of hemodynamically significant stenosis. Detailed evaluation of plaque morphology and identification of high-risk plaque features by CCTA have been confirmed as predictors of future outcomes, identifying patients at risk for ACSs. With quantitative coronary plaque assessment, the progression of the CAD or the response to therapy could be monitored by CCTA. The aim of this article is to review the future directions of emerging applications in CCTA, such as computed tomography (CT)-fractional flow reserve, imaging of vulnerable plaque features, and quantitative plaque imaging. We will also briefly discuss novel methods appearing in the coronary imaging scenario, such as machine learning, radiomics, and spectral CT.
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Affiliation(s)
| | - Arzu Canan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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40
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Abstract
PURPOSE OF REVIEW This review addresses recent developments in studies of lipid regulation of calcific disease of arteries and cardiac valves, including the role of nuclear receptors. The role of lipid-soluble signals and their receptors is timely given the recent evidence and concerns that lipid-lowering treatment may increase the rate of progression of coronary artery calcification, which has been long associated with increased cardiovascular risk. Understanding the mechanisms will be important for interpreting such clinical information. RECENT FINDINGS New findings support regulation of calcific vascular and valvular disease by nuclear receptors, including the vitamin D receptor, glucocorticoid receptor, nutrient-sensing nuclear receptors (liver X receptor, farnesoid X receptor, and peroxisome proliferator-activated receptors), and sex hormone (estrogen and androgen) receptors. There were two major unexpected findings: first, vitamin D supplementation, which was previously believed to prevent or reduce vascular calcification, showed no cardiovascular benefit in large randomized, controlled trials. Second, both epidemiological studies and coronary intravascular ultrasound studies suggest that treatment with HMG-CoA reductase inhibitors increases progression of coronary artery calcification, raising a question of whether there are mechanically stable and unstable forms of coronary calcification. SUMMARY For clinical practice and research, these new findings offer new fundamental mechanisms for vascular calcification and provide new cautionary insights for therapeutic avenues.
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Affiliation(s)
- Tamer Sallam
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1679
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA 90095-1679
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095-1679
| | - Yin Tintut
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1679
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA 90095-1679
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA 90095-1679
| | - Linda L. Demer
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1679
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA 90095-1679
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA 90095-1679
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41
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Emuna N, Durban D, Osovski S. Sensitivity of Arterial Hyperelastic Models to Uncertainties in Stress-Free Measurements. J Biomech Eng 2019; 140:2683233. [PMID: 30029245 DOI: 10.1115/1.4040400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 12/14/2022]
Abstract
Despite major advances made in modeling vascular tissue biomechanics, the predictive power of constitutive models is still limited by uncertainty of the input data. Specifically, key measurements, like the geometry of the stress-free (SF) state, involve a definite, sometimes non-negligible, degree of uncertainty. Here, we introduce a new approach for sensitivity analysis of vascular hyperelastic constitutive models to uncertainty in SF measurements. We have considered two vascular hyperelastic models: the phenomenological Fung model and the structure-motivated Holzapfel-Gasser-Ogden (HGO) model. Our results indicate up to 160% errors in the identified constitutive parameters for a 5% measurement uncertainty in the SF data. Relative margins of errors of up to 30% in the luminal pressure, 36% in the axial force, and over 200% in the stress predictions were recorded for 10% uncertainties. These findings are relevant to the large body of studies involving experimentally based modeling and analysis of vascular tissues. The impact of uncertainties on calibrated constitutive parameters is significant in context of studies that use constitutive parameters to draw conclusions about the underlying microstructure of vascular tissues, their growth and remodeling processes, and aging and disease states. The propagation of uncertainties into the predictions of biophysical parameters, e.g., force, luminal pressure, and wall stresses, is of practical importance in the design and execution of clinical devices and interventions. Furthermore, insights provided by the present findings may lead to more robust parameters identification techniques, and serve as selection criteria in the trade-off between model complexity and sensitivity.
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Affiliation(s)
- Nir Emuna
- Faculty of Aerospace Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel e-mail:
| | - David Durban
- Faculty of Aerospace Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel e-mail:
| | - Shmuel Osovski
- Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel e-mail:
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42
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Genkel VV, Shaposhnik II. [Carotid Wall Shear Rate as a Marker of Systemic Atherosclerosis and Atherosclerotic Cardiovascular Disease]. KARDIOLOGIYA 2019; 59:45-52. [PMID: 31131767 DOI: 10.18087/cardio.2019.5.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
AIM to assess possibility of the use of carotid wall shear rate (WSR) as a marker of systemic atherosclerosis and atherosclerotic cardiovascular disease (ASCVD). MATERIALS AND METHODS We included into this study 200 patients with different cardiovascular risk (142 patients already had one or more ASCVD). All patients underwent ultrasound scanning of carotid and lower limb arteries with measurement of the ankle-brachial index. Carotid WSR was determined during ultrasonic scanning of carotid arteries in accordance with the Hagen-Poiseuille law. RESULTS Mean WSR value in this cohort of patients was 434±139 s-1. Based on the results of the ROCanalysis, it was found that WSR below the threshold value of 300 s-1 allowed to predict the presence of ASCVD with sensitivity of 97.1 % and specificity of 84.6 %. WSR <300 s-1 was associated with relative risk (RR) of ASCVD presence 11.2 (95 % CI 1.26-99.3, p=0.03), adjusted for factors such as sex, age, smoking, obesity, hypertension, estimated glomerular filtration rate (eGFR), low density lipoprotein cholesterol, and high sensitivity C-reactive protein, carotid intima-media thickness. The model which included carotid WSR, as well as factors such as the presence of type 2 diabetes, obesity, sex, age, eGFR, allowed to diagnose combined atherosclerotic lesions of peripheral arteries with a sensitivity of 73.1 % and a specificity of 90.3 %. CONCLUSION Evaluation of the carotid WSR allows to diagnose with satisfactory sensitivity and specificity the presence of combined atherosclerosis of peripheral arteries and ASCVD.
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43
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Wu X, von Birgelen C, Zhang S, Ding D, Huang J, Tu S. Simultaneous evaluation of plaque stability and ischemic potential of coronary lesions in a fluid-structure interaction analysis. Int J Cardiovasc Imaging 2019; 35:1563-1572. [PMID: 31053979 DOI: 10.1007/s10554-019-01611-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 04/23/2019] [Indexed: 01/31/2023]
Abstract
The measurement of fractional flow reserve (FFR) and superficial wall stress (SWS) identifies inducible myocardial ischemia and plaque vulnerability, respectively. A simultaneous evaluation of both FFR and SWS is still lacking, while it may have a major impact on therapy. A new computational model of one-way fluid-structure interaction (FSI) was implemented and used to perform a total of 54 analyses in virtual coronary lesion models, based on plaque compositions, arterial remodeling patterns, and stenosis morphologies under physiological conditions. Due to a greater lumen dilation and more induced strain, FFR in the lipid-rich lesions (0.81 ± 0.15) was higher than that in fibrous lesions (0.79 ± 0.16, P = 0.001) and calcified lesions (0.79 ± 0.16, P = 0.001). Four types of lesions were further defined, based on the combination of cutoff values for FFR (0.80) and maximum relative SWS (30 kPa): The level of risk increased from (1) plaques with mild-to-moderate stenosis but negative remodeling for lipid-rich (Type A: non-ischemic, stable) to (2) lipid-rich plaques with mild-to-moderate stenosis and without-to-positive remodeling (Type B: non-ischemic, unstable) or plaques with severe stenosis but negative remodeling for lipid-rich (Type C: ischemic, stable) to (3) lipid-rich plaques with severe stenosis and without-to-positive remodeling (Type D: ischemic, unstable). The analysis of FSI to simultaneously evaluate inducible myocardial ischemia and plaque stability may be useful to identify coronary lesions at a high risk and to ultimately optimize treatment. Further research is warranted to assess whether a more aggressive treatment may improve the prognosis of patients with non-ischemic, intermediate, and unstable lesions.
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Affiliation(s)
- Xinlei Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | | | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayue Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
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Bourantas CV, Zanchin T, Sakellarios A, Karagiannis A, Ramasamy A, Yamaji K, Taniwaki M, Heg D, Moschovitis A, Fotiadis D, Mihalis L, Baumbach A, Torii R, Serruys P, Garcia-Garcia HM, Windecker S, Räber L. Implications of the local haemodynamic forces on the phenotype of coronary plaques. Heart 2019; 105:1078-1086. [PMID: 30877239 DOI: 10.1136/heartjnl-2018-314086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 11/03/2022] Open
Abstract
AIM To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype. METHODS Patients with myocardial infarction that had intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of ≥2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable phenotype. Linear mixed effects models were used to assess the effect of ESS in different phenotypes. RESULTS Sixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and phenotype (p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (β=0.70, p<0.001) than fibrotic/fibrocalcific (β=0.28, p<0.001) or lipid-rich plaques (β=0.15, p=0.015). Standalone IVUS-VH misclassified plaque morphology in one-third of the cases leading to erroneous estimations about the effect of ESS on plaque evolution in different phenotypes. CONCLUSIONS The effect of ESS on plaque progression is similar in all phenotypes and cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution. CLINICAL TRIAL REGISTRATION NCT00962416; Post-results.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK.,School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.,Department of Mechanical Engineering, University College London, London, UK
| | - Antonis Sakellarios
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Alexios Karagiannis
- Clinical Trial Unit, Institute of Social and Preventive Medicine, Bern, Switzerland
| | | | - Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Masanori Taniwaki
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Clinical Trial Unit, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Aris Moschovitis
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Dimitrios Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Lampros Mihalis
- Department of Cardiology, University of Ioannina, Ioannina, Greece
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,School of Medicine and Dentistry, Queen Mary University London, London, London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Patrick Serruys
- International Centre for Circulatory Health, Imperial College London Institute of Clinical Sciences, London, UK
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, Columbia, USA
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Cao Y, Li R, Zhang F, Guo Z, Tuo S, Li Y. Correlation between angiopoietin-like proteins in inflammatory mediators in peripheral blood and severity of coronary arterial lesion in patients with acute myocardial infarction. Exp Ther Med 2019; 17:3495-3500. [PMID: 30988729 PMCID: PMC6447790 DOI: 10.3892/etm.2019.7386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
The effects of angiopoietin-like protein 2 (Angptl 2) and interleukin-6 (IL-6) in inflammatory mediators on the severity of coronary arterial lesion in patients with acute myocardial infarction were investigated. One hundred and twenty-six patients with acute myocardial infarction admitted to Tianjin Union Medical Center (the myocardial infarction group) and 133 healthy individuals (the control group) were selected for retrospective analysis from January 2013 to December 2015. The levels of Angptl 2 and IL-6 in serum of patients were detected by enzyme linked immunosorbent assay (ELISA), and the correlation analysis between the levels and the degree of coronary stenosis in patients with myocardial infarction was conducted. The expression level of Angptl 2 and IL-6 in the myocardial infarction group was significantly higher than that in the control group P<0.001. In the myocardial infarction group, the expression levels of Angptl 2 and IL-6 were the highest in the patients with severe stenosis, followed by the moderate stenosis, and the lowest in the patients with mild stenosis (P<0.050). Pearson's correlation analysis showed that Angptl 2 and IL-6 were positively correlated with the diameter of coronary stenosis (r=0.696, 0.750, P<0.001). In conclusion, both Angptl 2 and IL-6 are highly expressed in the peripheral blood of patients with acute myocardial infarction and involved in the occurrence and development of the disease. Moreover, Angptl2 and IL-6 are positively correlated with the severity of coronary arterial lesion in patients with acute myocardial infarction, and they are expected to become a target for the diagnosis and treatment of coronary atherosclerosis (CA) in the future.
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Affiliation(s)
- Yuejuan Cao
- Department of Cardiology, Tianjin Union Medical Center, Tianjin 300121, P.R. China
| | - Rongqing Li
- Department of Vascular Surgery, Tianjin Union Medical Center, Tianjin 300121, P.R. China
| | - Fengping Zhang
- Department of Cardiology, Tianjin Union Medical Center, Tianjin 300121, P.R. China
| | - Zhaozeng Guo
- Department of Cardiology, Tianjin Union Medical Center, Tianjin 300121, P.R. China
| | - Shaoyong Tuo
- Department of Cardiology, Tianjin Union Medical Center, Tianjin 300121, P.R. China
| | - Yuming Li
- Department of Radiology, Pingjin Hospital Heart Center and Tianjin, Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Logistics University of PAPF, Tianjin 300162, P.R. China
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46
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Bechiri MY, Souteyrand G, Lefèvre T, Trouillet C, Rangé G, Cayla G, Dérimay F, Mangin L, Meneveau N, Caussin C, Motreff P, Amabile N. Characteristics of stent thrombosis in bifurcation lesions analysed by optical coherence tomography. EUROINTERVENTION 2018; 13:e2174-e2181. [DOI: 10.4244/eij-d-17-00794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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47
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Poon EKW, Thondapu V, Hayat U, Barlis P, Yap CY, Kuo PH, Wang Q, Ma J, Zhu SJ, Moore S, Ooi ASH. Elevated Blood Viscosity and Microrecirculation Resulting From Coronary Stent Malapposition. J Biomech Eng 2018; 140:2673009. [DOI: 10.1115/1.4039306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Indexed: 01/09/2023]
Abstract
One particular complexity of coronary artery is the natural tapering of the vessel with proximal segments having larger caliber and distal tapering as the vessel get smaller. The natural tapering of a coronary artery often leads to proximal incomplete stent apposition (ISA). ISA alters coronary hemodynamics and creates pathological path to develop complications such as in-stent restenosis, and more worryingly, stent thrombosis (ST). By employing state-of-the-art computer-aided design software, generic stent hoops were virtually deployed in an idealized tapered coronary artery with decreasing malapposition distance. Pulsatile blood flow simulations were carried out using computational fluid dynamics (CFD) on these computer-aided design models. CFD results reveal unprecedented details in both spatial and temporal development of microrecirculation environments throughout the cardiac cycle (CC). Arterial tapering also introduces secondary microrecirculation. These primary and secondary microrecirculations provoke significant fluctuations in arterial wall shear stress (WSS). There has been a direct correlation with changes in WSS and the development of atherosclerosis. Further, the presence of these microrecirculations influence strongly on the local levels of blood viscosity in the vicinity of the malapposed stent struts. The observation of secondary microrecirculations and changes in blood rheology is believed to complement the wall (-based) shear stress, perhaps providing additional physical explanations for tissue accumulation near ISA detected from high resolution optical coherence tomography (OCT).
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Affiliation(s)
- Eric K. W. Poon
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Vikas Thondapu
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia
- Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Umair Hayat
- Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Peter Barlis
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Chooi Yin Yap
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Po-Hung Kuo
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Qisen Wang
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Jiawei Ma
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Shuang J. Zhu
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
| | - Stephen Moore
- IBM Research Australia, Carlton 3053, Victoria, Australia e-mail:
| | - Andrew S. H. Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne 3010, Victoria, Australia e-mail:
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48
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Szilágyi SM, Popovici MM, Szilágyi L. Review. Automatic Segmentation Techniques of the Coronary Artery Using CT Images in Acute Coronary Syndromes. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Coronary artery disease represents one of the leading reasons of death worldwide, and acute coronary syndromes are their most devastating consequences. It is extremely important to identify the patients at risk for developing an acute myocardial infarction, and this goal can be achieved using noninvasive imaging techniques. Coronary computed tomography angiography (CCTA) is currently one of the most reliable methods used for assessing the coronary arteries; however, its use in emergency settings is sometimes limited due to time constraints. This paper presents the main characteristics of plaque vulnerability, the role of CCTA in the assessment of vulnerable plaques, and automatic segmentation techniques of the coronary artery tree based on CT angiography images. A detailed inventory of existing methods is given, representing the state-of-the-art of computational methods applied in vascular system segmentation, focusing on the current applications in acute coronary syndromes.
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Affiliation(s)
| | - Monica Marton Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, 21601, 76th Ave W, Edmonds, Washington , 98026, USA
| | - László Szilágyi
- Department of Electrical Engineering, Sapientia University, Tîrgu Mureș , Romania
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49
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Douglas GR, Brown AJ, Gillard JH, Bennett MR, Sutcliffe MPF, Teng Z. Impact of Fiber Structure on the Material Stability and Rupture Mechanisms of Coronary Atherosclerotic Plaques. Ann Biomed Eng 2017; 45:1462-1474. [PMID: 28361184 PMCID: PMC5415591 DOI: 10.1007/s10439-017-1827-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/22/2017] [Indexed: 12/19/2022]
Abstract
The rupture of an atherosclerotic plaque in the coronary circulation remains the main cause of heart attack. As a fiber-oriented structure, the fiber structure, in particular in the fibrous cap (FC), may affect both loading and material strength in the plaque. However, the role of fiber orientation and dispersion in plaque rupture is unclear. Local orientation and dispersion of fibers were calculated for the shoulder regions, mid FC, and regions with intimal thickening (IT) from histological images of 16 human coronary atherosclerotic lesions. Finite element analysis was performed to assess the effect of these properties on mechanical conditions. Fibers in shoulder regions had markedly reduced alignment (Median [interquartile range] 12.9° [6.6, 18.0], p < 0.05) compared with those in mid FC (6.1° [5.5, 9.0]) and IT regions (6.7° [5.1, 8.6]). Fiber dispersion was highest in shoulders (0.150 [0.121, 0.192]), intermediate in IT (0.119 [0.103, 0.144]), and lowest in mid FC regions (0.093 [0.081, 0.105], p < 0.05). When anisotropic properties were considered, stresses were significantly higher for the mid FC (p = 0.030) and IT regions (p = 0.002) and no difference was found for the shoulder or global regions. Shear (sliding) stress between fibers in each region and their proportion of maximum principal stress were: shoulder (25.8 kPa [17.1, 41.2], 12.4%), mid FC (13.9 kPa [5.8, 29.6], 13.8%), and IT (36.5 kPa [25.9, 47.3], 15.5%). Fiber structure within the FC has a marked effect on principal stresses, resulting in considerable shear stress between fibers. Fiber structure including orientation and dispersion may determine mechanical strength and thus rupture of atherosclerotic plaques.
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Affiliation(s)
- Graeham R Douglas
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan H Gillard
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Michael P F Sutcliffe
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK.
| | - Zhongzhao Teng
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK. .,Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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50
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Zaromytidou M, Antoniadis AP, Siasos G, Coskun AU, Andreou I, Papafaklis MI, Lucier M, Feldman CL, Stone PH. Heterogeneity of Coronary Plaque Morphology and Natural History: Current Understanding and Clinical Significance. Curr Atheroscler Rep 2016; 18:80. [PMID: 27822680 DOI: 10.1007/s11883-016-0626-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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