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Benites-Yshpilco L, Cupe-Chacalcaje K, Cachicatari-Beltrán A, Moscoso J, Velarde-Acosta K, Demarini-Orellana A, Lévano-Pachas G, Baltodano-Arellano R. Complex aortic plaques: hidden danger in aortic stenosis. Role of transesophageal echocardiography. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e377. [PMID: 39015195 PMCID: PMC11247973 DOI: 10.47487/apcyccv.v5i2.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/15/2024] [Indexed: 07/18/2024]
Abstract
Aortic stenosis is associated with aortic plaques in up to 85% of cases because they share risk factors and pathogenic pathways. Intrinsically, complex aortic plaques carry a high risk of stroke, which has also been demonstrated in the context of aortic stenosis, especially in patients who underwent percutaneous or surgical replacement. Transesophageal echocardiography (TEE) is the imaging test of choice to detect plaques in the thoracic aorta and classify them as complex plaques. Furthermore, the 3D modality allows us to better specify its dimensions and anatomical characteristics, such as added thrombi or the presence of ulcers inside. This review aims to evaluate the use of TEE to detect complex aortic plaques in patients with an indication for percutaneous or surgical aortic valve replacement. To highlight the association between aortic stenosis and complex aortic plaques, we attached to the review some TEE studies from our experience.
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Affiliation(s)
- Lindsay Benites-Yshpilco
- Departamento de Cardiología Clínica, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Departamento de Cardiología Clínica Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
| | - Kelly Cupe-Chacalcaje
- Servicio de Cardiología, Área de Imagen Cardíaca, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Servicio de Cardiología, Área de Imagen Cardíaca Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
| | - Angela Cachicatari-Beltrán
- Servicio de Cardiología, Área de Imagen Cardíaca, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Servicio de Cardiología, Área de Imagen Cardíaca Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
| | - Josh Moscoso
- Departamento de Cardiología Clínica, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Departamento de Cardiología Clínica Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
| | - Kevin Velarde-Acosta
- Departamento de Cardiología Clínica, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Departamento de Cardiología Clínica Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
| | - Alessio Demarini-Orellana
- Universidad de San Martín de Porres, Lima, Peru. Universidad de San Martín de Porres Universidad de San Martín de Porres Lima Peru
| | - Gerald Lévano-Pachas
- Departamento de Cardiología Clínica, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Departamento de Cardiología Clínica Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
| | - Roberto Baltodano-Arellano
- Servicio de Cardiología, Área de Imagen Cardíaca, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru. Servicio de Cardiología, Área de Imagen Cardíaca Hospital Guillermo Almenara Irigoyen - EsSalud Lima Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru. Universidad Nacional Mayor de San Marcos Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
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Wehrum T, Dragonu I, Strecker C, Schuchardt F, Hennemuth A, Drexl J, Reinhard T, Böhringer D, Vach W, Hennig J, Harloff A. Aortic atheroma as a source of stroke - assessment of embolization risk using 3D CMR in stroke patients and controls. J Cardiovasc Magn Reson 2017; 19:67. [PMID: 28877718 PMCID: PMC5586056 DOI: 10.1186/s12968-017-0379-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND It was our purpose to identify vulnerable plaques in the thoracic aorta using 3D multi-contrast CMR and estimate the risk of cerebral embolization using 4D flow CMR in cryptogenic stroke patients and controls. METHODS One hundred patients (40 with cryptogenic stroke, 60 ophthalmologic controls matched for age, sex and presence of hypertension) underwent a novel 3D multi-contrast (T1w, T2w, PDw) CMR protocol at 3 Tesla for plaque detection and characterization within the thoracic aorta, which was combined with 4D flow CMR for mapping potential embolization pathways. Plaque morphology was assessed in consensus reading by two investigators and classified according to the modified American-Heart-Association (AHA) classification of atherosclerotic plaques. RESULTS In the thoracic aorta, plaques <4 mm thickness were found in a similar number of stroke patients and controls [23 (57.5%) versus 33 (55.0%); p = 0.81]. However, plaques ≥4 mm were more frequent in stroke patients [22 (55.0%) versus 10 (16.7%); p < 0.001]. Of those patients with plaques ≥4 mm, seven (17.5%) stroke patients and two (3.3%) controls (p < 0.001) had potentially vulnerable AHA type VI plaques. Six stroke patients with vulnerable AHA type VI plaques ≥4 mm had potential embolization pathways connecting the plaque, located in the aortic arch (n = 3) and proximal descending aorta (n = 3), with the individual territory of stroke, which made them the most likely source of stroke in those patients. CONCLUSIONS Our findings underline the significance of ≥4 mm thick and vulnerable plaques in the aortic arch and descending aorta as a relevant etiology of stroke. CLINICAL TRIAL REGISTRATION Unique identifier: DRKS00006234 ; date of registration: 11/06/2014.
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Affiliation(s)
- Thomas Wehrum
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Iulius Dragonu
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic Radiology – Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Strecker
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Schuchardt
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Thomas Reinhard
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Böhringer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Werner Vach
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic Radiology – Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Serin Hİ, Yilmaz YK, Turan Y, Arslan E, Erkoç MF, Doğan A, Celikbilek M. The association between gallstone disease and plaque in the abdominopelvic arteries. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:11. [PMID: 28458703 PMCID: PMC5367247 DOI: 10.4103/1735-1995.199087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 10/01/2016] [Indexed: 01/05/2023]
Abstract
Background: The aim of this study was to assess the atheromatous plaque, in the abdominopelvic arteries as a marker of cardiac risk in patients with or without gallstone disease (GD). Materials and Methods: A total of 136 patients were enrolled in this cross-sectional study. Forty-eight patients had GD and the remaining 88 patients did not. The presence or absence of gallstones was noted during abdominal ultrasonography while vascular risk factors such as plaque formation, intima-media thickness, plaque calcification, mural thrombus, stenosis, aneurysm, and inflammation were recorded during an abdominopelvic computed tomography scan. In addition, percentage of the abdominopelvic aorta surface covered by atheromatous plaque was calculated. Results: The mean age of patients with GD and without GD was 50.81 ± 16.20 and 50.40 ± 12.43, respectively. Patients with GD were more likely to have diabetes mellitus, a higher body mass index (BMI) (P < 0.001), and higher cholesterol (P < 0.01), and low-density lipoprotein-cholesterol (P < 0.02) levels. No significant differences were found between the groups regarding other atherosclerotic risk factors. Patients with GD had significantly higher rates of the vascular risk factors as intima-media thickness, plaque formation, calcification, aneurysm, mural thrombosis, stenosis, and inflammation in all abdominal arterial segments other than aneurysm in the femoral arteries. In addition, patients with GD had severe atheromatous plaques in the abdominal aorta, common iliac, external iliac, and common femoral artery (CFA). In patients with GD, parameters of age, BMI, and systolic and diastolic blood pressure were all correlated with the severity of the atheromatous plaque in abdominal aorta, common iliac, external iliac, and CFA. Conclusion: We demonstrated a direct relationship between GD and abdominopelvic atheromatous plaque, which is a marker for increased cardiovascular risk, for the first time in the literature. Patients with GD exhibit greater abdominopelvic atherosclerosis and therefore, have a higher risk of cardiovascular disease.
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Affiliation(s)
- Halil İbrahim Serin
- Department of Radiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Yunus Keser Yilmaz
- Department of Cardiovascular Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Yaşar Turan
- Department of Cardiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Ergin Arslan
- Department of General Surgery, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Mustafa Fatih Erkoç
- Department of Radiology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Aytaç Doğan
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Celikbilek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Faculty of Medicine, Bozok University, Yozgat, Turkey
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Zhou C, Qiao H, He L, Yuan C, Chen H, Zhang Q, Li R, Wang W, Du F, Li C, Zhao X. Characterization of atherosclerotic disease in thoracic aorta: A 3D, multicontrast vessel wall imaging study. Eur J Radiol 2016; 85:2030-2035. [DOI: 10.1016/j.ejrad.2016.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/01/2016] [Accepted: 09/10/2016] [Indexed: 01/25/2023]
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5
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Preclinical models of atherosclerosis. The future of Hybrid PET/MR technology for the early detection of vulnerable plaque. Expert Rev Mol Med 2016; 18:e6. [PMID: 27056676 DOI: 10.1017/erm.2016.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are the leading cause of death in developed countries. The aetiology is currently multifactorial, thus making them very difficult to prevent. Preclinical models of atherothrombotic diseases, including vulnerable plaque-associated complications, are now providing significant insights into pathologies like atherosclerosis, and in combination with the most recent advances in new non-invasive imaging technologies, they have become essential tools to evaluate new therapeutic strategies, with which can forecast and prevent plaque rupture. Positron emission tomography (PET)/computed tomography imaging is currently used for plaque visualisation in clinical and pre-clinical cardiovascular research, albeit with significant limitations. However, the combination of PET and magnetic resonance imaging (MRI) technologies is still the best option available today, as combined PET/MRI scans provide simultaneous data acquisition together with high quality anatomical information, sensitivity and lower radiation exposure for the patient. The coming years may represent a new era for the implementation of PET/MRI in clinical practice, but first, clinically efficient attenuation correction algorithms and research towards multimodal reagents and safety issues should be validated at the preclinical level.
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van Engelen A, van Dijk AC, Truijman MTB, Van't Klooster R, van Opbroek A, van der Lugt A, Niessen WJ, Kooi ME, de Bruijne M. Multi-Center MRI Carotid Plaque Component Segmentation Using Feature Normalization and Transfer Learning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:1294-1305. [PMID: 25532205 DOI: 10.1109/tmi.2014.2384733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Automated segmentation of plaque components in carotid artery magnetic resonance imaging (MRI) is important to enable large studies on plaque vulnerability, and for incorporating plaque composition as an imaging biomarker in clinical practice. Especially supervised classification techniques, which learn from labeled examples, have shown good performance. However, a disadvantage of supervised methods is their reduced performance on data different from the training data, for example on images acquired with different scanners. Reducing the amount of manual annotations required for each new dataset will facilitate widespread implementation of supervised methods. In this paper we segment carotid plaque components of clinical interest (fibrous tissue, lipid tissue, calcification and intraplaque hemorrhage) in a multi-center MRI study. We perform voxelwise tissue classification by traditional same-center training, and compare results with two approaches that use little or no annotated same-center data. These approaches additionally use an annotated set of different-center data. We evaluate 1) a nonlinear feature normalization approach, and 2) two transfer-learning algorithms that use same and different-center data with different weights. Results showed that the best results were obtained for a combination of feature normalization and transfer learning. While for the other approaches significant differences in voxelwise or mean volume errors were found compared with the reference same-center training, the proposed approach did not yield significant differences from that reference. We conclude that both extensive feature normalization and transfer learning can be valuable for the development of supervised methods that perform well on different types of datasets.
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Mihai G, Varghese J, Lu B, Zhu H, Simonetti OP, Rajagopalan S. Reproducibility of thoracic and abdominal aortic wall measurements with three-dimensional, variable flip angle (SPACE) MRI. J Magn Reson Imaging 2013; 41:202-12. [DOI: 10.1002/jmri.24545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/15/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Georgeta Mihai
- Department of Radiology; The Ohio State University; Columbus Ohio USA
| | - Juliet Varghese
- The Dorothy M. Davis Heart and Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University; Columbus Ohio USA
| | - Bo Lu
- College of Public Health; The Ohio State University; Columbus Ohio USA
| | - Hong Zhu
- Department of Clinical Sciences Division of Biostatistics; University of Texas, Southwestern Medical Center; Dallas Texas USA
| | - Orlando P. Simonetti
- Department of Radiology; The Ohio State University; Columbus Ohio USA
- The Dorothy M. Davis Heart and Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University; Columbus Ohio USA
| | - Sanjay Rajagopalan
- The Dorothy M. Davis Heart and Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University; Columbus Ohio USA
- Department of Medicine Division of Cardiology; The University of Maryland; Baltimore Maryland USA
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8
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Mihai G, Varghese J, Kampfrath T, Gushchina L, Hafer L, Deiuliis J, Maiseyeu A, Simonetti OP, Lu B, Rajagopalan S. Aliskiren effect on plaque progression in established atherosclerosis using high resolution 3D MRI (ALPINE): a double-blind placebo-controlled trial. J Am Heart Assoc 2013; 2:e004879. [PMID: 23686372 PMCID: PMC3698800 DOI: 10.1161/jaha.112.004879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The renin–angiotensin system is well recognized as a mediator of pathophysiological events in atherosclerosis. The benefits of renin inhibition in atherosclerosis, especially when used in combination with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are currently not known. We hypothesized that treatment with the renin inhibitor aliskiren in patients with established cardiovascular disease will prevent the progression of atherosclerosis as determined by high-resolution magnetic resonance imaging (MRI) measurements of arterial wall volume in the thoracic and abdominal aortas of high-risk patients with preexisting cardiovascular disease. Methods and Results This was a single-center, randomized, double-blind, placebo-controlled trial in patients with established cardiovascular disease. After a 2-week single-blind placebo phase, patients were randomized to receive either placebo (n=37, mean±SD age 64.5±8.9 years, 3 women) or 150 mg of aliskiren (n=34, mean±SD age 63.9±11.5 years, 9 women). Treatment dose was escalated to 300 mg at 2 weeks and maintained during the remainder of the study. Patients underwent dark-blood, 3-dimensional MRI assessment of atherosclerotic plaque in the thoracic and abdominal segments at baseline and on study completion or termination (up to 36 weeks of drug or matching placebo). Aliskiren use resulted in significant progression of aortic wall volume (normalized total wall volume 5.31±6.57 vs 0.15±4.39 mm3, P=0.03, and percentage wall volume 3.37±2.96% vs 0.97±2.02%, P=0.04) compared with placebo. In a subgroup analysis of subjects receiving ACEI/ARB therapy, atherosclerosis progression was observed only in the aliskiren group, not in the placebo group. Conclusions MRI quantification of atheroma plaque burden demonstrated that aliskiren use in patients with preexisting cardiovascular disease resulted in an unexpected increase in aortic atherosclerosis compared with placebo. Although preliminary, these results may have implications for the use of renin inhibition as a therapeutic strategy in patients with cardiovascular disease, especially in those receiving ACEI/ARB therapy. Clinical Trial Registration URL: http://ClinicalTrials.gov Unique identifier: NCT01417104.
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Affiliation(s)
- Georgeta Mihai
- Dorothy M. Davis Heart & Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH 43210, USA
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Di Cesare E, Cademartiri F, Carbone I, Carriero A, Centonze M, De Cobelli F, De Rosa R, Di Renzi P, Esposito A, Faletti R, Fattori R, Francone M, Giovagnoni A, La Grutta L, Ligabue G, Lovato L, Marano R, Midiri M, Romagnoli A, Russo V, Sardanelli F, Natale L, Bogaert J, De Roos A. [Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging]. Radiol Med 2012. [PMID: 23184241 DOI: 10.1007/s11547-012-0899-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiac magnetic resonance (CMR) is considered an useful method in the evaluation of many cardiac disorders. Based on our experience and available literature, we wrote a document as a guiding tool in the clinical use of CMR. Synthetically we describe different cardiac disorders and express for each one a classification, I to IV, depending on the significance of diagnostic information expected.
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Affiliation(s)
- E Di Cesare
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università di L'Aquila, L'Aquila, Italy.
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10
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Antibody phage display assisted identification of junction plakoglobin as a potential biomarker for atherosclerosis. PLoS One 2012; 7:e47985. [PMID: 23110151 PMCID: PMC3480477 DOI: 10.1371/journal.pone.0047985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 09/19/2012] [Indexed: 11/19/2022] Open
Abstract
To date, no plaque-derived blood biomarker is available to allow diagnosis, prognosis or monitoring of atherosclerotic vascular diseases. In this study, specimens of thrombendarterectomy material from carotid and iliac arteries were incubated in protein-free medium to obtain plaque and control secretomes for subsequent subtractive phage display. The selection of nine plaque secretome-specific antibodies and the analysis of their immunopurified antigens by mass spectrometry led to the identification of 22 proteins. One of them, junction plakoglobin (JUP-81) and its smaller isoforms (referred to as JUP-63, JUP-55 and JUP-30 by molecular weight) were confirmed by immunohistochemistry and immunoblotting with independent antibodies to be present in atherosclerotic plaques and their secretomes, coronary thrombi of patients with acute coronary syndrome (ACS) and macrophages differentiated from peripheral blood monocytes as well as macrophage-like cells differentiated from THP1 cells. Plasma of patients with stable coronary artery disease (CAD) (n = 15) and ACS (n = 11) contained JUP-81 at more than 2- and 14-fold higher median concentrations, respectively, than plasma of CAD-free individuals (n = 13). In conclusion, this proof of principle study identified and verified JUP isoforms as potential plasma biomarkers for atherosclerosis. Clinical validation studies are needed to determine its diagnostic efficacy and clinical utility as a biomarker for diagnosis, prognosis or monitoring of atherosclerotic vascular diseases.
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11
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Caballero P, Alonso R, Rosado P, Mata N, Fernández-Friera L, Jiménez-Borreguero LJ, Badimon L, Mata P. Detection of subclinical atherosclerosis in familial hypercholesterolemia using non-invasive imaging modalities. Atherosclerosis 2012; 222:468-72. [PMID: 22460051 DOI: 10.1016/j.atherosclerosis.2012.02.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 02/02/2012] [Accepted: 02/27/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the extent of subclinical atherosclerosis in asymptomatic familial hypercholesterolemia (FH) patients using non-invasive images techniques. PATIENTS, METHODS AND RESULTS The atherosclerotic burden of 36 molecularly defined FH patients (18 males, 45.7±10.9 years) without evidence of cardiovascular disease receiving lipid-lowering treatment and 19 (47.8±11.3 years) controls was investigated. Descending thoracic aorta magnetic resonance imaging (MRI) was performed in a 1.5 T equipment with T1 and T2 sequences to characterize atherosclerotic plaques and to measure aortic wall volumen. Carotid intima-media thickness (cIMT) and presence of plaques were measured using B-mode carotid ultrasound. Mean aortic wall volumen, cIMT and atherosclerotic plaques in aorta were significantly higher in FH cases (P<0.001). A significant correlation between aortic wall volume and cIMT was observed (P<0.01). Aortic MRI detected plaques in 94% and carotid ultrasound in 14% of cases. Lipid-rich plaques were observed only in FH cases (33%) and were associated with family history of premature coronary artery disease (P<0.05). CONCLUSIONS Asymptomatic middle-aged FH patients have significantly higher atherosclerotic burden than controls. cIMT has shown a significant correlation with aortic wall volume and MRI allowed the detection of lipid-rich plaques in FH subjects that were associated with family history of premature coronary artery disease.
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12
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Sharma U, Tak T. Aortic Atheromas: Current Knowledge and Controversies: A Brief Review of the Literature. Echocardiography 2011; 28:1157-63. [DOI: 10.1111/j.1540-8175.2011.01478.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Frullano L, Caravan P. Strategies for the preparation of bifunctional gadolinium(III) chelators. Curr Org Synth 2011; 8:535-565. [PMID: 22375102 DOI: 10.2174/157017911796117250] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The development of gadolinium chelators that can be easily and readily linked to various substrates is of primary importance for the development high relaxation efficiency and/or targeted magnetic resonance imaging (MRI) contrast agents. Over the last 25 years a large number of bifunctional chelators have been prepared. For the most part, these compounds are based on ligands that are already used in clinically approved contrast agents. More recently, new bifunctional chelators have been reported based on complexes that show a more potent relaxation effect, faster complexation kinetics and in some cases simpler synthetic procedures. This review provides an overview of the synthetic strategies used for the preparation of bifunctional chelators for MRI applications.
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Affiliation(s)
- Luca Frullano
- Case Western Reserve University. 11100 Euclid Ave Cleveland, OH 44106
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14
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Dong L, Kerwin WS, Ferguson MS, Li R, Wang J, Chen H, Canton G, Hatsukami TS, Yuan C. Cardiovascular magnetic resonance in carotid atherosclerotic disease. J Cardiovasc Magn Reson 2009; 11:53. [PMID: 20003520 PMCID: PMC2806867 DOI: 10.1186/1532-429x-11-53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/15/2009] [Indexed: 11/13/2022] Open
Abstract
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.
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Affiliation(s)
- Li Dong
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Rui Li
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jinnan Wang
- Clinical Sites Research Program, Philips Research North America, Briarcliff Manor, NY, USA
| | - Huijun Chen
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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15
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Abstract
This review examines the state of the art in vessel wall imaging by magnetic resonance imaging (MRI) with an emphasis on the biomechanical assessment of atherosclerotic plaque. Three areas of advanced techniques are discussed. First, alternative contrast mechanisms, including susceptibility, magnetization transfer, diffusion, and perfusion, are presented as to how they facilitate accurate determination of plaque constituents underlying biomechanics. Second, imaging technologies including hardware and sequences, are reviewed as to how they provide the resolution and signal-to-noise ratio necessary for determining plaque structure. Finally, techniques for combining MRI data into an overall assessment of plaque biomechanical properties, including wall shear stress and internal plaque strain, are presented. The paper closes with a discussion of the extent to which these techniques have been applied to different arteries commonly targeted by vessel wall MRI.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA.
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Mani V, Muntner P, Gidding SS, Aguiar SH, El Aidi H, Weinshelbaum KB, Taniguchi H, van der Geest R, Reiber JHC, Bansilal S, Farkouh M, Fuster V, Postley JE, Woodward M, Fayad ZA. Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events. J Cardiovasc Magn Reson 2009; 11:10. [PMID: 19393089 PMCID: PMC2680849 DOI: 10.1186/1532-429x-11-10] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 04/24/2009] [Indexed: 02/08/2023] Open
Abstract
AIMS Patients with prior major cardiovascular or cerebrovascular events (MACE) are more likely to have future recurrent events independent of traditional cardiovascular disease risk factors. The purpose of this study was to determine if patients with traditional risk factors and prior MACE had increased cardiovascular magnetic resonance (CMR) plaque burden measures compared to patients with risk factors but no prior events. METHODS AND RESULTS Black blood carotid and thoracic aorta images were obtained from 195 patients using a rapid extended coverage turbo spin echo sequence. CMR measures of plaque burden were obtained by tracing lumen and outer vessel wall contours. Patients with prior MACE had significantly higher MR plaque burden (wall thickness, wall area and normalized wall index) in carotids and thoracic aorta compared to those without prior MACE (Wall thickness carotids: 1.03 +/- 0.03 vs. 0.93+/- 0.03, p = 0.001; SD wall thickness carotids: 0.137 +/- 0.0008 vs. 0.102 +/- 0.0004, p < 0.001; wall thickness aorta: 1.63 +/- 0.10 vs. 1.50 +/- 0.04, p = 0.009; SD wall thickness aorta: 0.186 +/- 0.035 vs. 0.139 +/- 0.012, p = 0.009 respectively). Plaque burden (wall thickness) and plaque eccentricity (standard deviation of wall thickness) of carotid arteries were associated with prior MACE after adjustment for age, sex, and traditional risk factors. Area under ROC curve (AUC) for discriminating prior MACE improved by adding plaque eccentricity to models incorporating age, sex, and traditional CVD risk factors as model inputs (AUC = 0.79, p = 0.05). CONCLUSION A greater plaque burden and plaque eccentricity is prevalent among patients with prior MACE.
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Affiliation(s)
- Venkatesh Mani
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Paul Muntner
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Silvia H Aguiar
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Hamza El Aidi
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Karen B Weinshelbaum
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Hiroaki Taniguchi
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | | | | | - Sameer Bansilal
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Michael Farkouh
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Valentin Fuster
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Mark Woodward
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Zahi A Fayad
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
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Karmonik C, Basto P, Vickers K, Martin K, Reardon MJ, Lawrie GM, Morrisett JD. Quantitative segmentation of principal carotid atherosclerotic lesion components by feature space analysis based on multicontrast MRI at 1.5 T. IEEE Trans Biomed Eng 2008; 56:352-60. [PMID: 19272944 DOI: 10.1109/tbme.2008.2003100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this paper is to evaluate the capability of feature space analysis (FSA) for quantifying the relative volumes of principal components (thrombus, calcification, fibrous, normal intima, and lipid) of atherosclerotic plaque tissue in multicontrast magnetic resonance images (mc-MRI) acquired in a setup resembling clinical conditions ex vivo. Utilizing endogenous contrast, proton density, T1-weighted, and T2-weighted images were acquired for 13 carotid endarterectomy (CEA) tissues under near-clinical conditions (human 1.5 T GE Excite scanner with sequence parameters comparable to an in vivo acquisition). An FSA algorithm was utilized to segment and quantify the principal components of atherosclerotic plaques. Pilot in vivo mc-MRI images were analyzed in the same way as the ex vivo images for exploring the possible adaptation of this technique to in vivo imaging. Relative abundance of principal plaque components in CEA tissues as determined by mc-MRI/FSA were compared to those measured by histology. Mean differences +/- standard deviations were 5.8 +/- 4.1% for thrombus, 1.5 +/-1.4 % for calcification, 4.0 +/-2.8% for fibrous, 8.2 +/- 10% for normal intima, and 2.4 +/- 2.2% for lipid. Reasonable quantitative agreement between the classification results obtained with FSA and histological data was obtained for near-clinical imaging conditions. Combination of mc-MRI and FSA may have an application for determining atherosclerotic lesion composition and monitoring treatment in vivo.
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Affiliation(s)
- Christof Karmonik
- Department of Radiology, The Methodist Hospital Research Institute, Houston, TX 77030, USA.
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