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Homorodean C, Leucuta DC, Ober M, Homorodean R, Spinu M, Olinic M, Tataru D, Olinic DM. Intravascular ultrasound insights into the unstable features of the coronary atherosclerotic plaques: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13671. [PMID: 34411283 DOI: 10.1111/eci.13671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients. METHODS A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models. RESULTS Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina. CONCLUSION Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non-culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.
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Affiliation(s)
- Calin Homorodean
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Ober
- Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | | | - Mihail Spinu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan Tataru
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency County Hospital Cluj Napoca, Cluj-Napoca, Romania
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2
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Ghanem AM, Hamimi AH, Gharib AM, Abd-Elmoniem KZ. Automatic Assessment of 3D Coronary Artery Distensibility from Time-Resolved Coronary CT Angiography .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:836-840. [PMID: 31946025 DOI: 10.1109/embc.2019.8856732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Measuring coronary artery distensibility can determine the arterial remodeling type, arterial wall inflammation, and atherosclerotic plaques in early stage even before any observed narrowing in the lumen. This is crucial to promote an appropriate, preventive, and effective treatment. This study introduces a framework for calculating the 3D distensibility of the left coronary artery (LCA) from time-resolved coronary computerized tomography angiography (CCTA) images. Vesselness, region growing, and level sets are utilized for segmenting the LCA lumen in the systole and diastole CCTA time frames. The segmented arteries are then analyzed and registered using computational geometry to calculate the changes in the lumen cross-section areas between both time frames. In-vivo validation of the framework performance was accomplished against that of two radiologists and their consensus. Results demonstrate that the framework was accurate and reliable tool for measuring the coronary arteries distensibility.
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3
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The relationship between coronary artery distensibility and fractional flow reserve. PLoS One 2017; 12:e0181824. [PMID: 28742827 PMCID: PMC5526528 DOI: 10.1371/journal.pone.0181824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/09/2017] [Indexed: 11/27/2022] Open
Abstract
Discordance between angiography-based anatomical assessment of coronary stenosis severity and fractional flow reserve (FFR) has been attributed to several factors including lesion length and irregularity, and the myocardial territory supplied by the target vessel. We sought to examine if coronary arterial distensibility is an independent contributor to this discordance. There were two parts to this study. The first consisted of “in silico” models of 26 human coronary arteries. Computational fluid dynamics-derived FFR was calculated for fully rigid, partially distensible and fully distensible models of the 26 arteries. The second part of the study consisted of 104 patients who underwent coronary angiography and FFR measurement. Distensibility at the lesion site (DistensibilityMLA) and for the reference vessel (DistensibilityRef) was determined by analysing three-dimensional angiography images during end-systole and end-diastole. Computational fluid dynamics-derived FFR was 0.67±0.19, 0.70±0.18 and 0.75±0.17 (P<0.001) in the fully rigid, partially distensible and fully distensible models respectively. FFR correlated with both DistensibilityMLA (r = 0.36, P<0.001) and DistensibilityRef (r = 0.44, P<0.001). Two-way ANCOVA analysis revealed that DistensibilityMLA (F (1, 100) = 4.17, p = 0.031) and percentage diameter stenosis (F (1, 100) = 60.30, p < 0.01) were both independent predictors of FFR. Coronary arterial distensibility is a novel, independent determinant of FFR, and an important factor contributing to the discordance between anatomical and functional assessment of stenosis severity.
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4
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Harbaoui B, Courand PY, Cividjian A, Lantelme P. Development of Coronary Pulse Wave Velocity: New Pathophysiological Insight Into Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.116.004981. [PMID: 28154161 PMCID: PMC5523779 DOI: 10.1161/jaha.116.004981] [Citation(s) in RCA: 6] [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: 01/09/2023]
Abstract
Background Although aortic stiffness assessed by pulse wave velocity (PWV) is a strong predictor of coronary artery disease, the significance of local coronary stiffness has never been tackled. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV in patients presenting with acute coronary syndromes or stable coronary artery disease. Methods and Results In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment. Similarly, aortic PWV was measured invasively when the wire was pulled across the ascending aorta; carotid–femoral PWV was also measured noninvasively using the SphygmoCor system (AtCor Medical). Mean CoPWV was 10.3±6.1 m/s. Determinants of increased CoPWV were fractional flow reserve, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was lower in patients with acute coronary syndromes versus stable coronary artery disease (7.6±3 versus 11.5±6.4 m/s; P=0.02), and this persisted after adjustment for confounders. In contrast, aortic stiffness, assessed by aortic and carotid–femoral PWV, did not differ significantly. Conclusions CoPWV seems associated with acute coronary events more closely than aortic PWV. High coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research.
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Affiliation(s)
- Brahim Harbaoui
- Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1 Hospices Civils de Lyon Université de Lyon, France
| | - Pierre-Yves Courand
- Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1 Hospices Civils de Lyon Université de Lyon, France
| | - Andrei Cividjian
- Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France
| | - Pierre Lantelme
- Cardiology Department, European Society of Hypertension Excellence Center Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France .,CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1 Hospices Civils de Lyon Université de Lyon, France
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5
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Rotman OM, Zaretsky U, Shitzer A, Einav S. Pressure drop and arterial compliance – Two arterial parameters in one measurement. J Biomech 2017; 50:130-137. [DOI: 10.1016/j.jbiomech.2016.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/15/2022]
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6
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The Relation of Angiographic-Based Coronary Artery Diameters with Gender and Traditional Cardiovascular Risk Factors in Patients with Normal or Mild CAD. Res Cardiovasc Med 2016. [DOI: 10.5812/cardiovascmed.38532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Reddy HK, Koshy SKG, Wasson S, Quan EE, Pagni S, Roberts AM, Joshua IG, Tyagi SC. Adaptive-Outward and Maladaptive-Inward Arterial Remodeling Measured by Intravascular Ultrasound in Hyperhomocysteinemia and Diabetes. J Cardiovasc Pharmacol Ther 2016; 11:65-76. [PMID: 16703221 DOI: 10.1177/107424840601100106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Coronary artery remodeling implies structural changes in the vessel wall in response to various pathophysiologic conditions. However, the classification of remodeling is unclear. We hypothesized that the adaptive, positive-outward remodeling is a reactive and compensatory response to the stress. The maladaptive negative-inward constrictive remodeling is a passive atherosclerotic condition in which the vessel becomes stiffer. Methods: Patients with atherosclerotic lesions underwent intravascular ultrasound (IVUS) scans. The size of the vessels distal to and proximal to plaques were analyzed by IVUS. Diabetes was created in mice by an intraperitoneal injection of alloxan (65 mg/kg). To reduce remodeling, mice received ciglitazone, an agonist of peroxisome proliferators activated receptor-g (PPARg) in drinking water. After 8 weeks, atherosclerotic vessels were analyzed for collagen and elastin. Results: IVUS data suggest an adaptive coronary arterial remodeling was a positive compensatory response to various pathologic stimuli; for example, with the deposition of atherosclerotic plaque, coronary arterial segments enlarged to maintain luminal area. This phenomenon was commonly observed during the initial phases of the development of atherosclerosis. However, negative coronary artery remodeling, or a decrease in vessel area with the formation of atherosclerotic plaque, was maladaptive and was associated with smoking, hypertension, hyperhomocysteinemia, diabetes mellitus, and also after percutaneous coronary interventions (restenosis). In diabetic mice, there was increased collagen and decreased elastin contents; however, treatment with ciglitazone ameliorated the decrease in elastin contents. Conclusion: Global enlargement of the coronary vascular tree occurs during pressure and volume overload associated with ventricular hypertrophic states such as athletic conditioning, hypertensive heart disease, and dilated cardiomyopathy. On the other hand, maladaptive coronary arterial remodeling occurs in patients with severe deconditioning, diabetes mellitus, after coronary artery bypass surgery, and in some instances, postintervention.
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Affiliation(s)
- Hanumanth K Reddy
- Division of Cardiology, University of Missouri Hospital, Columbia, MO, USA
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8
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Nörenberg D, Ebersberger HU, Diederichs G, Hamm B, Botnar RM, Makowski MR. Molecular magnetic resonance imaging of atherosclerotic vessel wall disease. Eur Radiol 2015; 26:910-20. [DOI: 10.1007/s00330-015-3881-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/27/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022]
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9
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Hüseyinova G, Aslanger E, Çakır O, Atıcı A, Panç C, Demirkıran A, Sürmen S, Sarıkaya R, Erdoğan O, Gölcük E, Umman S, Sezer M. Potential contribution of virtual histology plaque composition to hemodynamic–morphologic dissociation in patients with non-ST elevation acute coronary syndrome. Int J Cardiol 2015; 187:33-8. [DOI: 10.1016/j.ijcard.2015.03.316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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10
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Ahmadi N, Ruiz-Garcia J, Hajsadeghi F, Azen S, Mack W, Hodis H, Lerman A. Impaired coronary artery distensibility is an endothelium-dependent process and is associated with vulnerable plaque composition. Clin Physiol Funct Imaging 2014; 36:261-8. [PMID: 25524149 DOI: 10.1111/cpf.12220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
Coronary endothelial-dependent microvascular dysfunction, an early reversible stage of coronary artery disease (CAD), is associated with poor clinical outcome. The current study investigated whether coronary artery distensibility index (CDI) is associated with: (i) coronary endothelial-dependent microvascular dysfunction and (ii) vulnerable plaque composition among subjects with non-obstructive CAD. Seventy-four subjects with non-obstructive CAD (luminal stenosis <30%) were studied. In 20 subjects with and without coronary endothelial-dependent microvascular dysfunction, coronary flow reserve (CFR) of target segment during intracoronary (IC) infusion of acetylcholine (Ach) and bolus injection of adenosine as well as CDI at rest of corresponding target segment were measured. In 54 subjects, plaque compositions and CDI at rest of 154 non-obstructive coronary segments as well as proximal segment without disease were measured by intravascular ultrasound (IVUS). CDI was defined as: [(Early-diastolic cross-sectional-area (CSA) - End-diastolic CSA of target segment)/(end-diastolic CSA of target segment × coronary-pulse-pressure) × 10(3) ]. There is a direct association between endothelial dysfunction and impaired CDI of a coronary segment both in the given coronary segment and corresponding microvessels in which a strong agreement between CDI and CFR Ach (r(2) = 0·85, P = 0·0001) was observed. Multivariable regression-analysis showed that CDI was an independent predictor of the vulnerable plaque characteristics. The risk of impaired CDI was 125% higher in segments with necrotic core and 60% higher in segments with fibrofatty components as compared to normal segments (P = 0·001). In conclusions, the current study reveals that impaired CDI is an endothelial-dependent process of both given coronary segment and corresponding microvessels and is associated with vulnerable plaque composition.
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Affiliation(s)
- Naser Ahmadi
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Juan Ruiz-Garcia
- Mayo Clinic, Mayo Graduate School of Medicine, Rochester, MN, USA
| | - Fereshteh Hajsadeghi
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Stanley Azen
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wendy Mack
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard Hodis
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amir Lerman
- Mayo Clinic, Mayo Graduate School of Medicine, Rochester, MN, USA
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11
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Garcia-Garcia HM, Jang IK, Serruys PW, Kovacic JC, Narula J, Fayad ZA. Imaging plaques to predict and better manage patients with acute coronary events. Circ Res 2014; 114:1904-17. [PMID: 24902974 DOI: 10.1161/circresaha.114.302745] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Culprit lesions of patients, who have had an acute coronary syndrome commonly, are ruptured coronary plaques with superimposed thrombus. The precursor of such lesions is an inflamed thin-capped fibroatheroma. These plaques can be imaged by means of invasive techniques, such as intravascular ultrasound (and derived techniques), optical coherence tomography, and near-infrared spectroscopy. Often these patients exhibit similar (multiple) plaques beyond the culprit lesion. These remote plaques can be assessed noninvasively by computed tomographic angiography and MRI and also using invasive imaging. The detection of these remote plaques is not only feasible but also in natural history studies have been associated with clinical coronary events. Different systemic pharmacological treatments have been studied (mostly statins) with modest success and, therefore, newer approaches are being tested. Local treatment for such lesions is in its infancy and larger, prospective, and randomized trials are needed. This review will describe the pathological and imaging findings in culprit lesions of patients with acute coronary syndrome and the assessment of remote plaques. In addition, the pharmacological and local treatment options will be reviewed.
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Affiliation(s)
- Hector M Garcia-Garcia
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ik-Kyung Jang
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick W Serruys
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jason C Kovacic
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zahi A Fayad
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY.
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12
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Harmouche M, Maasrani M, Verhoye JP, Corbineau H, Drochon A. Coronary three-vessel disease with occlusion of the right coronary artery: What are the most important factors that determine the right territory perfusion? Ing Rech Biomed 2014. [DOI: 10.1016/j.irbm.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Phinikaridou A, Andia ME, Lacerda S, Lorrio S, Makowski MR, Botnar RM. Molecular MRI of atherosclerosis. Molecules 2013; 18:14042-69. [PMID: 24232739 PMCID: PMC6270261 DOI: 10.3390/molecules181114042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 11/22/2022] Open
Abstract
Despite advances in prevention, risk assessment and treatment, coronary artery disease (CAD) remains the leading cause of morbidity and mortality in Western countries. The lion's share is due to acute coronary syndromes (ACS), which are predominantly triggered by plaque rupture or erosion and subsequent coronary thrombosis. As the majority of vulnerable plaques does not cause a significant stenosis, due to expansive remodeling, and are rather defined by their composition and biological activity, detection of vulnerable plaques with x-ray angiography has shown little success. Non-invasive vulnerable plaque detection by identifying biological features that have been associated with plaque progression, destabilization and rupture may therefore be more appropriate and may allow earlier detection, more aggressive treatment and monitoring of treatment response. MR molecular imaging with target specific molecular probes has shown great promise for the noninvasive in vivo visualization of biological processes at the molecular and cellular level in animals and humans. Compared to other imaging modalities; MRI can provide excellent spatial resolution; high soft tissue contrast and has the ability to simultaneously image anatomy; function as well as biological tissue composition and activity.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Marcelo E. Andia
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 8331150, Chile
| | - Sara Lacerda
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Silvia Lorrio
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
| | - Marcus R. Makowski
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Department of Radiology, Charite, Berlin 10117, Germany
| | - René M. Botnar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; E-Mails: (A.P.); (M.E.A.); (S.L.); (S.L.); (M.R.M.)
- Wellcome Trust and ESPRC Medical Engineering Center, King’s College London, London SE1 7EH, UK
- BHF Centre of Excellence, King’s College London, London SE1 7EH, UK
- NIHR Biomedical Research Centre, King’s College London, London SE1 7EH, UK
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14
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Hamirani YS, Nasir K, Avanes E, Kadakia J, Budoff MJ. Coronary artery diameter related to calcium scores and coronary risk factors as measured with multidetector computed tomography: a substudy of the ACCURACY trial. Tex Heart Inst J 2013; 40:261-267. [PMID: 23914015 PMCID: PMC3709210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Arterial remodeling, an early change of atherosclerosis, can cause dilated arterial diameter. We measured coronary artery diameter with use of noncontrast 64-slice multidetector computed tomography (MDCT), and studied its association with coronary artery calcium levels and traditional coronary risk factors. We included 140 patients from the ACCURACY trial whose noncontrast MDCT images showed measurable coronary arteries. Using 3 measurements of left main coronary artery (LMCA) and right coronary artery (RCA) diameters within 3 mm of the ostium, we associated the results with traditional coronary risk factors and calcium scores. The prevalence of LMCA and RCA calcium was 22% and 51%, respectively. Mean arterial diameters were 5.67±1.18 mm (LMCA) and 4.66±1.08 mm (RCA). Correlations for LMCA and RCA diameters in 50 randomly chosen patients were 0.91 and 0.93 (interobserver) and 0.98 and 0.93 (intraobserver). Adjusted odds ratios for the relationship of LMCA and RCA diameters to calcium in male versus female patients were 5.65 (95% confidence interval [CI], 2.78-11.5) and 4.35 (95% CI, 2.24-8.47), respectively. Adjusted ratios and 95% CIs for the association of larger RCA diameter with age, hypertension, and body mass index were 1.36 (1.00-1.86), 3.13 (1.26-7.78), and 1.60 (1.16-2.22), respectively. Arterial diameters were larger in women and patients with higher calcium levels, and body mass index and hypertension were predictors of larger RCA diameters. These findings suggest a link between arterial remodeling and the severity of atherosclerosis.
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Affiliation(s)
- Yasmin S Hamirani
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California 90502, USA.
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15
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Longitudinal heterogeneity of coronary artery distensibility in plaques related to acute coronary syndrome. Clin Res Cardiol 2012; 101:545-51. [PMID: 22322568 DOI: 10.1007/s00392-012-0424-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/31/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND How coronary distensibility contributes to stable or unstable clinical manifestations remains obscure. We postulated that the heterogeneous plaque distensibility is associated with unstable clinical presentations in patients with acute coronary syndrome (ACS). METHODS AND RESULTS Seventeen and 19 ACS-related and -unrelated lesions, respectively, were visualized using intravascular ultrasound imaging with simultaneous intracoronary pressure recording. Systolic and diastolic lumen cross-sectional areas were measured at the lesion site and at five evenly spaced sites between the proximal and distal reference sites. The coronary distensibility index and stiffness index β were calculated for each site and averaged for each coronary segment. Maximal distensibility index, standard deviation and the difference between maximal and minimal distensibility indices within each segment were significantly higher in the ACS-related than -unrelated plaques (5.6 ± 2.3 vs. 3.7 ± 1.8, p < 0.001, 2.1 ± 0.9 vs. 1.1 ± 0.6, p < 0.001 and 5.3 ± 2.3 vs. 2.8 ± 1.5, p < 0.001, respectively). Moreover, the difference in the distensibility index between the lesion site of ACS-related plaques and the immediate proximal site was significantly larger (2.88 ± 2.35 vs. 1.17 ± 1.44, p = 0.022) than that in ACS-unrelated plaques. CONCLUSIONS Coronary artery distensibility is longitudinally more heterogeneous in ACS-related than-unrelated plaques, especially between the lesion and the immediate proximal site.
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16
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Sihan K, Botha C, Post F, de Winter S, Gonzalo N, Regar E, Serruys P, Hamers R, Bruining N. Retrospective image-based gating of intracoronary optical coherence tomography: implications for quantitative analysis. EUROINTERVENTION 2011; 6:1098-103. [DOI: 10.4244/eijv6i9a191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Gogas BD, Farooq V, Serruys PW, Garcìa-Garcìa HM. Assessment of coronary atherosclerosis by IVUS and IVUS-based imaging modalities: progression and regression studies, tissue composition and beyond. Int J Cardiovasc Imaging 2011; 27:225-37. [PMID: 21373888 PMCID: PMC3078316 DOI: 10.1007/s10554-010-9791-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/30/2010] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease remains the leading cause of mortality, morbidity and disability in the developed world, predominantly affecting the adult population. In the early 1990s coronary heart disease (CHD) was established as affecting one in two men and one in three women by the age of forty. Despite the dramatic progress in the field of cardiovascular medicine in terms of diagnosis and treatment of heart disease, modest improvements have only been achieved when the reduction of cardiovascular mortality and morbidity indices are assessed. To better understand coronary atherosclerosis, new imaging modalities have been introduced. These novel imaging modalities have been used in two ways: (1) for the characterization of plaque types; (2) for the assessment of the progression and regression of tissue types. These two aspects will be discussed in this review.
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Affiliation(s)
- Bill D Gogas
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, z120 Erasmus MC Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands
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18
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Konala BC, Das A, Banerjee RK. Influence of arterial wall-stenosis compliance on the coronary diagnostic parameters. J Biomech 2011; 44:842-7. [DOI: 10.1016/j.jbiomech.2010.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 11/17/2022]
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Puri R, Worthley MI, Nicholls SJ. Intravascular imaging of vulnerable coronary plaque: current and future concepts. Nat Rev Cardiol 2011; 8:131-9. [PMID: 21263456 DOI: 10.1038/nrcardio.2010.210] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Advances in coronary imaging are needed to enable the early detection of plaque segments considered to be 'vulnerable' for causing clinical events. Pathological studies have contributed to our current understanding of these vulnerable or unstable segments of plaque. Intravascular ultrasonography (IVUS) has provided insights into the morphology of atherosclerosis, the mediators of plaque progression and the factors associated with acute coronary syndrome (ACS). In addition, the demonstration of pancoronary arterial instability has highlighted that ACS involves a multifocal disease process. Various second-generation intravascular imaging technologies-employing advanced processing of ultrasound radiofrequency backscatter signals, light-based imaging, spectroscopic imaging and molecular targeting-possess inherent advantages for the identification of meaningful surrogates of plaque instability. The fusion of these imaging technologies within a single imaging catheter is likely to allow for greater synergism in image quality and early disease detection. However, natural-history studies to validate the use of these novel imaging tools for enhanced risk prediction are needed before these strategies can be incorporated into mainstream clinical practice.
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Affiliation(s)
- Rishi Puri
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, North Terrace, SA, Australia
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20
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Yamada R, Okura H, Kume T, Saito K, Miyamoto Y, Imai K, Tsuchiya T, Maehama T, Okahashi N, Obase K, Hayashida A, Neishi Y, Kawamoto T, Yoshida K. Relationship Between Arterial and Fibrous Cap Remodeling. Circ Cardiovasc Interv 2010; 3:484-90. [DOI: 10.1161/circinterventions.109.928911] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Positive arterial remodeling and thin fibrous cap are characteristics of rupture-prone or vulnerable plaque. The natural course of the fibrous cap thickness and the relationship between serial arterial remodeling and changes in fibrous cap thickness are unknown. Therefore, the purpose of this study was to evaluate the relationship between changes in fibrous cap thickness and arterial remodeling by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS) during 6-month follow-up.
Methods and Results—
Both IVUS and OCT examinations were performed on 108 vessels from 36 patients with ischemic heart disease who underwent percutaneous coronary intervention. Fifty-eight fibroatheromas were selected from 82 nonsignificant, nonculprit lesions (angiographic diameter stenosis, 25% to 75%; plaque burden, >40% by IVUS). Fibroatheroma was defined by OCT as lipid-rich plaque in >1 quadrant that has lipid. Thickness of the fibrous cap was measured by OCT. IVUS and OCT examinations were repeated at 6-month follow-up. Serial changes and relationships between IVUS indices and fibrous cap thickness were investigated. Overall, fibrous cap thickness (98.1±38.9 to 96.9±44.5 μm) as well as IVUS indices did not change significantly within 6 months. The percent changes in fibrous cap thickness correlated negatively and significantly (
r
=−0.54;
P
<0.0001; generalized estimating equation adjusted,
r
=−0.42;
P
=0.001) with the percent changes in external elastic membrane cross-sectional area.
Conclusions—
Arterial remodeling is related to changes in fibrous cap thickness. Positive arterial remodeling is not only an adaptive process, but also related to thinning of the fibrous cap.
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Affiliation(s)
- Ryotaro Yamada
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Hiroyuki Okura
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Teruyoshi Kume
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Ken Saito
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Yoshinori Miyamoto
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Koichiro Imai
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Tetsuo Tsuchiya
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Tomoko Maehama
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Noriko Okahashi
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Kikuko Obase
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Akihiro Hayashida
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Yoji Neishi
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Takahiro Kawamoto
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
| | - Kiyoshi Yoshida
- From the Division of Cardiology (R.Y., H.O., K.S., Y.M., K.I., T.T., T.M., N.O., K.O., A.H., Y.N., T. Kawamoto, K.Y.), Kawasaki Medical School, Kurashiki, Japan; and Division of Cardiovascular Medicine (T. Kume), Stanford University, Calif
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Garcia-Garcia HM, Costa MA, Serruys PW. Imaging of coronary atherosclerosis: intravascular ultrasound. Eur Heart J 2010; 31:2456-69. [DOI: 10.1093/eurheartj/ehq280] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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White AJ, Duffy SJ, Walton AS, Mukherjee S, Shaw JA, Jennings GL, Dart AM, Kingwell BA. Compliance mismatch between stenotic and distal reference segment is associated with coronary artery disease instability. Atherosclerosis 2009; 206:179-85. [DOI: 10.1016/j.atherosclerosis.2009.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/01/2009] [Accepted: 02/16/2009] [Indexed: 10/21/2022]
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Sipahi I, Tuzcu EM. Candidate mechanisms for regression of coronary atherosclerosis with high-dose statins: insight from intravascular ultrasonography trials. Am J Cardiovasc Drugs 2009; 8:365-71. [PMID: 19159123 DOI: 10.2165/0129784-200808060-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Animal models and serial imaging studies in humans have shown that atherosclerosis is a potentially reversible disease. Several drug classes have been tested to determine whether they can promote reversal of atherosclerosis. Of these, HMG-CoA reductase inhibitors (statins) have been consistently proven to have anti-atherosclerotic effects in large-scale clinical trials. In this article, we review the lipid- and non-lipid-based mechanisms of statin-induced disease regression using the information provided by the recent intravascular ultrasonography trials. We conclude that, despite several potential mechanisms, reduction of low-density lipoprotein cholesterol appears to be the dominant mechanism responsible for regression of atherosclerosis.
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Affiliation(s)
- Ilke Sipahi
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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24
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Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings. AJR Am J Roentgenol 2009; 192:584-98. [DOI: 10.2214/ajr.08.1178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Farhan S, Hemetsberger R, Matiasek J, Strehblow C, Pavo N, Khorsand A, Petneházy O, Petrási Z, Kaider A, Glogar D, Huber K, Gyöngyösi M. Implantation of paclitaxel-eluting stent impairs the vascular compliance of arteries in porcine coronary stenting model. Atherosclerosis 2008; 202:144-51. [PMID: 18514201 DOI: 10.1016/j.atherosclerosis.2008.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impaired compliance of large and medium-sized muscular arteries has been shown to correlate with the risk of adverse cardiovascular events. We assessed coronary artery distensibility using simultaneous intracoronary ultrasound and pressure wire measurements in porcine coronary arteries after implantation of paclitaxel-eluting (PES) and bare metal stents (BMS) and compared this with the histopathology of the arterial wall injury. METHODS PES and BMS were implanted into porcine left coronary arteries under general anesthesia. At 1-month follow-up (FUP) the endothelium-dependent and endothelium-independent vascular compliances were measured after intracoronary infusion of 10(-6)M acetylcholine for 2.5min, and intracoronary bolus of 100microg nitroglycerine, respectively. The arterial stiffness index, distensibility and reflexion index were calculated in stented arteries (n=25 PES and n=25 BMS), and correlated with histopathologic and histomorphometric changes of the vessel wall. RESULTS In spite of smaller neointimal area, the fibrin deposition, medial thickening, vascular wall inflammation scores and arterial remodeling index were elevated and endothelialization was impaired in arteries with PES. Arteries with PES exhibited significantly worse endothelium-dependent vascular compliance: the stiffness (p<0.001) and reflexion index (p<0.001) were significantly higher and the distensibility index (p<0.001) lower as compared with the arteries with BMS. The endothelium-independent vascular reaction was similarly impaired in arteries with PES, as the stiffness index (p<0.001) and the distensibility index (p<0.001) differed significantly between the PES and BMS groups. Incomplete endothelialization (r=0.617, p<0.001) was significantly associated with the endothelium-dependent increased vascular stiffness. The increased fibrin score (r=0.646, p<0.001), vessel wall inflammation (r=0.657, p<0.001) and medial thickening (r=0.672, p<0.001) correlated significantly with the endothelium-independent stiffness index. CONCLUSIONS Implantation of PES impairs the coronary artery wall structure and the endothelium-dependent and independent vessel wall dynamics more than does the implantation of BMS.
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Affiliation(s)
- Serdar Farhan
- 3rd Department of Medicine (Cardiology and Emergency Medicine) Wilhelminenhospital, Vienna, Austria
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26
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Abstract
Little is known of the relationship between plaque rupture and adaptive geometric remodelling, especially in the context of unstable atherosclerosis. We have assessed remodelling in the proximal brachiocephalic arteries of fat-fed apoE (apolipoprotein E)-knockout mice. The rate of vessel expansive remodelling is similar in vessels with plaques and without plaques, suggesting that the presence of plaque is not necessary for remodelling to occur. In vessels with plaques, the degree of expansive remodelling was strongly associated with the stability of the plaque. Vessels with stable plaques (i.e. with neither buried fibrous caps nor acute plaque ruptures) showed no expansion, whereas those with evidence of plaque rupture expanded at a significant rate. Vessels with stable plaques suffered significant loss of lumen over time, but those with unstable plaques maintained lumen area over time. Pravastatin treatment of male apoE-knockout mice caused a 5-fold increase in fibrous cap thickness and, although it did not influence overall rates of vessel remodelling, it significantly increased both the amount of vessel expansion and the period of time between plaque ruptures, suggesting that it increases the ability of the plaque to resist the rupturing force caused by vessel expansion. These results suggest that vessel expansion in brachiocephalic arteries of fat-fed apoE-knockout mouse does not require the presence of plaque. When a plaque is present, the outward remodelling force is exerted across its cap: vessels with smaller outward remodelling forces cannot overcome the strength of the cap, and the plaque remains stable. When the remodelling force is greater than the strength of the cap, the plaque ruptures. Thus plaque rupture can be viewed as a consequence of vessel remodelling. Interventions that strengthen the plaque, such as pravastatin therapy, do not alter remodelling parameters but instead allow for more outward remodelling before a rupture is caused.
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27
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Iwami T, Nishioka T, Fishbein MC, Luo H, Jeon D, Miyamoto T, Wakeyama T, Iida H, Takaki A, Oda T, Mochizuki M, Ogawa H, Siegel RJ. Coronary arterial remodeling in differing clinical presentations of unstable angina pectoris--an intravascular ultrasound study. Clin Cardiol 2006; 26:384-9. [PMID: 12918641 PMCID: PMC6653948 DOI: 10.1002/clc.4950260807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronary arterial remodeling influences the clinical presentation of ischemic heart disease; however, there is little information on the relationship between coronary arterial remodeling and the type of angina pectoris that patients manifest. HYPOTHESIS The study was undertaken to determine the difference of coronary arterial remodeling in patients with different types of angina pectoris. METHODS We analyzed 100 patients with ischemic heart disease using intravascular ultrasound (IVUS). Intracoronary IVUS images of proximal reference (PR), distal reference (DR), and target lesion were recorded, and intraluminal area (LA) and external elastic membrane (EEM) were measured. We defined a remodeling index as 100 x (lesion EEM - [PR-EEM + DR-EEM]/2) / ([PR-EEM + DR-EEM]/2). Cases were classified into three groups according to the clinical history (Group 1a: de novo unstable angina pectoris, Group 1b: accelerating unstable angina pectoris, and Group 2; stable angina pectoris). RESULTS The remodeling index in Group 1a was significantly larger than that in Groups 1b and 2 (18.6 +/- 28.5 vs. 5.3 +/- 27.1 and 18.6 +/- 28.5 vs. -2.7 +/- 17.6, p = 0.0347 and p = 0.0005, respectively), but there was no statistical difference in remodeling index between Groups 1b and 2. CONCLUSIONS Our results indicate that positive coronary arterial remodeling is more prevalent in patients with new onset of angina pectoris. The specific type of coronary arterial remodeling may affect the clinical presentation of patients with coronary artery disease.
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Affiliation(s)
- Takahiro Iwami
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Toshihiko Nishioka
- Division of Cardiology, Self‐Defense Forces Central Hospital, Tokyo, Japan
| | - Michael C. Fishbein
- Department of Pathology, UCLA School of Medicine, Los Angeles, California, USA
| | - Huai Luo
- Division of Cardiology, Cedars‐Sinai Medical Center, Los Angeles, USA
| | - Doo‐Soo Jeon
- Division of Cardiology, Cedars‐Sinai Medical Center, Los Angeles, USA
| | - Takashi Miyamoto
- Division of Cardiology, Cedars‐Sinai Medical Center, Los Angeles, USA
| | - Takatoshi Wakeyama
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Hiroshi Iida
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Akira Takaki
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Tetsuro Oda
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Mamoru Mochizuki
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Hiroshi Ogawa
- Division of Cardiology, Tokuyama Central Hospital, Tokuyama, Tokyo, Japan
| | - Robert J Siegel
- Division of Cardiology, Cedars‐Sinai Medical Center, Los Angeles, USA
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Kyriakides ZS, Kremastinos DT, Raptis AE, Johnston N, Raptis SA, Webb DJ, Kyrzopoulos S, Sbarouni E. Impaired effect of endothelin-1 on coronary artery stiffness in type 2 diabetes. Int J Cardiol 2006; 112:207-12. [PMID: 16325943 DOI: 10.1016/j.ijcard.2005.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 08/04/2005] [Accepted: 09/18/2005] [Indexed: 11/29/2022]
Abstract
AIM We examined whether there is a differential effect of endothelin-A antagonism on coronary artery compliance in type 2 diabetes mellitus compared to non-diabetic patients. PATIENT AND METHODS We examined 32 patients, 11 type 2 diabetes mellitus and 21 non-diabetic patients, with atherosclerotic epicardial arteries free of significant luminal stenoses. Intracoronary BQ-123 (6 micromol), an endothelin-A receptor antagonist, was infused over 20 min. The artery lumen area in the proximal arterial segment was measured at end diastole and end systole before and after BQ-123 administration using an intravascular ultrasound catheter. Calculations were made of normalized arterial compliance index, in mm Hg(-1) x 10(3) and of arterial stiffness index beta. RESULTS Pulse pressure and heart rate did not change after BQ-123. In type 2 diabetes mellitus, normalized compliance index decreased from 1.79+/-1.36 at baseline to 1.29+/-0.82 after BQ-123 administration, whereas in non-diabetic patients it increased from 2.10+/-1.36 to 3.00+/-2.07 (p<0.05 versus baseline) (F=6.39, p=0.02). In type 2 diabetes mellitus, beta index increased from 1.97+/-0.53 to 2.46+/-0.95, whereas in non-diabetic patients it decreased from 1.83+/-0.95 to 1.63+/-0.84 (F=7.80, p=0.009). Big endothelin-1 at baseline was correlated with the baseline beta index (p<0.0001, r=0.68). CONCLUSIONS Big endothelin-1 is correlated with the coronary artery stiffness. The effect of endogenous endothelin-1 on coronary artery stiffness is impaired in type 2 diabetes mellitus. This may have important therapeutic implications with respect to the introduction of endothelin receptor antagonists as cardiovascular therapeutic agents.
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29
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Houslay ES, Uren NG. Intravascular ultrasound: defining plaque regression. Br J Hosp Med (Lond) 2005; 66:27-31. [PMID: 15686163 DOI: 10.12968/hmed.2005.66.1.17532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intravascular ultrasound allows accurate assessment of the arterial vessel, including vessel luminal diameter and assessment of vessel disease in terms of plaque morphology, plaque volume and extent of calcification. Recently published trials highlight the role of intravascular ultrasound in monitoring disease progression in a clinical setting.
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Affiliation(s)
- Emma S Houslay
- Department of Cardiology, New Royal Infirmary, Edinburgh EH16 4SA
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30
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McLeod AL, Watson RJ, Anderson T, Inglis S, Newby DE, Northridge DB, Uren NG, McDicken WN. Classification of arterial plaque by spectral analysis in remodelled human atherosclerotic coronary arteries. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:155-159. [PMID: 14998667 DOI: 10.1016/j.ultrasmedbio.2003.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Revised: 09/23/2003] [Accepted: 10/14/2003] [Indexed: 05/24/2023]
Abstract
We aimed to characterise and to identify the predominant plaque type in vivo using unprocessed radiofrequency (RF) intravascular ultrasound (US) backscatter, in remodelled segments of human atherosclerotic coronary arteries. A total of 16 remodelled segments were identified using a 30-MHz intravascular ultrasound (IVUS) scanner in vivo. Of these, 9 segments were classified as positively remodelled (>1.05 of the total vessel area in comparison with the proximal and distal reference segments) and 7 as negatively remodelled (<0.95 of reference segment area). Spectral parameters (maximum power, mean power, minimum power and power at 30 MHz) were determined and plaque type was defined as mixed fibrous, calcified or lipid-rich. Positively remodelled segments had a larger total vessel area (16.5 +/- 1.1 mm2 vs. 8.7 +/- 0.9 mm2, p<0.01) and plaque area (7.3 +/- 1.1 mm2 vs. 4.4 +/- 0.8 mm2, p=0.05) than negatively remodelled segments. Both positively and negatively remodelled segments had a greater percentage of fibrous plaque (p<0.01) than calcified or lipid-rich plaque. Comparing positively and negatively remodelled segments, there was no significant difference between the proportion of fibrous, calcified or lipid-rich plaque. We have been able to characterise and to identify plaque composition in vivo in human atherosclerotic coronary arteries. Our data suggest that remodelled segments are predominantly composed of fibrous plaque, as identified by RF analysis, although plaque composition is similar, irrespective of the remodelling type.
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Affiliation(s)
- Andrew L McLeod
- Department of Cardiology, Lothian University Hospitals NHS Trust, Edinburgh, UK.
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Tsutsui H, Schoenhagen P, Crowe TD, Klingensmith JD, Vince DG, Nissen SE, Tuzcu EM. Influence of coronary pulsation on volumetric intravascular ultrasound measurements performed without ECG-gating. Validation in vessel segments with minimal disease. Int J Cardiovasc Imaging 2003; 19:51-7. [PMID: 12602482 DOI: 10.1023/a:1021784107536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Volumetric analysis of coronary arteries can be performed using intravascular ultrasound (IVUS) images selected at 1 mm intervals without ECG gating. However, there are few data regarding the influence of coronary pulsation on this volumetric analysis. We developed two models of consecutive area measurements consisting of duplicated area measurements from short coronary segments and virtual measurements based on a sine function. These models allowed the re-calculation of volumes using different sets of frames from the same simulated segments. The variability of the volume determinations was evaluated by its percent standard deviation [%SD = (SD/the mean value) x 100]. The relation of the variability to the extent of external elastic membrane (EEM) area change during the cardiac cycle (amplitude) and heart rates (frequency) were examined. In 58 short coronary segments of 15 patients, consecutive IVUS images were measured [%EEM area change: 12.3 +/- 7.7%, heart rate 78 +/- 21 beats/min (bpm)]. In both models, %SD of the volume calculations was directly proportional to the %EEM area change and showed two peaks at heart rates of 60 +/- 2 and 90 +/- 2 bpm. In the model based on actual coronary measurements, the %SD of volume calculations of a segment with 10% EEM area change was 0.7% except for heart rates of 60 +/- 2 and 90 +/- 2 bpm. The variability of a volumetric analysis based upon measuring IVUS images at constant intervals without ECG gating is affected by coronary pulsation, extent of cross-sectional area changes, and heart rate. Despite these limitations, this method is feasible and provides reproducible volume measurements.
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Affiliation(s)
- Hiroshi Tsutsui
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. ,
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Jimenez J, Escaned J. Intracoronary ultrasound in acute coronary syndromes: from characterization of vulnerable plaques to guidance of percutaneous treatment of complex stenoses. J Interv Cardiol 2002; 15:447-59. [PMID: 12476647 DOI: 10.1111/j.1540-8183.2002.tb01088.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Our current knowledge on the substrate and genesis of acute coronary syndromes (ACS) results from the integration of pathological, angiographic, and intracoronary imaging techniques. To summarize briefly the current paradigm, eight differentiated stages of development of atherosclerotic lesions are currently accepted, defined not only by the cellular elements involved, but also by the appearance of sudden alterations of plaque structure and coronary thrombosis. The latter constitutes not only the dominant substrate for the most devastating manifestations of coronary artery disease, but also accelerates plaque size at a faster pace than in earlier stages. The composition of atherosclerotic plaque varies significantly along the different evolutive stages, and thus includes cellular (macrophage, smooth muscle cells) and noncellular elements (glicosaminglycan or collagen-rich cellular matrix, extracellular lipid deposits, calcification, fresh, or organized thrombus) in a varying proportion. Furthermore, a dynamic process of vessel remodeling occurs along the atherosclerotic process, resulting, in most cases, in a protective mechanism against myocardial ischemia by preserving luminal dimensions during plaque enlargement. Intravascular ultrasound (IVUS) is one of the intracoronary imaging techniques that has contributed to the understanding of these changes in man. In addition, IVUS has the potential of being a useful clinical tool for predicting the chances of future acute coronary events by identifying vulnerable plaques, of characterizing which is the culprit lesion in ACS, and in guiding revascularization procedures in the treacherous field of thrombotic coronary syndromes. In this article, we review the current evidence on the potential of IVUS imaging for fulfilling these purposes.
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Affiliation(s)
- Jesús Jimenez
- Department of Interventional Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
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