1
|
Emfietzoglou M, Mavrogiannis MC, García-García HM, Stamatelopoulos K, Kanakakis I, Papafaklis MI. Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept. Life (Basel) 2023; 13:life13030696. [PMID: 36983851 PMCID: PMC10052113 DOI: 10.3390/life13030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Despite major advances in pharmacotherapy and interventional procedures, coronary artery disease (CAD) remains a principal cause of morbidity and mortality worldwide. Invasive coronary imaging along with the computation of hemodynamic forces, primarily endothelial shear stress and plaque structural stress, have enabled a comprehensive identification of atherosclerotic plaque components, providing a unique insight into the understanding of plaque vulnerability and progression, which may help guide patient treatment. However, the invasive-only approach to CAD has failed to show high predictive value. Meanwhile, it is becoming increasingly evident that along with the “vulnerable plaque”, the presence of a “vulnerable patient” state is also necessary to precipitate an acute coronary thrombotic event. Non-invasive imaging techniques have also evolved, providing new opportunities for the identification of high-risk plaques, the study of atherosclerosis in asymptomatic individuals, and general population screening. Additionally, risk stratification scores, circulating biomarkers, immunology, and genetics also complete the armamentarium of a broader “vulnerable plaque and patient” concept approach. In the current review article, the invasive and non-invasive modalities used for the detection of high-risk plaques in patients with CAD are summarized and critically appraised. The challenges of the vulnerable plaque concept are also discussed, highlighting the need to shift towards a more interdisciplinary approach that can identify the “vulnerable plaque” in a “vulnerable patient”.
Collapse
Affiliation(s)
| | - Michail C. Mavrogiannis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Hector M. García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Kimon Stamatelopoulos
- Department of Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Ioannis Kanakakis
- Catheterization and Hemodynamic Unit, Alexandra University Hospital, 115 28 Athens, Greece
| | - Michail I. Papafaklis
- Catheterization and Hemodynamic Unit, Alexandra University Hospital, 115 28 Athens, Greece
- Correspondence: ; Tel.: +30-6944376572
| |
Collapse
|
2
|
Lin A, Kolossváry M, Cadet S, McElhinney P, Goeller M, Han D, Yuvaraj J, Nerlekar N, Slomka PJ, Marwan M, Nicholls SJ, Achenbach S, Maurovich-Horvat P, Wong DTL, Dey D. Radiomics-Based Precision Phenotyping Identifies Unstable Coronary Plaques From Computed Tomography Angiography. JACC Cardiovasc Imaging 2022; 15:859-871. [PMID: 35512957 PMCID: PMC9072980 DOI: 10.1016/j.jcmg.2021.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to precisely phenotype culprit and nonculprit lesions in myocardial infarction (MI) and lesions in stable coronary artery disease (CAD) using coronary computed tomography angiography (CTA)-based radiomic analysis. BACKGROUND It remains debated whether any single coronary atherosclerotic plaque within the vulnerable patient exhibits unique morphology conferring an increased risk of clinical events. METHODS A total of 60 patients with acute MI prospectively underwent coronary CTA before invasive angiography and were matched to 60 patients with stable CAD. For all coronary lesions, high-risk plaque (HRP) characteristics were qualitatively assessed, followed by semiautomated plaque quantification and extraction of 1,103 radiomic features. Machine learning models were built to examine the additive value of radiomic features for discriminating culprit lesions over and above HRP and plaque volumes. RESULTS Culprit lesions had higher mean volumes of noncalcified plaque (NCP) and low-density noncalcified plaque (LDNCP) compared with the highest-grade stenosis nonculprits and highest-grade stenosis stable CAD lesions (NCP: 138.1 mm3 vs 110.7 mm3 vs 102.7 mm3; LDNCP: 14.2 mm3 vs 9.8 mm3 vs 8.4 mm3; both Ptrend < 0.01). In multivariable linear regression adjusted for NCP and LDNCP volumes, 14.9% (164 of 1,103) of radiomic features were associated with culprits and 9.7% (107 of 1,103) were associated with the highest-grade stenosis nonculprits (critical P < 0.0007) when compared with highest-grade stenosis stable CAD lesions as reference. Hierarchical clustering of significant radiomic features identified 9 unique data clusters (latent phenotypes): 5 contained radiomic features specific to culprits, 1 contained features specific to highest-grade stenosis nonculprits, and 3 contained features associated with either lesion type. Radiomic features provided incremental value for discriminating culprit lesions when added to a machine learning model containing HRP and plaque volumes (area under the receiver-operating characteristic curve 0.86 vs 0.76; P = 0.004). CONCLUSIONS Culprit lesions and highest-grade stenosis nonculprit lesions in MI have distinct radiomic signatures compared with lesions in stable CAD. Within the vulnerable patient may exist individual vulnerable plaques identifiable by coronary CTA-based precision phenotyping.
Collapse
Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastien Cadet
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Markus Goeller
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Faculty of Medicine, Erlangen, Germany
| | - Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Piotr J Slomka
- Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Faculty of Medicine, Erlangen, Germany
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Faculty of Medicine, Erlangen, Germany
| | - Pál Maurovich-Horvat
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary; MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| |
Collapse
|
3
|
Bajaj R, Eggermont J, Grainger SJ, Räber L, Parasa R, Khan AHA, Costa C, Erdogan E, Hendricks MJ, Chandrasekharan KH, Andiapen M, Serruys PW, Torii R, Mathur A, Baumbach A, Dijkstra J, Bourantas CV. Machine learning for atherosclerotic tissue component classification in combined near-infrared spectroscopy intravascular ultrasound imaging: Validation against histology. Atherosclerosis 2022; 345:15-25. [DOI: 10.1016/j.atherosclerosis.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/09/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
|
4
|
Circulating Biomarkers Reflecting Destabilization Mechanisms of Coronary Artery Plaques: Are We Looking for the Impossible? Biomolecules 2021; 11:biom11060881. [PMID: 34198543 PMCID: PMC8231770 DOI: 10.3390/biom11060881] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022] Open
Abstract
Despite significant strides to mitigate the complications of acute coronary syndrome (ACS), this clinical entity still represents a major global health burden. It has so far been well-established that most of the plaques leading to ACS are not a result of gradual narrowing of the vessel lumen, but rather a result of sudden disruption of vulnerable atherosclerotic plaques. As most of the developed imaging modalities for vulnerable plaque detection are invasive, multiple biomarkers were proposed to identify their presence. Owing to the pivotal role of lipids and inflammation in the pathophysiology of atherosclerosis, most of the biomarkers originated from one of those processes, whereas recent advancements in molecular sciences shed light on the use of microRNAs. Yet, at present there are no clinically implemented biomarkers or any other method for that matter that could non-invasively, yet reliably, diagnose the vulnerable plaque. Hence, in this review we summarized the available knowledge regarding the pathophysiology of plaque instability, the current evidence on potential biomarkers associated with plaque destabilization and finally, we discussed if search for biomarkers could one day bring us to non-invasive, cost-effective, yet valid way of diagnosing the vulnerable, rupture-prone coronary artery plaques.
Collapse
|
5
|
Impact of Arterial Remodeling of Intermediate Coronary Lesions on Long-Term Clinical Outcomes in Patients with Stable Coronary Artery Disease: An Intravascular Ultrasound Study. J Interv Cardiol 2021; 2021:9915759. [PMID: 34220369 PMCID: PMC8213497 DOI: 10.1155/2021/9915759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Treatment of coronary intermediate lesions remains a controversy, and the role of arterial remodeling patterns determined by intravascular ultrasound in intermediate lesion is still not well known. The aim of this study was to investigate the impact of arterial remodeling of intermediate coronary lesions on long-term clinical outcomes. Methods Arterial remodeling patterns were assessed in 212 deferred intermediate lesions from 162 patients after IVUS examination. Negative, intermediate, and positive remodeling was defined as a remodeling index of <0.88, 0.88∼1.0, and >1.0, respectively. The primary endpoint was the composite vessel-oriented clinical events, defined as the composition of target vessel-related cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Quantitative flow ratio was assessed for evaluating the functional significance of intermediate lesions. Results 72 intermediate remodeling lesions were present in 66 patients, whereas 77 negative remodeling lesions were present in 71 patients, and 63 positive remodeling lesions were present in 55 patients. Negative remodeling lesions had the smallest minimum lumen area (4.16 ± 1.03 mm2 vs. 5.05 ± 1.39 mm2 vs. 4.85 ± 1.76 mm2; P < 0.01), smallest plaque burden (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%; P < 0.01), and highest area stenosis rate (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%; P < 0.01). No significant difference was found in terms of quantitative flow ratio among three groups. At 5 years follow-up, negative remodeling lesions had a higher rate of composite vessel-oriented clinical event (14.3%), compared to intermediate (1.4%, P=0.004) or positive remodeling lesions (4.8%, P=0.06). After adjusting for multiple covariates, negative remodeling remained an independent determinant for vessel-oriented clinical event (HR: 4.849, 95% CI 1.542-15.251, P=0.007). Conclusion IVUS-derived negative remodeling is associated with adverse long-term clinical outcome in stable patients with intermediate coronary artery stenosis.
Collapse
|
6
|
Tufaro V, Safi H, Torii R, Koo BK, Kitslaar P, Ramasamy A, Mathur A, Jones DA, Bajaj R, Erdoğan E, Lansky A, Zhang J, Konstantinou K, Little CD, Rakhit R, Karamasis GV, Baumbach A, Bourantas CV. Wall shear stress estimated by 3D-QCA can predict cardiovascular events in lesions with borderline negative fractional flow reserve. Atherosclerosis 2021; 322:24-30. [PMID: 33706080 DOI: 10.1016/j.atherosclerosis.2021.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS There is some evidence of the implications of wall shear stress (WSS) derived from three-dimensional quantitative coronary angiography (3D-QCA) models in predicting adverse cardiovascular events. This study investigates the efficacy of 3D-QCA-derived WSS in detecting lesions with a borderline negative fractional flow reserve (FFR: 0.81-0.85) that progressed and caused events. METHODS In this retrospective cohort study, we identified 548 patients who had at least one lesion with an FFR 0.81-0.85 and complete follow-up data; 293 lesions (286 patients) with suitable angiographic characteristics were reconstructed using a dedicated 3D-QCA software and included in the analysis. In the reconstructed models blood flow simulation was performed and the value of 3D-QCA variables and WSS distribution in predicting events was examined. The primary endpoint of the study was the composite of cardiac death, target lesion related myocardial infarction or clinically indicated target lesion revascularization. RESULTS During a median follow-up of 49.4 months, 37 events were reported. Culprit lesions had a greater area stenosis [(AS), 66.1% (59.5-72.3) vs 54.8% (46.5-63.2), p<0.001], smaller minimum lumen area [(MLA), 1.66 mm2 (1.45-2.30) vs 2.10 mm2 (1.69-2.70), p=0.011] and higher maximum WSS [9.0 Pa (5.10-12.46) vs 5.0 Pa (3.37-7.54), p < 0.001] than those that remained quiescent. In multivariable analysis, AS [hazard ratio (HR): 1.06, 95% confidence interval (CI): 1.03-1.10, p=0.001] and maximum WSS (HR: 1.08, 95% CI: 1.02-1.14, p=0.012) were the only independent predictors of the primary endpoint. Lesions with an increased AS (≥58.6%) that were exposed to high WSS (≥7.69Pa) were more likely to progress and cause events (27.8%) than those with a low AS exposed to high WSS (7.4%) or those exposed to low WSS that had increased (12.8%) or low AS (2.7%, p<0.001). CONCLUSIONS This study for the first time highlights the potential value of 3D-QCA-derived WSS in detecting, among lesions with a borderline negative FFR, those that cause cardiovascular events.
Collapse
Affiliation(s)
- Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Hannah Safi
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, South Korea
| | - Pieter Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands; Medis Medical Imaging Systems Bv, Leiden, the Netherlands
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Emrah Erdoğan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Department of Cardiology, Van Yüzüncü Yıl University, Van, Turkey
| | - Alexandra Lansky
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Yale University School of Medicine, New Haven, CT, USA
| | - Jinlong Zhang
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, South Korea
| | | | - Callum D Little
- Department of Cardiology, Royal Free London NHS Trust, London, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Trust, London, UK
| | | | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Yale University School of Medicine, New Haven, CT, USA
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
| |
Collapse
|
7
|
Bourantas CV, Jaffer FA, Onuma Y, Serruys PW. Editorial: Advances in Intravascular Imaging. Front Cardiovasc Med 2021; 8:764378. [PMID: 34604363 PMCID: PMC8481618 DOI: 10.3389/fcvm.2021.764378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, London, United Kingdom.,William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Farouc A Jaffer
- Cardiovascular Research Center and Cardiology Division, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
| | - Yoshinubo Onuma
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland.,Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
8
|
Johnson TW, Räber L, di Mario C, Bourantas C, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas K, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2020; 40:2566-2584. [PMID: 31112213 DOI: 10.1093/eurheartj/ehz332] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
Collapse
Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, UK
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Alessio Mattesini
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Nieves Gonzalo
- Department of Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation Rome, Italy
| | - Konstantinos Koskinas
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Joner
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Maria D Radu
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Erlinge
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Evelyn Regar
- Department of Cardiovascular Surgery, Zürich University Hospital, Zürich, Switzerland
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Akiko Maehara
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Robert A Byrne
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Gary S Mintz
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
9
|
Safi H, Bourantas CV, Ramasamy A, Zanchin T, Bär S, Tufaro V, Jin C, Torii R, Karagiannis A, Reiber JHC, Mathur A, Onuma Y, Windecker S, Lansky A, Maehara A, Serruys PW, Stone P, Baumbach A, Stone GW, Räber L. Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study. Int J Cardiovasc Imaging 2020; 36:993-1002. [PMID: 32152810 DOI: 10.1007/s10554-020-01805-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/22/2020] [Indexed: 01/07/2023]
Abstract
Studies have shown that the quantitative flow ratio (QFR), recently introduced to assess lesion severity from coronary angiography, provides useful prognostic information; however the additive value of this technique over intravascular imaging in detecting lesions that are likely to cause events is yet unclear. We analysed data acquired in the PROSPECT and IBIS-4 studies, in particular the baseline virtual histology-intravascular ultrasound (VH-IVUS) and angiographic data from 17 non-culprit lesions with a presumable vulnerable phenotype (i.e., thin or thick cap fibroatheroma) that caused major adverse cardiac events or required revascularization (MACE) at 5-year follow-up and from a group of 78 vulnerable plaques that remained quiescent. The segments studied by VH-IVUS were identified in coronary angiography and the QFR was estimated. The additive value of 3-dimensional quantitative coronary angiography (3D-QCA) and of the QFR in predicting MACE at 5 year follow-up beyond plaque characteristics was examined. It was found that MACE lesions had a greater plaque burden (PB) and smaller minimum lumen area (MLA) on VH-IVUS, a longer length and a smaller minimum lumen diameter (MLD) on 3D-QCA and a lower QFR compared with lesions that remained quiescent. By univariate analysis MLA, PB, MLD, lesion length on 3D-QCA and QFR were predictors of MACE. In multivariate analysis a low but normal QFR (> 0.80 to < 0.97) was the only independent prediction of MACE (HR 3.53, 95% CI 1.16-10.75; P = 0.027). In non-flow limiting lesions with a vulnerable phenotype, QFR may provide additional prognostic information beyond plaque morphology for predicting MACE throughout 5 years.
Collapse
Affiliation(s)
- Hannah Safi
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK. .,Institute of Cardiovascular Sciences, University College London, London, UK. .,William Harvey Research Institute, Queen Mary University London, London, UK.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | | | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Yoshinubo Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Alexandra Lansky
- Institute of Cardiovascular Sciences, University College London, London, UK.,Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Akiko Maehara
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Peter Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Gregg W Stone
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
10
|
Bourantas CV, Zanchin T, Torii R, Serruys PW, Karagiannis A, Ramasamy A, Safi H, Coskun AU, Koning G, Onuma Y, Zanchin C, Krams R, Mathur A, Baumbach A, Mintz G, Windecker S, Lansky A, Maehara A, Stone PH, Raber L, Stone GW. Shear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events. JACC Cardiovasc Imaging 2020; 13:2206-2219. [PMID: 32417338 DOI: 10.1016/j.jcmg.2020.02.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/05/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study examined the value of endothelial shear stress (ESS) estimated in 3-dimensional quantitative coronary angiography (3D-QCA) models in detecting plaques that are likely to progress and cause events. BACKGROUND Cumulative evidence has shown that plaque characteristics and ESS derived from intravascular ultrasound (IVUS)-based reconstructions enable prediction of lesions that will cause cardiovascular events. However, the prognostic value of ESS estimated by 3D-QCA in nonflow limiting lesions is yet unclear. METHODS This study analyzed baseline virtual histology (VH)-IVUS and angiographic data from 28 lipid-rich lesions (i.e., fibroatheromas) that caused major adverse cardiovascular events or required revascularization (MACE-R) at 5-year follow-up and 119 lipid-rich plaques from a control group that remained quiescent. The segments studied by VH-IVUS at baseline were reconstructed using 3D-QCA software. In the obtained geometries, blood flow simulation was performed, and the pressure gradient across the lipid-rich plaque and the mean ESS values in 3-mm segments were estimated. The additive value of these hemodynamic indexes in predicting MACE-R beyond plaque characteristics was examined. RESULTS MACE-R lesions were longer, had smaller minimum lumen area, increased plaque burden (PB), were exposed to higher ESS, and exhibited a higher pressure gradient. In multivariable analysis, PB (hazard ratio: 1.08; p = 0.004) and the maximum 3-mm ESS value (hazard ratio: 1.11; p = 0.001) were independent predictors of MACE-R. Lesions exposed to high ESS (>4.95 Pa) with a high-risk anatomy (minimal lumen area <4 mm2 and PB >70%) had a higher MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS who had high- (20.0%) or low-risk anatomy (7.1%; p < 0.001). CONCLUSIONS In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information, and, in combination with lesion anatomy, enabled more accurate identification of MACE-R lesions.
Collapse
Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom.
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Hannah Safi
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Ahmet Umit Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts
| | - Gerhard Koning
- Medis medical imaging systems bv, Leiden, the Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christian Zanchin
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Rob Krams
- Department of Molecular Bioengineering Engineering and Material Sciences, Queen Mary University London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Gary Mintz
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Alexandra Lansky
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Akiko Maehara
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Peter H Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lorenz Raber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gregg W Stone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
11
|
Ramasamy A, Safi H, Moon J, Andiapen M, Rathod K, Maurovich-Horvat P, Bajaj R, Serruys P, Mathur A, Baumbach A, Pugliese F, Torii R, Bourantas C. Evaluation of the Efficacy of Computed Tomographic Coronary Angiography in Assessing Coronary Artery Morphology and Physiology: Rationale and Study Design. Cardiology 2020; 145:285-293. [DOI: 10.1159/000506537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022]
Abstract
Computed tomographic coronary angiography (CTCA) is a non-invasive imaging modality, which allows plaque burden and composition assessment and detection of plaque characteristics associated with increased vulnerability. In addition, CTCA-based coronary artery reconstruction enables local haemodynamic forces assessment, which regulate plaque formation and vascular inflammation and prediction of lesions that are prone to progress and cause events. However, the use of CTCA for vulnerable plaque detection in the clinical arena remains limited. To unlock the full potential of CTCA and enable its broad use, further work is needed to develop user-friendly processing tools that will allow fast and accurate analysis of CTCA, computational fluid dynamic modelling, and evaluation of the local haemodynamic forces. The present study aims to develop a seamless platform that will overcome the limitations of CTCA and enable fast and accurate evaluation of plaque morphology and physiology. We will analyse imaging data from 70 patients with coronary artery disease who will undergo state-of-the-art CTCA and near-infrared spectroscopy-intravascular ultrasound imaging and develop and train algorithms that will take advantage of the intravascular imaging data to optimise vessel segmentation and plaque characterisation. Furthermore, we will design an advanced module that will enable reconstruction of coronary artery anatomy from CTCA, blood flow simulation, shear stress estimation, and comprehensive visualisation of vessel pathophysiology. These advances are expected to facilitate the broad use of CTCA, not only for risk stratification but also for the evaluation of the effect of emerging therapies on plaque evolution.
Collapse
|
12
|
Lenz T, Nicol P, Castellanos MI, Engel LC, Lahmann AL, Alexiou C, Joner M. Small Dimension-Big Impact! Nanoparticle-Enhanced Non-Invasive and Intravascular Molecular Imaging of Atherosclerosis In Vivo. Molecules 2020; 25:E1029. [PMID: 32106607 PMCID: PMC7179220 DOI: 10.3390/molecules25051029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 01/16/2023] Open
Abstract
Extensive translational research has provided considerable progress regarding the understanding of atherosclerosis pathophysiology over the last decades. In contrast, implementation of molecular in vivo imaging remains highly limited. In that context, nanoparticles represent a useful tool. Their variable shape and composition assure biocompatibility and stability within the environment of intended use, while the possibility of conjugating different ligands as well as contrast dyes enable targeting of moieties of interest on a molecular level and visualization throughout various imaging modalities. These characteristics have been exploited by a number of preclinical research approaches aimed at advancing understanding of vascular atherosclerotic disease, in order to improve identification of high-risk lesions prior to oftentimes fatal thromboembolic events. Furthermore, the combination of these targeted nanoparticles with therapeutic agents offers the potential of site-targeted drug delivery with minimized systemic secondary effects. This review gives an overview of different groups of targeted nanoparticles, designed for in vivo molecular imaging of atherosclerosis as well as an outlook on potential combined diagnostic and therapeutic applications.
Collapse
Affiliation(s)
- Tobias Lenz
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany; (T.L.); (P.N.); (M.I.C.); (L.-C.E.); (A.L.L.)
| | - Philipp Nicol
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany; (T.L.); (P.N.); (M.I.C.); (L.-C.E.); (A.L.L.)
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Maria Isabel Castellanos
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany; (T.L.); (P.N.); (M.I.C.); (L.-C.E.); (A.L.L.)
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Leif-Christopher Engel
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany; (T.L.); (P.N.); (M.I.C.); (L.-C.E.); (A.L.L.)
| | - Anna Lena Lahmann
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany; (T.L.); (P.N.); (M.I.C.); (L.-C.E.); (A.L.L.)
| | - Christoph Alexiou
- Department of Oto-rhino-laryngology, head and neck surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Michael Joner
- German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany; (T.L.); (P.N.); (M.I.C.); (L.-C.E.); (A.L.L.)
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| |
Collapse
|
13
|
Baumbach A, Bourantas CV, Serruys PW, Wijns W. The year in cardiology: coronary interventions. Eur Heart J 2020; 41:394-405. [PMID: 31901934 PMCID: PMC6964232 DOI: 10.1093/eurheartj/ehz947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/16/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Patrick W Serruys
- International Centre for Circulatory Health, Imperial College London, London, UK.,The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, National University of Ireland Galway, Galway, Ireland
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
14
|
Johnson TW, Räber L, Di Mario C, Bourantas CV, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas KC, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2019; 15:434-451. [PMID: 31258132 DOI: 10.4244/eijy19m06_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
Collapse
Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bourantas CV, Ramasamy A, Karagiannis A, Sakellarios A, Zanchin T, Yamaji K, Ueki Y, Shen X, Fotiadis DI, Michalis LK, Mathur A, Serruys PW, Garcia-Garcia HM, Koskinas K, Torii R, Windecker S, Räber L. Angiographic derived endothelial shear stress: a new predictor of atherosclerotic disease progression. Eur Heart J Cardiovasc Imaging 2019; 20:314-322. [PMID: 30020435 DOI: 10.1093/ehjci/jey091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/19/2018] [Indexed: 12/16/2022] Open
Abstract
AIMS To examine the efficacy of angiography derived endothelial shear stress (ESS) in predicting atherosclerotic disease progression. METHODS AND RESULTS Thirty-five patients admitted with ST-elevation myocardial infarction that had three-vessel intravascular ultrasound (IVUS) immediately after revascularization and at 13 months follow-up were included. Three dimensional (3D) reconstruction of the non-culprit vessels were performed using (i) quantitative coronary angiography (QCA) and (ii) methodology involving fusion of IVUS and biplane angiography. In both models, blood flow simulation was performed and the minimum predominant ESS was estimated in 3 mm segments. Baseline plaque characteristics and ESS were used to identify predictors of atherosclerotic disease progression defied as plaque area increase and lumen reduction at follow-up. Fifty-four vessels were included in the final analysis. A moderate correlation was noted between ESS estimated in the 3D QCA and the IVUS-derived models (r = 0.588, P < 0.001); 3D QCA accurately identified segments exposed to low (<1 Pa) ESS in the IVUS-based reconstructions (AUC: 0.793, P < 0.001). Low 3D QCA-derived ESS (<1.75 Pa) was associated with an increase in plaque area, burden, and necrotic core at follow-up. In multivariate analysis, low ESS estimated either in 3D QCA [odds ratio (OR): 2.07, 95% confidence interval (CI): 1.17-3.67; P = 0.012) or in IVUS (<1 Pa; OR: 2.23, 95% CI: 1.23-4.03; P = 0.008) models, and plaque burden were independent predictors of atherosclerotic disease progression; 3D QCA and IVUS-derived models had a similar accuracy in predicting disease progression (AUC: 0.826 vs. 0.827, P = 0.907). CONCLUSIONS 3D QCA-derived ESS can predict disease progression. Further research is required to examine its value in detecting vulnerable plaques.
Collapse
Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | | | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Antonis Sakellarios
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Thomas Zanchin
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Xiaohui Shen
- Department of Mechanical Engineering, University College London, London, UK
| | - Dimitrios I Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
16
|
Kole A, Cao Y, Hui J, Bolad IA, Alloosh M, Cheng JX, Sturek M. Comparative Quantification of Arterial Lipid by Intravascular Photoacoustic-Ultrasound Imaging and Near-Infrared Spectroscopy-Intravascular Ultrasound. J Cardiovasc Transl Res 2019; 12:211-220. [PMID: 30488332 PMCID: PMC6611754 DOI: 10.1007/s12265-018-9849-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/19/2018] [Indexed: 01/04/2023]
Abstract
Intravascular photoacoustic-ultrasound (IVPA-US) imaging and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) are two hybrid modalities that detect arterial lipid, with comparison necessary to understand the relative advantages of each. We performed in vivo and ex vivo IVPA-US imaging of the iliac arteries of Ossabaw swine with metabolic syndrome (MetS) and lean swine to investigate sensitivity for early-stage atherosclerosis. We repeated imaging ex vivo with NIRS-IVUS for comparison to IVPA-US and histology. Both modalities showed significantly greater lipid in MetS vs. lean swine, but only IVPA-US localized the lipid as perivascular. To investigate late-stage atherosclerosis, we performed ex vivo IVPA-US imaging of a human coronary artery with comparison to NIRS-IVUS and histology. Two advanced fibroatheromas were identified, with agreement between IVPA-measured lipid area and NIRS-derived lipid content. As confirmed histologically, IVPA-US has sensitivity to detect lipid content similar to NIRS-IVUS and provides additional depth resolution, enabling quantification and localization of lipid cores within plaques.
Collapse
Affiliation(s)
- Ayeeshik Kole
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, MS 385, Indianapolis, IN, 46202, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Yingchun Cao
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Jie Hui
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, 47907, USA
| | - Islam A Bolad
- Roudebush VA Medical Center and Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Mouhamad Alloosh
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, MS 385, Indianapolis, IN, 46202, USA
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Photonics Center, Boston University, Boston, MA, 02215, USA
| | - Michael Sturek
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, MS 385, Indianapolis, IN, 46202, USA.
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA.
| |
Collapse
|
17
|
|
18
|
|
19
|
McDermott MM, Carroll T, Carr J, Yuan C, Ferrucci L, Guralnik JM, Kibbe M, Criqui MH, Tian L, Polonsky T, Zhao L, Gao Y, Hippe DS, Xu D, McCarthy W, Kramer CM. Femoral artery plaque characteristics, lower extremity collaterals, and mobility loss in peripheral artery disease. Vasc Med 2017; 22:473-481. [PMID: 28965473 PMCID: PMC6127853 DOI: 10.1177/1358863x17729030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Little is known about the prognostic significance of specific characteristics of magnetic resonance imaging (MRI) measured plaque in the superficial femoral artery (SFA). Associations of MRI-measured plaque quantity, lumen area, and plaque composition in the SFA with subsequent mobility loss were studied in people with lower extremity peripheral artery disease (PAD). Participants with an ankle-brachial index (ABI) < 1.00 were identified from Chicago medical centers and underwent direct visualization of atherosclerotic plaque in the SFA using MRI. Participants were followed annually for up to 4 years. Mobility loss was defined as becoming unable to walk up and down a flight of stairs or walk one-quarter of a mile without assistance among participants without mobility impairment at baseline. Analyses adjusted for age, sex, race, comorbidities, ABI, physical activity, and other confounders. Of 308 PAD participants without baseline mobility impairment, 100 (32.5%) developed mobility loss during follow-up. Compared to the lowest mean plaque area tertile at baseline, participants in the highest (worst) plaque area tertile had a higher rate of mobility loss (hazard ratio (HR) = 2.08, 95% confidence interval (CI) = 1.14-3.79, p = 0.018). Compared to the highest mean lumen area tertile, the smallest (worst) mean lumen area tertile was associated with greater mobility loss (HR = 2.18, 95% CI = 1.20-3.96, p = 0.011). Neither lipid rich necrotic core nor calcium in the SFA were associated with mobility loss. In conclusion, greater plaque quantity and smaller lumen area in the proximal SFA, but not lipid rich necrotic core or calcium, were associated with higher mobility loss in people with PAD.
Collapse
Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
| | - Timothy Carroll
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - James Carr
- Department of Radiology, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
| | - Chun Yuan
- Department of Radiology and Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Melina Kibbe
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tamar Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
| | - Ying Gao
- Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Walter McCarthy
- University Cardiovascular Surgeons, Rush University Medical Center, Chicago, IL, USA
| | - Christopher M Kramer
- Departments of Medicine, Radiology, and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| |
Collapse
|
20
|
Parma L, Baganha F, Quax PHA, de Vries MR. Plaque angiogenesis and intraplaque hemorrhage in atherosclerosis. Eur J Pharmacol 2017; 816:107-115. [PMID: 28435093 DOI: 10.1016/j.ejphar.2017.04.028] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/31/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
Acute cardiovascular events, due to rupture or erosion of an atherosclerotic plaque, represent the major cause of morbidity and mortality in patients. Growing evidence suggests that plaque neovascularization is an important contributor to plaque growth and instability. The vessels' immaturity, with profound structural and functional abnormalities, leads to recurrent intraplaque hemorrhage. This review discusses new insights of atherosclerotic neovascularization, including the effects of leaky neovessels on intraplaque hemorrhage, both in experimental models and humans. Furthermore, modalities for in vivo imaging and therapeutic interventions to target plaque angiogenesis will be discussed.
Collapse
Affiliation(s)
- Laura Parma
- Department of Surgery and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Fabiana Baganha
- Department of Surgery and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Paul H A Quax
- Department of Surgery and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Margreet R de Vries
- Department of Surgery and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
21
|
Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017; 6:JAHA.117.005543. [PMID: 28314799 PMCID: PMC5524044 DOI: 10.1161/jaha.117.005543] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Dimitrios Tsiachris
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| | - Panagiota Pietri
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| |
Collapse
|
22
|
Patel K, Tarkin J, Serruys PW, Tenekecioglu E, Foin N, Zhang YJ, Crake T, Moon J, Mathur A, Bourantas CV. Invasive or non-invasive imaging for detecting high-risk coronary lesions? Expert Rev Cardiovasc Ther 2017; 15:165-179. [PMID: 28256179 DOI: 10.1080/14779072.2017.1297231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an arsenal of invasive and non-invasive imaging modalities have been developed that are capable of identifying these features allowing in vivo assessment of plaque vulnerability. Areas covered: This review article presents the available and emerging imaging modalities introduced to assess plaque morphology and biology, describes the evidence from the first large scale studies that evaluated the efficacy of invasive and non-invasive imaging in detecting lesions that are likely to progress and cause cardiovascular events and discusses the potential implications of the in vivo assessment of coronary artery pathology in the clinical setting. Expert commentary: Invasive imaging, with its high resolution, and in particular hybrid intravascular imaging appears as the ideal approach to study the mechanisms regulating atherosclerotic disease progression; whereas non-invasive imaging is expected to enable complete assessment of coronary tree pathology, detection of high-risk lesions, more accurate risk stratification and thus to allow a personalized treatment of vulnerable patients.
Collapse
Affiliation(s)
- Kush Patel
- a Barts Heart Centre, Barts Health NHS Trust , London , UK
| | - Jason Tarkin
- a Barts Heart Centre, Barts Health NHS Trust , London , UK.,b Division of Cardiovascular Medicine , University of Cambridge , Cambridge , UK
| | - Patrick W Serruys
- c Thoraxcenter , Erasmus Medical Centre , Rotterdam , The Netherlands.,d Faculty of Medicine , National Heart & Lung Institute, Imperial College , London , UK
| | | | - Nicolas Foin
- e National Heart Centre Singapore , Duke-NUS Medical School , Singapore
| | - Yao-Jun Zhang
- f Nanjing First Hospital , Nanjing Medical University , Nanjing , China
| | - Tom Crake
- a Barts Heart Centre, Barts Health NHS Trust , London , UK
| | - James Moon
- a Barts Heart Centre, Barts Health NHS Trust , London , UK
| | - Anthony Mathur
- a Barts Heart Centre, Barts Health NHS Trust , London , UK
| | - Christos V Bourantas
- a Barts Heart Centre, Barts Health NHS Trust , London , UK.,g Institute of Cardiovascular Sciences , University College London , London , UK
| |
Collapse
|
23
|
Michail M, Serruys PW, Stettler R, Crake T, Torii R, Tenekecioglu E, Zeng Y, Onuma Y, Mathur A, Bourantas CV. Intravascular multimodality imaging: feasibility and role in the evaluation of coronary plaque pathology. Eur Heart J Cardiovasc Imaging 2017; 18:613-620. [DOI: 10.1093/ehjci/jew330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/22/2016] [Indexed: 12/23/2022] Open
|
24
|
Bourantas CV, Jaffer FA, Gijsen FJ, van Soest G, Madden SP, Courtney BK, Fard AM, Tenekecioglu E, Zeng Y, van der Steen AF, Emelianov S, Muller J, Stone PH, Marcu L, Tearney GJ, Serruys PW. Hybrid intravascular imaging: recent advances, technical considerations, and current applications in the study of plaque pathophysiology. Eur Heart J 2017; 38:400-412. [PMID: 27118197 PMCID: PMC5837589 DOI: 10.1093/eurheartj/ehw097] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
Cumulative evidence from histology-based studies demonstrate that the currently available intravascular imaging techniques have fundamental limitations that do not allow complete and detailed evaluation of plaque morphology and pathobiology, limiting the ability to accurately identify high-risk plaques. To overcome these drawbacks, new efforts are developing for data fusion methodologies and the design of hybrid, dual-probe catheters to enable accurate assessment of plaque characteristics, and reliable identification of high-risk lesions. Today several dual-probe catheters have been introduced including combined near infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), that is already commercially available, IVUS-optical coherence tomography (OCT), the OCT-NIRS, the OCT-near infrared fluorescence (NIRF) molecular imaging, IVUS-NIRF, IVUS intravascular photoacoustic imaging and combined fluorescence lifetime-IVUS imaging. These multimodal approaches appear able to overcome limitations of standalone imaging and provide comprehensive visualization of plaque composition and plaque biology. The aim of this review article is to summarize the advances in hybrid intravascular imaging, discuss the technical challenges that should be addressed in order to have a use in the clinical arena, and present the evidence from their first applications aiming to highlight their potential value in the study of atherosclerosis.
Collapse
Affiliation(s)
| | - Farouc A. Jaffer
- Cardiovascular Research Center and Cardiology Division, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Frank J. Gijsen
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Gijs van Soest
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | | | - Brian K. Courtney
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ali M. Fard
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Erhan Tenekecioglu
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Yaping Zeng
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | | | - Stanislav Emelianov
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA
| | | | - Peter H. Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, CA, USA
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Patrick W. Serruys
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
- International Centre for Cardiovascular Health, NHLI, Imperial College London, London, UK
| |
Collapse
|