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Tomizawa N, Fujimoto S, Mita T, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kurita M, Kumamaru KK, Watada H, Minamino T, Aoki S. Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus. Radiol Cardiothorac Imaging 2023; 5:e230016. [PMID: 37693191 PMCID: PMC10483244 DOI: 10.1148/ryct.230016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023]
Abstract
Purpose To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus. Materials and Methods This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis. Results Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec-1; IQR: 730-1253 vs 443 sec-1; IQR: 295-602; P < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; P < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; P = .004). Conclusion In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.Keywords: Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Nobuo Tomizawa
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tomoya Mita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daigo Takahashi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yui Nozaki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ruiheng Fan
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ayako Kudo
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko Kawaguchi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Makoto Hiki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mika Kurita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kanako K. Kumamaru
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tohru Minamino
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Ishii H. Cardiovascular events and atherosclerosis in patients with type 2 diabetes and impaired glucose tolerance -What are the medical treatments to prevent cardiovascular events in such patients? J Diabetes Investig 2022; 13:1114-1121. [PMID: 35377559 PMCID: PMC9248425 DOI: 10.1111/jdi.13799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) significantly induce advanced coronary artery disease and systemic atherosclerosis. Thus, T2DM and IGT are traditional risk factors of cardiovascular disease (CVD). On the other hand, acute coronary syndrome is frequently caused by the rupture of coronary atherosclerotic plaques, which reduces patients' quality of life and may result in death. To date, many trials have sought to identify ways to determine the coronary plaque volume and its vulnerability, and many studies have demonstrated that some specific antihyperglycemic agents may prevent coronary or carotid plaque progression, decrease plaque volume, induce plaque stability, and improve clinical outcomes in patients with T2DM and IGT. This article reviews i) the association between coronary or carotid plaques and abnormal glucose tolerance, including T2DM; and ii) the effects of oral antihyperglycemic drugs to improve clinical outcomes and stabilize atherosclerotic plaques in patients with T2DM and IGT.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
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Adriaenssens T, Allard-Ratick MP, Thondapu V, Sugiyama T, Raffel OC, Barlis P, Poon EKW, Araki M, Nakajima A, Minami Y, Takano M, Kurihara O, Fuster V, Kakuta T, Jang IK. Optical Coherence Tomography of Coronary Plaque Progression and Destabilization: JACC Focus Seminar Part 3/3. J Am Coll Cardiol 2021; 78:1275-1287. [PMID: 34531029 DOI: 10.1016/j.jacc.2021.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The development of optical coherence tomography (OCT) has revolutionized our understanding of coronary artery disease. In vivo OCT research has paralleled with advances in computational fluid dynamics, providing additional insights in the various hemodynamic factors influencing plaque growth and stability. Recent OCT studies introduced a new concept of plaque healing in relation to clinical presentation. In addition to known mechanisms of acute coronary syndromes such as plaque rupture and plaque erosion, a new classification of calcified plaque was recently reported. This review will focus on important new insights that OCT has provided in recent years into coronary plaque development, progression, and destabilization, with a focus on the role of local hemodynamics and endothelial shear stress, the layered plaque (signature of previous subclinical plaque destabilization and healing), and the calcified culprit plaque.
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Affiliation(s)
- Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc P Allard-Ratick
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vikas Thondapu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomoyo Sugiyama
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | | | - Peter Barlis
- Department of Medicine, St Vincent's Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Osamu Kurihara
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Kyung Hee University Hospital, Seoul, South Korea.
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Nishitani-Yokoyama M, Miyauchi K, Shimada K, Yokoyama T, Ouchi S, Aikawa T, Kunimoto M, Yamada M, Honzawa A, Okazaki S, Tsujita H, Koba S, Daida H. Preliminary Pilot Study of Combined Effects of Physical Activity and Achievement of LDL-Cholesterol Target on Coronary Plaque Volume Changes in Patients with Acute Coronary Syndrome. J Clin Med 2020; 9:E1578. [PMID: 32455937 PMCID: PMC7290587 DOI: 10.3390/jcm9051578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We investigated the combined effects of physical activity (PA) and aggressive low-density lipoprotein cholesterol (LDL-C) reduction on the changes in coronary plaque volume (PV) in patients with acute coronary syndrome (ACS) using volumetric intravascular ultrasound (IVUS) analysis. METHODS We retrospectively analyzed data from two different prospective clinical trials that involved 101 ACS patients who underwent percutaneous coronary intervention (PCI) and assessed the non-culprit sites of PCI lesions using IVUS at baseline and at the follow-up. After PCI, all the patients participated in early phase II comprehensive cardiac rehabilitation. Patients were divided into four groups based on whether the average daily step count, measured using a pedometer, was 7000 steps of more and whether the follow-up LDL-C level was <70 mg/dL. At the time of follow-up, we examined the correlation of changes in the PV with LDL-C and PA. RESULTS The baseline characteristics of the four study groups were comparable. At the follow-up, plaque regression in both the achievement group (PA and LDL-C reduction) was higher than that in the other three groups. In addition, plaque reduction independently correlated with increased PA and reduction in LDL-C level. CONCLUSIONS Combined therapy of intensive PA and achievement of LDL-C target retarded coronary PV in patients with ACS.
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Affiliation(s)
- Miho Nishitani-Yokoyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo 113-8431, Japan; (M.Y.); (A.H.)
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo 113-8431, Japan; (M.Y.); (A.H.)
| | - Takayuki Yokoyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
| | - Mitsuhiro Kunimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo 113-8431, Japan; (M.Y.); (A.H.)
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo 113-8431, Japan; (M.Y.); (A.H.)
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
| | - Hiroaki Tsujita
- Division of Cardiology, Department of Medicine, School of Medicine, Showa University, Tokyo 142-8666, Japan; (H.T.); (S.K.)
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, School of Medicine, Showa University, Tokyo 142-8666, Japan; (H.T.); (S.K.)
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (M.N.-Y.); (K.M.); (K.S.); (T.Y.); (S.O.); (T.A.); (M.K.); (S.O.)
- Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
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Kim YD, Noh KJ, Byun SJ, Lee S, Kim T, Sunwoo L, Lee KJ, Kang SH, Park KH, Park SJ. Effects of Hypertension, Diabetes, and Smoking on Age and Sex Prediction from Retinal Fundus Images. Sci Rep 2020; 10:4623. [PMID: 32165702 PMCID: PMC7067849 DOI: 10.1038/s41598-020-61519-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/28/2020] [Indexed: 12/25/2022] Open
Abstract
Retinal fundus images are used to detect organ damage from vascular diseases (e.g. diabetes mellitus and hypertension) and screen ocular diseases. We aimed to assess convolutional neural network (CNN) models that predict age and sex from retinal fundus images in normal participants and in participants with underlying systemic vascular-altered status. In addition, we also tried to investigate clues regarding differences between normal ageing and vascular pathologic changes using the CNN models. In this study, we developed CNN age and sex prediction models using 219,302 fundus images from normal participants without hypertension, diabetes mellitus (DM), and any smoking history. The trained models were assessed in four test-sets with 24,366 images from normal participants, 40,659 images from hypertension participants, 14,189 images from DM participants, and 113,510 images from smokers. The CNN model accurately predicted age in normal participants; the correlation between predicted age and chronologic age was R2 = 0.92, and the mean absolute error (MAE) was 3.06 years. MAEs in test-sets with hypertension (3.46 years), DM (3.55 years), and smoking (2.65 years) were similar to that of normal participants; however, R2 values were relatively low (hypertension, R2 = 0.74; DM, R2 = 0.75; smoking, R2 = 0.86). In subgroups with participants over 60 years, the MAEs increased to above 4.0 years and the accuracies declined for all test-sets. Fundus-predicted sex demonstrated acceptable accuracy (area under curve > 0.96) in all test-sets. Retinal fundus images from participants with underlying vascular-altered conditions (hypertension, DM, or smoking) indicated similar MAEs and low coefficients of determination (R2) between the predicted age and chronologic age, thus suggesting that the ageing process and pathologic vascular changes exhibit different features. Our models demonstrate the most improved performance yet and provided clues to the relationship and difference between ageing and pathologic changes from underlying systemic vascular conditions. In the process of fundus change, systemic vascular diseases are thought to have a different effect from ageing. Research in context. Evidence before this study. The human retina and optic disc continuously change with ageing, and they share physiologic or pathologic characteristics with brain and systemic vascular status. As retinal fundus images provide high-resolution in-vivo images of retinal vessels and parenchyma without any invasive procedure, it has been used to screen ocular diseases and has attracted significant attention as a predictive biomarker for cerebral and systemic vascular diseases. Recently, deep neural networks have revolutionised the field of medical image analysis including retinal fundus images and shown reliable results in predicting age, sex, and presence of cardiovascular diseases. Added value of this study. This is the first study demonstrating how a convolutional neural network (CNN) trained using retinal fundus images from normal participants measures the age of participants with underlying vascular conditions such as hypertension, diabetes mellitus (DM), or history of smoking using a large database, SBRIA, which contains 412,026 retinal fundus images from 155,449 participants. Our results indicated that the model accurately predicted age in normal participants, while correlations (coefficient of determination, R2) in test-sets with hypertension, DM, and smoking were relatively low. Additionally, a subgroup analysis indicated that mean absolute errors (MAEs) increased and accuracies declined significantly in subgroups with participants over 60 years of age in both normal participants and participants with vascular-altered conditions. These results suggest that pathologic retinal vascular changes occurring in systemic vascular diseases are different form the changes in spontaneous ageing process, and the ageing process observed in retinal fundus images may saturate at age about 60 years. Implications of all available evidence. Based on this study and previous reports, the CNN could accurately and reliably predict age and sex using retinal fundus images. The fact that retinal changes caused by ageing and systemic vascular diseases occur differently motivates one to understand the retina deeper. Deep learning-based fundus image reading may be a more useful and beneficial tool for screening and diagnosing systemic and ocular diseases after further development.
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Affiliation(s)
- Yong Dae Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.,Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kyoung Jin Noh
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Soochahn Lee
- School of Electrical Engineering, Kookmin University, Seoul, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Intraplaque neovascularization attenuated statin benefit on atherosclerotic plaque in CAD patients: A follow-up study with combined imaging modalities. Atherosclerosis 2019; 287:134-139. [PMID: 31272069 DOI: 10.1016/j.atherosclerosis.2019.06.912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Plaque progression increases the risk of a cardiovascular event. This study aims to determine whether intraplaque neovascularization (NV) associates with a greater risk of plaque progression. METHODS Baseline and 12-month follow-up IVUS was used in combination with baseline OCT to assess 164 non-culprit plaques in 118 CAD patients. A generalized estimating equation approach with exchangeable correlation structure was used to correct for the dependency of repeated measurements. RESULTS Patients were divided into two groups according to NV (52 patients with 62 NV plaques, 66 patients with 102 non-NV plaques). Non-culprit plaques in the NV group exhibited a more frequent occurrence of TCFA (p = 0.004), macrophage (p = 0.005), cholesterol crystal (p = 0.012), calcification (p = 0.030), thinner fibrous cap thickness (FCT) [(86.8 ± 55.1) vs. (127.4 ± 70.1) μm, p = 0.015], larger lipid arc [(219.5 ± 66.9) vs. (179.8 ± 61.4), p = 0.002] compared to the non-NV group. A large change in percent atheroma volume (PAV), plaque plus media cross-sectional area (P&M CSA), plaque volume, and plaque burden was observed from baseline to follow-up in the NV group. Changes in P&M CSA, plaque volume, and plaque burden showed significant differences in fibroatheroma with NV. Intraplaque NV could predict a high risk of plaque progression despite statin therapy [OR 6.521 (95% CI 2.457-17.308), p < 0.001]. CONCLUSIONS NV might attenuate the benefits of statin therapy in plaque progression. This study may provide a new basis for anti-angiogenic strategies to prevent atherosclerotic plaque progression.
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Sinning D, Landmesser U. Effective low-density lipoprotein-lowering therapy: Implementation in clinical practice. Eur J Prev Cardiol 2018; 24:71-76. [PMID: 28618905 DOI: 10.1177/2047487317708349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although age-adjusted mortality of coronary heart disease has been successfully reduced over recent years, coronary heart disease still represents a leading cause of death and morbidity, in particular in patients at very high cardiovascular risk. Dyslipidaemia plays a major and causal role in the development and clinical progression of coronary heart disease. At present, low-density lipoprotein cholesterol represents the primary target of lipid-directed therapies for the prevention of cardiovascular disease and events. The new European guidelines recommend intensive statin therapy and the possible addition of ezetimibe to reduce low-density lipoprotein cholesterol to a goal of less than 1.8 mmol/L (<70 mg/dL) or by at least 50% if the baseline low-density lipoprotein cholesterol is between 1.8 and 3.5 mmol/L (70-135 mg/dL) in patients at very high cardiovascular risk. Also, the new European guidelines now mention the potential use of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in very high-risk patients with persistently high levels of low-density lipoprotein cholesterol despite maximally tolerated statin treatment in combination with ezetimibe or in patients with statin intolerance. A recent European consensus document discusses the practical clinical use of PCSK9 inhibitors and provides more detailed recommendations. However, despite the overwhelming scientific evidence of the beneficial effects of lipid-lowering therapies, a large proportion of patients at very high cardiovascular risk are not treated according to the current European guideline recommendations. Reinforcing lipid-lowering therapies provides an excellent chance effectively to reduce morbidity and mortality from coronary heart disease.
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Affiliation(s)
- David Sinning
- 1 Department of Cardiology, Charité - University Medicine Berlin (Campus Benjamin Franklin), Germany
| | - Ulf Landmesser
- 1 Department of Cardiology, Charité - University Medicine Berlin (Campus Benjamin Franklin), Germany.,2 Berlin Institute of Health (BIH), Germany.,3 German Centre for Cardiovascular Research (DZHK), Germany
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8
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Yamamoto MH, Yamashita K, Matsumura M, Fujino A, Ishida M, Ebara S, Okabe T, Saito S, Hoshimoto K, Amemiya K, Yakushiji T, Isomura N, Araki H, Obara C, McAndrew T, Ochiai M, Mintz GS, Maehara A. Serial 3-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated With Lesion Progression in Patients With Stable Angina Pectoris. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006347. [DOI: 10.1161/circimaging.117.006347] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022]
Abstract
Background—
Optical coherence tomographic (OCT) morphologies associated with lesion progression are not well studied. The aim of this study was to determine the morphological change for untreated lesion progression using both OCT and intravascular ultrasound (IVUS).
Methods and Results—
We used baseline and 8-month follow-up 3-vessel OCT and IVUS to assess 127 nonculprit lesions (IVUS plaque burden ≥40%) in 45 patients with stable angina after target lesion treatment. Lesion progression was defined as an IVUS lumen area decrease >0.5 mm
2
. A layered pattern was identified as a superficial layer that had a different optical intensity and a clear demarcation from underlying plaque. Lesion progression was observed in 19% (24/127) lesions, and its pattern was characterized into 3 types: type I, new superficial layered pattern at follow-up that was not present at baseline (n=9); type II, a layered pattern at baseline whose layer thickness increased at follow-up (n=7); or type III, no layered pattern at baseline or follow-up (n=8). The increase of IVUS plaque+media area was largest in type I and least in type III (1.9 mm
2
[1.6–2.1], 1.1 mm
2
[0.9–1.4], and 0.3 mm
2
[−0.2 to 0.8], respectively;
P
=0.002). Type III, but not types I or II, showed negative remodeling during follow-up (IVUS vessel area; from 14.3 mm
2
[11.4–17.2] to 13.5 mm
2
[10.4–16.7];
P
=0.02). OCT lipidic plaque was associated with lesion progression (odds ratio, 13.6; 95% confidence interval, 3.7–50.6;
P
<0.001).
Conclusions—
Lesion progression was categorized to distinct OCT morphologies that were related to changes in plaque mass or vessel remodeling.
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Affiliation(s)
- Myong Hwa Yamamoto
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Kennosuke Yamashita
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Mitsuaki Matsumura
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Akiko Fujino
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Masaru Ishida
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Seitarou Ebara
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Toshitaka Okabe
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Shigeo Saito
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Koichi Hoshimoto
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Kisaki Amemiya
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Tadayuki Yakushiji
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Naoei Isomura
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Hiroshi Araki
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Chiaki Obara
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Thomas McAndrew
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Masahiko Ochiai
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Gary S. Mintz
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
| | - Akiko Maehara
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.H.Y, M.M., A.F., M.I., T.M., G.S.M., A.M.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (M.H.Y, A.F., M.I., A.M.); and Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Japan (M.H.Y, K.Y., S.E., T.O., S.S., K.H., K.A., T.Y., N.I., H.A., C.O., M.O.)
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9
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Kawashiri MA, Sakata K, Hayashi K, Gamou T, Kanaya H, Miwa K, Ueda K, Higashikata T, Mizuno S, Michishita I, Namura M, Nitta Y, Katsuda S, Okeie K, Hirase H, Tada H, Uchiyama K, Konno T, Ino H, Nagase K, Yamagishi M. Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study. Heart Vessels 2016; 32:539-548. [PMID: 27798731 DOI: 10.1007/s00380-016-0910-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022]
Abstract
The aim of the study was to elucidate the aggressive reduction of both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) reduced coronary atherosclerotic plaque volume compared with a standard treatment of LDL-C and BP in Japanese patients with coronary artery disease (CAD). This study is a prospective, randomized, and open-labelled with a blind-endpoint evaluation study. A total of 97 patients (81 men, mean age 62.0 ± 9.6) with CAD undergoing intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) were randomized, and 68 patients had IVUS examinations at baseline and at 18-24 months follow-up. Patients were randomly assigned to standard or aggressive strategies targeting LDL-C and a BP of 100 mg/dL and 140/90 mmHg vs. 70 mg/dL and 120/70 mmHg, respectively. The primary endpoint was the percent change in coronary plaque volume. Both standard and aggressive strategies succeeded to achieve target levels of LDL-C and BP; 74.9 ± 14.7 vs. 63.7 ± 11.9 mg/dL (NS) and 124.1 ± 9.4/75.8 ± 7.7 vs. 113.6 ± 9.6/65.8 ± 9.4 mmHg (systolic BP; NS, diastolic BP; p < 0.05), respectively. Both groups showed a significant reduction in the coronary plaque volume of -9.4 ± 10.7% and -8.7 ± 8.6% (NS) in standard and aggressive therapies, respectively. Both standard and aggressive intervention significantly regressed coronary plaque volume by the same degree, suggesting the importance of simultaneous reductions of LDL-C and BP for prevention of CAD.
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Affiliation(s)
- Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tadatsugu Gamou
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Honin Kanaya
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenji Miwa
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kosei Ueda
- Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan
| | | | - Sumio Mizuno
- Department of Cardiology, Fukui Cardiovascular Center, Fukui, Japan
| | - Ichiro Michishita
- Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Masanobu Namura
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Yutaka Nitta
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Shoji Katsuda
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Kazuyasu Okeie
- Department of Cardiology, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Hiroaki Hirase
- Department of Internal Medicine, Takaoka Municipal Hospital, Takaoka, Japan
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuharu Uchiyama
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tetsuo Konno
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hidekazu Ino
- Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan
| | - Keisuke Nagase
- Division of Medical Sciences, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
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10
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Tsujita K, Yamanaga K, Komura N, Sakamoto K, Sugiyama S, Sumida H, Shimomura H, Yamashita T, Oka H, Nakao K, Nakamura S, Ishihara M, Matsui K, Sakaino N, Nakamura N, Yamamoto N, Koide S, Matsumura T, Fujimoto K, Tsunoda R, Morikami Y, Matsuyama K, Oshima S, Kaikita K, Hokimoto S, Ogawa H. Lipid profile associated with coronary plaque regression in patients with acute coronary syndrome: Subanalysis of PRECISE-IVUS trial. Atherosclerosis 2016; 251:367-372. [DOI: 10.1016/j.atherosclerosis.2016.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/30/2016] [Accepted: 05/16/2016] [Indexed: 01/08/2023]
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11
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Einfluss der Lipidstoffwechselparameter auf die Entstehung und Progression der koronaren Herzerkrankung. Herz 2016; 41:273-80. [DOI: 10.1007/s00059-016-4430-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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12
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Buljubasic N, Akkerhuis KM, de Boer SPM, Cheng JM, Garcia-Garcia HM, Lenzen MJ, Oemrawsingh RM, Battes LC, Rijndertse M, Regar E, Serruys PW, van Geuns RJ, Boersma E, Kardys I. Smoking in Relation to Coronary Atherosclerotic Plaque Burden, Volume and Composition on Intravascular Ultrasound. PLoS One 2015; 10:e0141093. [PMID: 26491969 PMCID: PMC4619630 DOI: 10.1371/journal.pone.0141093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/05/2015] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to evaluate the relationship between cigarette smoking and coronary atherosclerotic burden, volume and composition as determined in-vivo by grayscale and virtual histology (VH) intravascular ultrasound (IVUS). Methods and Results Between 2008 and 2011, (VH-)IVUS of a non-culprit coronary artery was performed in 581 patients undergoing coronary angiography. To account for differences in baseline characteristics, current smokers were matched to never smokers by age, gender and indication for catheterization, resulting in 280 patients available for further analysis. Coronary atherosclerotic plaque volume, burden, composition (fibrous, fibro-fatty, dense calcium and necrotic core) and high-risk lesions (VH-IVUS derived thin-cap fibroatheroma (TCFA), plaque burden ≥70%, minimal luminal area ≤4.0 mm2) were assessed. Cigarette smoking showed a tendency towards higher coronary plaque burden (mean±SD, 38.6±12.5% in current versus 36.4±11.0% in never smokers, p = 0.080; and odds ratio (OR) of current smoking for plaque burden above versus below the median 1.69 (1.04–2.75), p = 0.033). This effect was driven by an association in patients presenting with an acute coronary syndrome (ACS) (current smokers, plaque burden 38.3±12.8% versus never smokers, plaque burden 35.0±11.2%, p = 0.049; OR 1.88 (1.02–3.44), p = 0.042). Fibrous tissue tended to be lower in current smokers (mean±SD, 57.7±10.5% versus 60.4±12.6%, p = 0.050) and fibro-fatty tissue was higher in current smokers (median[IQR], 9.6[6.0–13.7]% versus 8.6[5.8–12.2]%, p = 0.039). However, differences in percentage necrotic core and dense calcium could not be demonstrated. Also, no differences were found with regard to high-risk lesions. Conclusions An association between smoking and degree of coronary atherosclerosis was present in patients undergoing coronary angiography who presented with ACS. Although smoking was associated with higher fibro-fatty percentage, no associations could be demonstrated with percentage necrotic core, nor with VH-IVUS derived TCFA lesions. Since the magnitude of the differences in both degree and composition of atherosclerosis was modest, clinical relevance of the findings may be questioned.
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Affiliation(s)
- Nermina Buljubasic
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - K. Martijn Akkerhuis
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Sanneke P. M. de Boer
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Jin M. Cheng
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Hector M. Garcia-Garcia
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Mattie J. Lenzen
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Rohit M. Oemrawsingh
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Linda C. Battes
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Melissa Rijndertse
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Evelyn Regar
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Patrick W. Serruys
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Robert-Jan van Geuns
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, Rotterdam, the Netherlands
- * E-mail:
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13
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Erbel R. [Progression of coronary atherosclerosis]. Herz 2015; 40:835-6. [PMID: 26296304 DOI: 10.1007/s00059-015-4348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R Erbel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr 55, 45147, Essen, Deutschland.
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14
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[Progression and regression of atherosclerotic plaques. New results based on intracoronary ultrasound]. Herz 2015; 40:855-62. [PMID: 26272272 DOI: 10.1007/s00059-015-4339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intravascular ultrasound has been established as the gold standard for analyzing alterations in coronary artery atherosclerosis during monitoring investigations. Cross-sectional imaging can be used to visualize the area of the lumen and the vessel size and the plaque size as the difference between them. New technology allows the 3-D reconstruction of the volume for prespecified vessel segments using specific algorithms. Investigations on the natural course demonstrated predominantly progression. Even regression of coronary atherosclerosis can be visualized and quantified. Regression can only be expected when the level of low-density lipoprotein (LDL) cholesterol is below the critical level of 75 mg/dl. Prospective randomized studies with highly effective statins showed that regression occurred in up to two thirds of patients when LDL cholesterol was below a cut-off of 78 mg/dl and was, therefore, very close to the threshold, which was calculated based on investigations of the natural course. Although the absolute values for plaque volume are in the range of 1 % over 1-2 years, it must be taken into consideration that coronary artery diseases are chronic diseases and a 1 % change per year will correspond to an enormous effect on plaque growth of coronary vessels. The great success of statins in reducing cardiovascular events is due to the possibility for reduction of progression and induction of regression. New developments in medication will be measured against the effectiveness of statins.
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Koskinas KC, Windecker S, Räber L. Regression of coronary atherosclerosis: Current evidence and future perspectives. Trends Cardiovasc Med 2015; 26:150-61. [PMID: 26089122 DOI: 10.1016/j.tcm.2015.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/09/2015] [Accepted: 05/09/2015] [Indexed: 12/20/2022]
Abstract
Coronary atherosclerosis has been considered a chronic disease characterized by ongoing progression in response to systemic risk factors and local pro-atherogenic stimuli. As our understanding of the pathobiological mechanisms implicated in atherogenesis and plaque progression is evolving, effective treatment strategies have been developed that led to substantial reduction of the clinical manifestations and acute complications of coronary atherosclerotic disease. More recently, intracoronary imaging modalities have enabled detailed in vivo quantification and characterization of coronary atherosclerotic plaque, serial evaluation of atherosclerotic changes over time, and assessment of vascular responses to effective anti-atherosclerotic medications. The use of intracoronary imaging modalities has demonstrated that intensive lipid lowering can halt plaque progression and may even result in regression of coronary atheroma when the highest doses of the most potent statins are used. While current evidence indicates the feasibility of atheroma regression and of reversal of presumed high-risk plaque characteristics in response to intensive anti-atherosclerotic therapies, these changes of plaque size and composition are modest and their clinical implications remain largely elusive. Growing interest has focused on achieving more pronounced regression of coronary plaque using novel anti-atherosclerotic medications, and more importantly on elucidating ways toward clinical translation of favorable changes of plaque anatomy into more favorable clinical outcomes for our patients.
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Affiliation(s)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Xie Z, Tian J, Ma L, Du H, Dong N, Hou J, He J, Dai J, Liu X, Pan H, Liu Y, Yu B. Comparison of optical coherence tomography and intravascular ultrasound for evaluation of coronary lipid-rich atherosclerotic plaque progression and regression. Eur Heart J Cardiovasc Imaging 2015; 16:1374-80. [PMID: 25911116 DOI: 10.1093/ehjci/jev104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/02/2015] [Indexed: 02/04/2023] Open
Abstract
AIMS Compared with intravascular ultrasound (IVUS), optical coherence tomography (OCT) has relative merits and demerits for detecting plaque characteristics. It remains unknown whether the IVUS and OCT evaluations of plaque progression/regression are consistent. We sought to analyse the correlations between IVUS and OCT evaluations of plaques at single time points, and compare temporal changes in the IVUS and OCT data. METHODS AND RESULTS Eighty-eight lipid-rich plaques from 65 patients with coronary artery disease were analysed with IVUS and OCT at baseline and 12-month follow-up. Fibrous cap thickness on OCT was negatively correlated with total atheroma volume on IVUS (r = -0.28, P = 0.009), but not with percent atheroma volume (P = 0.84). Changes on OCT were not significantly correlated with changes on IVUS. Plaques that showed progression, regression, or no change on IVUS showed no differences in terms of changes in the OCT parameters fibrous cap thickness (P = 0.199), maximum lipid core arc (P = 0.755), mean lipid core arc (P = 0.936), and lipid index (P = 0.91). The incidence of thin-cap fibroatheroma (TCFA) was similar among the above three plaque groups at baseline (P = 0.79) and follow-up (P = 0.609). CONCLUSION Although fibrous cap thickness on OCT was negatively correlated with plaque size on IVUS at single time points, changes in OCT parameters were not correlated with changes in IVUS measures over time. Lesion progression/regression on IVUS was not associated with changes in OCT parameters (fibrous cap thickness, lipid core arc, lipid index, and TCFA).
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Affiliation(s)
- Zulong Xie
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jinwei Tian
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lijia Ma
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Hongwei Du
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Nana Dong
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jingbo Hou
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jieqiong He
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jiannan Dai
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Xinxin Liu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Hong Pan
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Youbin Liu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Bo Yu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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Stegman B, Puri R, Cho L, Shao M, Ballantyne CM, Barter PJ, Chapman MJ, Erbel R, Libby P, Raichlen JS, Uno K, Kataoka Y, Nissen SE, Nicholls SJ. High-intensity statin therapy alters the natural history of diabetic coronary atherosclerosis: insights from SATURN. Diabetes Care 2014; 37:3114-20. [PMID: 25190674 DOI: 10.2337/dc14-1121] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although statins can induce coronary atheroma regression, this benefit has yet to be demonstrated in diabetic individuals. We tested the hypothesis that high-intensity statin therapy may promote coronary atheroma regression in patients with diabetes. RESEARCH DESIGN AND METHODS The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. This analysis compared changes in biochemistry and coronary percent atheroma volume (PAV) in patients with (n = 159) and without (n = 880) diabetes. RESULTS At baseline, patients with diabetes had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels compared with patients without diabetes. At follow-up, diabetic patients had lower levels of LDL-C (61.0 ± 20.5 vs. 66.4 ± 22.9 mg/dL, P = 0.01) and HDL-C (46.3 ± 10.6 vs. 49.9 ± 12.0 mg/dL, P < 0.001) but higher levels of triglycerides (127.6 [98.8, 163.0] vs. 113.0 mg/dL [87.6, 151.9], P = 0.001) and CRP (1.4 [0.7, 3.3] vs. 1.0 [0.5, 2.1] mg/L, P = 0.001). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (-0.83 ± 0.13 vs. -1.15 ± 0.13%, P = 0.08). PAV regression was less in diabetic compared with nondiabetic patients when on-treatment LDL-C levels were >70 mg/dL (-0.31 ± 0.23 vs. -1.01 ± 0.21%, P = 0.03) but similar when LDL-C levels were ≤70 mg/dL (-1.09 ± 0.16 vs. -1.24 ± 0.16%, P = 0.50). CONCLUSIONS High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients.
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Affiliation(s)
- Brian Stegman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Leslie Cho
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Mingyuan Shao
- C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Phillip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | - M John Chapman
- INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpètrière University Hospital, Paris, France
| | | | - Peter Libby
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | | | - Kiyoko Uno
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Yu Kataoka
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
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Park KH, Han SJ, Kim HS, Kim MK, Jo SH, Kim SA, Park WJ. Impact of Framingham risk score, flow-mediated dilation, pulse wave velocity, and biomarkers for cardiovascular events in stable angina. J Korean Med Sci 2014; 29:1391-7. [PMID: 25368493 PMCID: PMC4214940 DOI: 10.3346/jkms.2014.29.10.1391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/26/2014] [Indexed: 12/22/2022] Open
Abstract
Although the age-adjusted Framingham risk score (AFRS), flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) can predict future cardiovascular events (CVEs), a comparison of these risk assessments for patients with stable angina has not been reported. We enrolled 203 patients with stable angina who had been scheduled for coronary angiography (CAG). After CAG, 134 patients showed significant coronary artery disease. During 4.2 yr follow-up, 36 patients (18%) showed CVEs, including myocardial infarction, de-novo coronary artery revascularization, in-stent restenosis, stroke, and cardiovascular death. ROC analysis showed that AFRS, FMD, baPWV, and hsCRP could predict CVEs (with AUC values of 0.752, 0.707, 0.659, and 0.702, respectively, all P<0.001 except baPWV P=0.003). A Cox proportional hazard analysis showed that AFRS and FMD were independent predictors of CVEs (HR, 2.945; 95% CI, 1.572-5.522; P=0.001 and HR, 0.914; 95% CI, 0.826-0.989; P=0.008, respectively). However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175). In patients with stable angina, AFRS and FMD are independent predictors of CVEs. However, there is no additive value of FMD on the AFRS in predicting CVEs.
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Affiliation(s)
- Kyoung-Ha Park
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Sang Jin Han
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Hyun-Sook Kim
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Min-Kyu Kim
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Sang Ho Jo
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Sung-Ai Kim
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Woo Jung Park
- Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
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Zhang JM, Zhong L, Su B, Wan M, Yap JS, Tham JPL, Chua LP, Ghista DN, Tan RS. Perspective on CFD studies of coronary artery disease lesions and hemodynamics: a review. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:659-680. [PMID: 24459034 DOI: 10.1002/cnm.2625] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/30/2013] [Accepted: 11/04/2013] [Indexed: 06/03/2023]
Abstract
Coronary artery disease (CAD) is the most common cardiovascular disease. Early diagnosis of CAD's physiological significance is of utmost importance for guiding individualized risk-tailored treatment strategies. In this paper, we first review the state-of-the-art clinical diagnostic indices to quantify the severity of CAD and the associated invasive and noninvasive imaging technologies in order to quantify the anatomical parameters of diameter stenosis, area stenosis, and hemodynamic indices of coronary flow reserve and fractional flow reserve. With the development of computational technologies and CFD methods, tremendous progress has been made in applying image-based CFD simulation techniques to elucidate the effects of hemodynamics in vascular pathophysiology toward the initialization and progression of CAD. So then, we review the advancements of CFD technologies in patient-specific modeling, involving the development of geometry reconstruction, boundary conditions, and fluid-structure interaction. Next, we review the applications of CFD to stenotic sites, in order to compute their hemodynamic parameters and study the relationship between the hemodynamic conditions and the clinical indices, to thereby assess the amount of viable myocardium and candidacy for percutaneous coronary intervention. Finally, we review the strengths and limitations of current researches of applying CFD to CAD studies.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Center Singapore, Mistri Wing 17, 3rd Hospital Avenue, 168752, Singapore
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20
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Nicholls SJ, Andrews J, Moon KW. Exploring the natural history of atherosclerosis with intravascular ultrasound. Expert Rev Cardiovasc Ther 2014; 5:295-306. [PMID: 17338673 DOI: 10.1586/14779072.5.2.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intravascular ultrasound has emerged as the preferred imaging modality for the characterization of atherosclerotic plaque within the coronary arteries. Ultrasonic imaging reveals the presence of more extensive atheroma than suggested by conventional angiography in patients with coronary artery disease. The ability to precisely quantify atheroma volume in an arterial segment at different time points provides the unique opportunity to investigate the factors that influence the natural history of atheroma progression. Accordingly, serial intravascular ultrasound has been incorporated into a number of clinical trials that have evaluated the impact of medical therapies that modify established risk factors and novel pathological targets. This article will review the increasing role of imaging modalities in the assessment of atherosclerosis and factors that influence its natural history.
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Affiliation(s)
- Stephen J Nicholls
- Cleveland Clinic, Department of Cardiovascular Medicine, Mail Code JJ65, 9500 Euclid Ave, Cleveland OH, USA.
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Kataoka Y, Hsu A, Wolski K, Uno K, Puri R, Tuzcu EM, Nissen SE, Nicholls SJ. Progression of coronary atherosclerosis in African-American patients. Cardiovasc Diagn Ther 2013; 3:161-9. [PMID: 24282765 DOI: 10.3978/j.issn.2223-3652.2013.08.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/28/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND African-Americans with coronary artery disease (CAD) demonstrate worse clinical outcomes than Caucasians. While this is partly due to a lack of accessibility to established therapies, the mechanisms underlying this difference remain to be elucidated. We aimed to characterize the progression of coronary atherosclerosis in African-Americans with CAD. METHODS 3,479 patients with CAD underwent serial intravascular ultrasound (IVUS) imaging to evaluate atheroma progression in 7 clinical trials of anti-atherosclerotic therapies. Risk factor control and atheroma progression were compared between African-Americans (n=170) and Caucasians (n=3,309). RESULTS African-Americans were more likely to be female (51.8% vs. 28.1%, P<0.001), have a higher body mass index (32.8±6.0 vs. 31.3±5.8 kg/m(2), P=0.002) and greater history of hypertension (85.9% vs. 78.8%, P=0.02), diabetes (41.8% vs. 30.6%, P=0.002) and stroke (12.9% vs. 3.0%, P<0.001). Despite a high use of anti-atherosclerotic medications (93% statin, 89% aspirin, 79% β-blocker, 52% ACE inhibitor), African-Americans demonstrated higher levels of LDL-C (2.4±0.7 vs. 2.2±0.7 mmol/L, P=0.006), CRP (2.9 vs. 2.0 mg/dL, P<0.001) and systolic blood pressure (133±15 vs. 129±13 mmHg, P<0.001) at follow-up. There was no significant difference in atheroma volume at baseline (189.0±82.2 vs. 191.6±83.3 mm(3), P=0.82) between two groups. Serial evaluation demonstrated a greater increase in atheroma volume in African-Americans (0.51±2.1 vs. -3.1±1.7 mm(3), P=0.01). This difference persisted with propensity matching accounting for differences in risk factor control (0.1±2.1 vs. -3.7±1.7 mm(3), P=0.02). CONCLUSIONS African-Americans with CAD achieve less optimal risk factor control and greater atheroma progression. These findings support the need for more intensive risk factor modification in African-Americans.
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Affiliation(s)
- Yu Kataoka
- South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia
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Sayin MR, Cetiner MA, Karabag T, Akpinar I, Sayin E, Kurcer MA, Dogan SM, Aydin M. Framingham risk score and severity of coronary artery disease. Herz 2013; 39:638-43. [PMID: 23873009 DOI: 10.1007/s00059-013-3881-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Easy-to-perform and reliable parameters are needed to predict the presence and severity of CAD and to implement efficient diagnostic and therapeutic modalities. We aimed to examine whether the Framingham risk scoring system can be used for this purpose. METHODS A total of 222 patients (96 women, 126 men; mean age, 59.1 ± 11.9 years) who underwent coronary angiography were enrolled in the study. Presence of > %50 stenosis in a coronary artery was assessed as critical CAD. The Framingham risk score (FRS) was calculated for each patient. CAD severity was assessed by the Gensini score. The relationship between the FRS and the Gensini score was analyzed by correlation and regression analyses. RESULTS The mean Gensini score was 18.9 ± 25.8, the median Gensini score was 7.5 (0-172), the mean FRS was 7.7 ± 4.2, and the median FRS was 7 (0-21). Correlation analysis revealed a significant relationship between FRS and Gensini score (r = 0.432, p < 0.0001). This relationship was confirmed by linear regression analysis (β = 0.341, p < 0.0001). A cut-off level of 7.5 for FRS predicted severe CAD with a sensitivity of 68 % and a specificity of 73.6 % (ROC area under curve: 0.776, 95 % CI: 0.706-0.845, PPV: 78.1 %, NPV: 62.3 %, p < 0.0001). CONCLUSION Our work suggests that the FRS system is a simple and feasible method that can be used for prediction of CAD severity. As the sample size was small in our study, further large-scale studies are needed on this subject to draw solid conclusions.
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Affiliation(s)
- M R Sayin
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, 67600, Kozlu/Zonguldak, Turkey,
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Ahmad S, Xue Z, Silverman A, Lindsay J. Complexity of the relation between hemoglobin A1C, diabetes mellitus, and progression of coronary narrowing in postmenopausal women. Am J Cardiol 2013; 111:793-9. [PMID: 23294997 DOI: 10.1016/j.amjcard.2012.11.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 11/19/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess the effect of diabetes mellitus (DM) and glycosylated hemoglobin (HbA1c) on the progression of atherosclerosis in postmenopausal women. A retrospective analysis of the Women's Angiographic and Vitamin and Estrogen (WAVE) trial, a multicenter randomized trial on progression of atherosclerosis in postmenopausal women, was performed. Baseline and follow-up angiography was performed in 320 women. Minimum luminal diameter and average luminal diameter at baseline and follow-up were measured in 1,735 coronary segments. Measurements and adverse events were grouped on the basis of history of DM and HbA1c. DM was associated with more total cardiac events but with similar rates of death or myocardial infarction. There were greater reductions in minimum luminal diameter and average luminal diameter in segments from patients with known DM (p <0.001) and with a baseline HbA1c ≥6.5% (p = 0.002 and p = 0.004, respectively). The greater reductions in minimum luminal diameter and average luminal diameter in the higher HbA1c strata were only in patients with known DM. More new lesions, however, appeared with baseline HbA1c ≥5.7%, irrespective of a history of DM. In conclusion, the relation between DM and the progression of coronary narrowing in postmenopausal women is complex. Clinically apparent DM, not elevated HbA1c alone, appears to promote the progression of established coronary lesions even in HbA1c ranges diagnostic of pre-DM and DM. This raises the possibility that coronary narrowing of existing stenosis in women with DM may be due to negative remodeling, a complex process that might be less dependent on hyperglycemia than new lesion formation.
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Fukushima Y, Daida H, Morimoto T, Kasai T, Miyauchi K, Yamagishi SI, Takeuchi M, Hiro T, Kimura T, Nakagawa Y, Yamagishi M, Ozaki Y, Matsuzaki M. Relationship between advanced glycation end products and plaque progression in patients with acute coronary syndrome: the JAPAN-ACS sub-study. Cardiovasc Diabetol 2013; 12:5. [PMID: 23289728 PMCID: PMC3571912 DOI: 10.1186/1475-2840-12-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/13/2012] [Indexed: 01/29/2023] Open
Abstract
Background The Japan Assessment of Pitavastatin and Atorvastatin in Acute Coronary Syndrome (JAPAN-ACS) trial demonstrated that early aggressive statin therapy in patients with ACS significantly reduces plaque volume (PV). Advanced glycation end products (AGEs) and the receptors of AGEs (RAGE) may lead to angiopathy in diabetes mellitus (DM) and may affect on the development of coronary PV. The present sub-study of JAPAN-ACS investigates the association between AGEs and RAGE, and PV. Methods Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) was undertaken, followed by the initiation of statin treatment (either 4 mg/day of pitavastatin or 20 mg/day of atorvastatin), in patients with ACS. In the 208 JAPAN-ACS subjects, PV using IVUS in non-culprit segment > 5 mm proximal or distal to the culprit lesion and, serum levels of AGEs and soluble RAGE (sRAGE) were measured at baseline and 8–12 months after PCI. Results At baseline, no differences in the levels of either AGEs or sRAGE were found between patients with DM and those without DM. The levels of AGEs decreased significantly with statin therapy from 8.6 ± 2.2 to 8.0 ± 2.1 U/ml (p < 0.001), whereas the levels of sRAGE did not change. There were no significant correlations between changes in PV and the changes in levels of AGEs as well as sRAGE. However, high baseline AGEs levels were significantly associated with plaque progression (odds ratio, 1.21; 95% confidence interval, 1.01 - 1.48; p = 0.044) even after adjusting for DM in multivariate logistic regression models. Conclusions High baseline AGEs levels were associated with plaque progression in the JAPAN-ACS trial. This relationship was independent of DM. These findings suggest AGEs may be related to long-term glucose control and other oxidative stresses in ACS. Trial registration NCT00242944
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Affiliation(s)
- Yoshifumi Fukushima
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
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Left Main Coronary Atherosclerosis Progression, Constrictive Remodeling, and Clinical Events. JACC Cardiovasc Interv 2013; 6:29-35. [DOI: 10.1016/j.jcin.2012.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 09/14/2012] [Indexed: 01/02/2023]
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Stolker JM, Cohen DJ, Kennedy KF, Pencina MJ, Lindsey JB, Mauri L, Cutlip DE, Kleiman NS. Repeat Revascularization After Contemporary Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2012; 5:772-82. [DOI: 10.1161/circinterventions.111.967802] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joshua M. Stolker
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - David J. Cohen
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - Kevin F. Kennedy
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - Michael J. Pencina
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - Jason B. Lindsey
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - Laura Mauri
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - Donald E. Cutlip
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
| | - Neal S. Kleiman
- From the Division of Cardiology, Saint Louis University, Saint Louis, MO (J.M.S.); Saint Luke’s Mid America Heart and Vascular Institute, University of Missouri-Kansas City, Kansas City, MO (D.J.C., K.F.K., J.B.L.); Harvard Clinical Research Institute, Boston, MA (M.J.P., L.M., D.E.C.); and Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K.)
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Comparison of the efficacy and safety of statin and statin/ezetimibe therapy after coronary stent implantation in patients with stable angina. J Cardiol 2012; 60:111-8. [DOI: 10.1016/j.jjcc.2012.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/17/2012] [Accepted: 03/01/2012] [Indexed: 11/15/2022]
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Is there a role for thoracic aortic calcium to fine-tune cardiovascular risk prediction? Int J Cardiovasc Imaging 2012; 29:217-9. [PMID: 22527263 PMCID: PMC3550699 DOI: 10.1007/s10554-012-0055-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 11/22/2022]
Abstract
Screening asymptomatic subjects to streamline measures for the prevention of cardiovascular events remains a major challenge. The established primary prevention risk-scoring methods use equations derived from large prospective cohort studies, but further fine-tuning of cardiovascular risk assessment remains important as 25 % of individuals with low estimated risk may experience cardiac events. Independent studies provided evidence that extended risk assessment using coronary artery calcium quantification may improve risk stratification as it can lead to reclassification of persons at increased risk. Particularly in intermediate-risk subjects, coronary artery calcium scoring can help to correctly identify individuals at highest risk. Data on the extent of calcification of the ascending and descending thoracic aorta might be useful for additional cardiovascular risk stratification. Future analyses and studies will be required to answer the question of whether the implementation of such data may allow further fine-tuning of cardiovascular risk prediction in specific subpopulations—for instance in women or men with an increased risk of stroke and/or symptomatic peripheral vascular disease.
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Puri R, Ong P, Kataoka Y, Kapadia SR, Tuzcu EM, Nicholls SJ, Worthley MI. “Framing” the Vessel. J Am Coll Cardiol 2012; 59:1038-9; author reply 1039. [DOI: 10.1016/j.jacc.2011.10.898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/11/2011] [Indexed: 10/28/2022]
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The Role of Intravascular Ultrasound in the Determination of Progression and Regression of Coronary Artery Disease. Curr Atheroscler Rep 2012; 14:175-85. [DOI: 10.1007/s11883-012-0234-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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32
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Nozue T, Yamamoto S, Tohyama S, Umezawa S, Kunishima T, Sato A, Miyake S, Takeyama Y, Morino Y, Yamauchi T, Muramatsu T, Hibi K, Sozu T, Terashima M, Michishita I. Statin treatment for coronary artery plaque composition based on intravascular ultrasound radiofrequency data analysis. Am Heart J 2012; 163:191-9.e1. [PMID: 22305836 DOI: 10.1016/j.ahj.2011.11.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 11/07/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic therapy with statin has been shown to lower the risk of coronary events; however, the in vivo effects of statin therapy on plaque volume and composition are less understood. METHODS We conducted a prospective, open-labeled, randomized, multicenter study in 11 centers in Japan. A total of 164 patients were randomized to receive either 4 mg/d of pitavastatin (intensive lipid-lowering therapy) or 20 mg/d of pravastatin (moderate lipid-lowering therapy). Analyzable intravascular ultrasound data were obtained for 119 patients at baseline and at 8-month follow-up. The primary end point was the difference of volume changes in each of the 4 main plaque components (fibrosis, fibrofatty, calcium, and necrosis), assessed by virtual histology intravascular ultrasound, between the 2 groups. RESULTS The mean low-density lipoprotein cholesterol level at follow-up was significantly lower in the pitavastatin than in the pravastatin group (74 vs 95 mg/dL, P < .0001). During the 8-month follow-up period, statin therapy reduced the absolute and relative amount of fibrofatty component (pitavastatin: from 1.09 to 0.81 mm(3)/mm, P = .001; pravastatin: from 1.05 to 0.83 mm(3)/mm, P = .0008) and increased in the amount of calcium (pitavastatin: from 0.42 to 0.55 mm(3)/mm, P < .0001; pravastatin: from 0.44 to 0.55 mm(3)/mm, P = .005), whereas volume changes in both plaque components were not statistically different between the 2 groups. CONCLUSIONS Both pitavastatin and pravastatin altered coronary artery plaque composition by significantly decreasing the fibrofatty plaque component and increasing the calcified plaque component.
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Affiliation(s)
- Tsuyoshi Nozue
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Japan.
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Fukushima M, Miura SI, Mitsutake R, Fukushima T, Fukushima K, Saku K. Cholesterol Metabolism in Patients With Hemodialysis in the Presence or Absence of Coronary Artery Disease. Circ J 2012; 76:1980-6. [DOI: 10.1253/circj.cj-11-1302] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mikio Fukushima
- Department of Cardiology, Fukuoka University School of Medicine
- Fukushima Hospital
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| | - Ryoko Mitsutake
- Department of Cardiology, Fukuoka University School of Medicine
| | | | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
- Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University School of Medicine
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Hirohata A, Yamamoto K, Miyoshi T, Hatanaka K, Hirohata S, Yamawaki H, Komatsubara I, Hirose E, Kobayashi Y, Ohkawa K, Ohara M, Takafuji H, Sano F, Toyama Y, Kusachi S, Ohe T, Ito H. Four-year clinical outcomes of the OLIVUS-Ex (impact of Olmesartan on progression of coronary atherosclerosis: evaluation by intravascular ultrasound) extension trial. Atherosclerosis 2011; 220:134-8. [PMID: 22119063 DOI: 10.1016/j.atherosclerosis.2011.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 10/04/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND The previous OLIVUS trial reported a positive role in achieving a lower rate of coronary atheroma progression through the administration of olmesartan, an angiotension-II receptor blocking agent (ARB), for stable angina pectoris (SAP) patients requiring percutaneous coronary intervention (PCI). However, the benefits between ARB administration on long-term clinical outcomes and serial atheroma changes by IVUS remain unclear. Thus, we examined the 4-year clinical outcomes from OLIVUS according to treatment strategy with olmesartan. METHODS Serial volumetric IVUS examinations (baseline and 14 months) were performed in 247 patients with hypertension and SAP. When these patients underwent PCI for culprit lesions, IVUS was performed in their non-culprit vessels. Patients were randomly assigned to receive 20-40mg of olmesartan or control, and treated with a combination of β-blockers, calcium channel blockers, glycemic control agents and/or statins per physician's guidance. Four-year clinical outcomes and annual progression rate of atherosclerosis, assessed by serial IVUS, were compared with major adverse cardio- and cerebrovascular events (MACCE). RESULTS Cumulative event-free survival was significantly higher in the olmesartan group than in the control group (p=0.04; log-rank test). By adjusting for validated prognosticators, olmesartan administration was identified as a good predictor of MACCE (p=0.041). On the other hand, patients with adverse events (n=31) had larger annual atheroma progression than the rest of the population (23.8% vs. 2.1%, p<0.001). CONCLUSIONS Olmesartan therapy appears to confer improved long-term clinical outcomes. Atheroma volume changes, assessed by IVUS, seem to be a reliable surrogate for future major adverse cardio- and cerebrovascular events in this study cohort.
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De Backer G, Petrella RJ, Goudev AR, Radaideh GA, Rynkiewicz A, Pathak A. Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension. Fundam Clin Pharmacol 2011; 27:210-5. [PMID: 22049922 DOI: 10.1111/j.1472-8206.2011.01006.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium.
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von Birgelen C, Hartmann M. Beyond the lumen border: on the use of intravascular ultrasound in the left main coronary artery. EUROINTERVENTION 2011; 7:300-2. [PMID: 21729830 DOI: 10.4244/eijv7i3a52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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König A, Klauss V. [Intravascular ultrasound for recognition of atherosclerotic plaques and plaque composition. Current state of the diagnostic value]. Herz 2011; 36:402-9. [PMID: 21732096 DOI: 10.1007/s00059-011-3485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coronary atherosclerosis including acute coronary syndrome (ACS) is the leading cause of death in the western world and in the majority of patients is caused by plaque rupture in flow-limiting and non-flow-limiting angiographically intermediate stenoses. Histopathologic analyses have shown the relationship of plaque composition to acute clinical events and therefore to the vulnerability of coronary lesions. Knowledge of remodeling processes of the coronary artery has focused interest on non-flow-limiting lesions of the coronary tree. Intravascular ultrasound (IVUS) can demonstrate discrepancies between the extent of coronary atherosclerosis and angiographic imaging by in vivo plaque imaging. In addition the spectral analysis of IVUS-derived radiofrequency (RF) data enables more precise analysis of the plaque composition and plaque type.As IVUS is best able to assess stent underexpansion and malapposition the guidance of catheter-based coronary interventions plays a major role in angiographically unclear lesions even in the drug-eluting stent era. In the field of percutaneous coronary interventions (PCI) IVUS can influence the therapy and therefore optimize the stratification of patients.In terms of secondary prevention it is of great clinical importance to detect progression of coronary artery disease and moreover to predict coronary lesions with significant progression up to ACS. Coronary angiography and clinical parameters are poor surrogates to predict future events in a broad cohort of patients after PCI. In addition non-invasive imaging fails to identify coronary plaques with potential rupture and subsequent ACS. This highlights the need to identify potentially high risk lesions. However, prospective studies with IVUS-RF imaging to detect lesions that are considered to be prone to rupture showed no evidence for catheter-based invasive treatment of a non-flow-limiting high risk plaque.In the future the integrated combination of multiple technologies (e.g. IVUS-RF and optical coherence tomography) can further improve the accuracy of the analysis of high risk lesions.
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Affiliation(s)
- A König
- Abteilung Kardiologie, Medizinische Klinik und Poliklinik-Campus Innenstadt, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, Munich, Germany.
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Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, Cicek D, Oguzhan A, Ergin A, Kaya MG. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology 2011; 63:213-7. [PMID: 21733954 DOI: 10.1177/0003319711412763] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hematologic parameters have prognostic importance in cardiovascular disease. However, the relation between atherosclerosis progression and hematologic parameters is not well defined. A total of 394 patients requiring repeat coronary angiography were included in the study. According to angiography, patients were divided into 2 groups, progressive (n = 196) and nonprogressive (n = 198) diseases. Hematologic parameters including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio were measured. Glucose, creatinine, and cholesterol were significantly higher in the progressive group. Mean platelet volume count was similar in both groups. The N/L ratio was significantly higher in the progressive group (5.0 ± 5.1 vs 3.2 ± 3; P = .001). In multivariate analysis, the N/L ratio was significantly related with progression (relative risk [RR]: 2.267, 95% CI: 1.068-4.815, P = .03). Progression rate was significantly high in patients with high N/L ratio (39% vs 56%). Our results suggest that the N/L ratio is a predictor of progression of atherosclerosis.
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Affiliation(s)
- Nihat Kalay
- Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey.
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[Progress in diagnostics is the driving force for developing interventional methods]. Herz 2011; 36:383-5. [PMID: 21725679 DOI: 10.1007/s00059-011-3482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Omori Y, Ueda Y, Okada K, Nishio M, Hirata A, Asai M, Nemoto T, Matsuo K, Kashiwase K, Kodama K. Patients with more coronary yellow plaques have higher risk of stenosis progression within 7 months. J Cardiol 2011; 58:46-53. [DOI: 10.1016/j.jjcc.2011.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/06/2011] [Accepted: 04/08/2011] [Indexed: 11/29/2022]
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41
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Mercado N, Moe T, Pieper M, House J, Dolla W, Seifert L, Stolker J, Lindsey J, Kennedy K, Marso S. Tissue characterisation of atherosclerotic plaque in the left main: an in vivo intravascular ultrasound radiofrequency data analysis. EUROINTERVENTION 2011; 7:347-52. [DOI: 10.4244/eijv7i3a59] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nicholls SJ, Borgman M, Nissen SE, Raichlen JS, Ballantyne C, Barter P, Chapman MJ, Erbel R, Libby P. Impact of statins on progression of atherosclerosis: rationale and design of SATURN (Study of Coronary Atheroma by InTravascular Ultrasound: effect of Rosuvastatin versus AtorvastatiN). Curr Med Res Opin 2011; 27:1119-29. [PMID: 21446892 DOI: 10.1185/03007995.2011.570746] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous imaging studies have demonstrated that the beneficial impact of high-dose statins on the progression of coronary atherosclerosis associates with their ability to lower levels of low-density lipoprotein cholesterol (LDL-C) and C-reactive protein (CRP) and to raise high-density lipoprotein cholesterol (HDL-C). The Study of Coronary Atheroma by InTravascular Ultrasound: Effect of Rosuvastatin versus AtorvastatiN (SATURN, NCT00620542) aims to compare the effects of high-dose atorvastatin and rosuvastatin on disease progression. METHODS A total of 1385 subjects with established coronary artery disease (CAD) on angiography were randomized to receive rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. The primary efficacy parameter will be the nominal change in percent atheroma volume (PAV), determined by analysis of intravascular ultrasound (IVUS) images of matched coronary artery segments acquired at baseline and at 24-month follow-up. The effect of statin therapy on plasma lipids and inflammatory markers, and the incidence of clinical cardiovascular events will also be assessed. The study does not have the statistical power to directly compare the treatment groups with regard to clinical events. CONCLUSION Serial IVUS has emerged as a sensitive imaging modality to assess the impact of treatments on arterial structure. In this study, IVUS will be used to determine whether high-dose statins have different effects on plaque progression.
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Affiliation(s)
- Stephen J Nicholls
- Department of Cardiovascular Medicine , Cleveland Clinic, Cleveland, OH , USA
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Kawai Y, Sato-Ishida R, Motoyama A, Kajinami K. Place of pitavastatin in the statin armamentarium: promising evidence for a role in diabetes mellitus. DRUG DESIGN DEVELOPMENT AND THERAPY 2011; 5:283-97. [PMID: 21625418 PMCID: PMC3100224 DOI: 10.2147/dddt.s13492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Indexed: 12/13/2022]
Abstract
Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, known as statins, have revolutionized the treatment of hypercholesterolemia and coronary artery disease prevention. However, there are considerable issues regarding statin safety and further development of residual risk control, particularly for diabetic and metabolic syndrome patients. Pitavastatin is a potent statin with low-density lipoprotein (LDL) cholesterol-lowering effects comparable to those of atorvastatin or rosuvastatin. Pitavastatin has a high-density lipoprotein (HDL) cholesterol raising effect, may improve insulin resistance, and has little influence on glucose metabolism. Considering these factors along with its unique pharmacokinetic properties, which suggest minimal drug–drug interaction, pitavastatin could provide an alternative treatment choice, especially in patients with glucose intolerance or diabetes mellitus. Many clinical trials are now underway to test the clinical efficacy of pitavastatin in various settings and are expected to provide further information.
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Affiliation(s)
- Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
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Tardif JC, Lesage F, Harel F, Romeo P, Pressacco J. Imaging Biomarkers in Atherosclerosis Trials. Circ Cardiovasc Imaging 2011; 4:319-33. [DOI: 10.1161/circimaging.110.962001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jean-Claude Tardif
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Frédéric Lesage
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - François Harel
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Romeo
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Josephine Pressacco
- From the Departments of Medicine (J.-C.T.), Radiology (J.P.), Nuclear Medicine (F.H.), and Pathology (P.R.) and the Research Center (F.L.), Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Hartmann M, Huisman J, Bose D, Jensen LO, Schoenhagen P, Mintz GS, Erbel R, von Birgelen C. Serial intravascular ultrasound assessment of changes in coronary atherosclerotic plaque dimensions and composition: an update. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:313-21. [DOI: 10.1093/ejechocard/jer017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Horinaka S, Yabe A, Yagi H, Ishimura K, Hara H, Iemura T, Ishimitsu T. Cardio-ankle vascular index could reflect plaque burden in the coronary artery. Angiology 2011; 62:401-8. [PMID: 21421633 DOI: 10.1177/0003319710395561] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardio-ankle vascular index (CAVI) using the volume plethysmographic method is a noninvasive atherosclerotic indicator which is not influenced by blood pressure. Coronary intravascular ultrasound (IVUS) is a reliable technique to measure progression of atherosclerosis. The association between CAVI and IVUS has not been reported. The aim of this study was to evaluate the association between CAVI and the plaque burden measured by IVUS in the left main coronary artery (LMCA) in patients with coronary heart disease and normal LMCA. Cardio-ankle vascular index was significantly correlated with percentage plaque area (r = .649, P < .0001) measured by IVUS in the most diseased segment of LMCA. Cardio-ankle vascular index remained significant among cardiovascular disease risk factors included in the multiple regression analysis predicting percentage plaque area. Cardio-ankle vascular index was a good atherosclerotic indicator and associated with the plaque burden in nonculprit and angiographically normal LMCA.
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Affiliation(s)
- Shigeo Horinaka
- Dokkyo Medical University, Department of Hypertension and Cardiorenal Medicine, Mibu, Tochigi, Japan.
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Ultrasound and light: friend or foe? On the role of intravascular ultrasound in the era of optical coherence tomography. Int J Cardiovasc Imaging 2011; 27:209-14. [PMID: 21337025 PMCID: PMC3078313 DOI: 10.1007/s10554-011-9797-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/06/2011] [Indexed: 11/15/2022]
Abstract
More than 20 years after its introduction, intravascular ultrasound (IVUS) has outlived many other intracoronary techniques. IVUS was useful to solve many interventional problems and assisted us in understanding the dynamics of atherosclerosis. It serves as an established imaging endpoint in large progression-regression trial and as an important workhorse in many catheterization laboratories. Nowadays, increasingly complex lesions are treated with drug-eluting stents. The application of IVUS during such interventions can be very useful. Recently, optical coherence tomography (OCT), a light-based imaging technique, has entered the clinical arena. The “omnipresence” of OCT during scientific sessions and live courses with PCI may raise in many the question: Does IVUS have a future in the “era of OCT”? Three review articles, highlighted by this editorial, demonstrate the broad spectrum of current IVUS applications and underline the significant role of IVUS during the last two decades. OCT, the much younger technique, still has to prove its value. Yet OCT is likely to take over some of the current indications of IVUS as a research tool. In addition, OCT is currently gaining clinical significance for stent optimization during complex interventional procedures. Nevertheless, there is little doubt that IVUS still has a major role in studies on coronary atherosclerosis and for guidance of coronary stenting. Thus, ultrasound and light—are they friend or foe? In fact, both methods are good in their own rights. They are complementary rather than competitive. Moreover, in combination, at least for certain indications, they could be even better.
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Matsumoto I, Miyake Y, Mizukawa M, Takagi Y. Impact of Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio on Long-Term Outcome in Patients Undergoing Percutaneous Coronary Intervention. Circ J 2011; 75:905-10. [DOI: 10.1253/circj.cj-10-0258] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Eandi M. Drug Therapy and Follow-Up. ATHEROSCLEROSIS DISEASE MANAGEMENT 2011:563-631. [DOI: 10.1007/978-1-4419-7222-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Berry C, Noble S, Ibrahim R, Grégoire J, Levesque S, L'Allier PL, Tardif JC. Remodeling is a more important determinant of lumen size than atheroma burden in left main coronary artery disease. Am Heart J 2010; 160:188-194.e1. [PMID: 20598991 DOI: 10.1016/j.ahj.2010.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Left main coronary artery (LMCA) disease influences survival; however, the predictors of LMCA changes over time are incompletely understood. METHODS Paired intravascular ultrasound (IVUS) and core laboratory analyses were performed in a standardized fashion in 207 subjects (mean +/- SD age 58 +/- 10 years, 80% men). The average follow-up duration was 18 months (range 12-24 months). The IVUS measurements were first obtained at the smallest lumen area and the largest plaque area at follow-up and the corresponding positions in the LMCA were then measured at baseline. RESULTS The LMCA percentage of atheroma area at baseline was 38.2% +/- 11.8%, and 133 patients (64%) experienced an increase in percentage of atheroma area. Change in lumen area correlated positively with change in total vessel area (R = 0.85, P < .0001) and negatively with change in percentage of atheroma area (R = -0.58, P < .0001). Change in plaque area correlated well with change in total vessel area (R = 0.64, P < .0001) but only weakly with change in lumen area (r = 0.14, P = .039). Although LMCA length correlated negatively with baseline lumen area and total vessel area, it did not correlate with their changes over time. On multivariable analyses, current smoking predicted an increase in percentage of atheroma area (P = .0013) and plaque area (P = .0041). Height negatively predicted change in percentage of atheroma area (P = .001). CONCLUSIONS The LMCA lumen dimensions are more tightly linked with remodeling than with atheroma progression/regression.
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