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Berggren CC, Jiang D, Jack Wang YF, Bergquist JA, Rupp LC, Liu Z, MacLeod RS, Narayan A, Timmins LH. Influence of material parameter variability on the predicted coronary artery biomechanical environment via uncertainty quantification. Biomech Model Mechanobiol 2024; 23:927-940. [PMID: 38361087 PMCID: PMC11102342 DOI: 10.1007/s10237-023-01814-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/30/2023] [Indexed: 02/17/2024]
Abstract
Central to the clinical adoption of patient-specific modeling strategies is demonstrating that simulation results are reliable and safe. Indeed, simulation frameworks must be robust to uncertainty in model input(s), and levels of confidence should accompany results. In this study, we applied a coupled uncertainty quantification-finite element (FE) framework to understand the impact of uncertainty in vascular material properties on variability in predicted stresses. Univariate probability distributions were fit to material parameters derived from layer-specific mechanical behavior testing of human coronary tissue. Parameters were assumed to be probabilistically independent, allowing for efficient parameter ensemble sampling. In an idealized coronary artery geometry, a forward FE model for each parameter ensemble was created to predict tissue stresses under physiologic loading. An emulator was constructed within the UncertainSCI software using polynomial chaos techniques, and statistics and sensitivities were directly computed. Results demonstrated that material parameter uncertainty propagates to variability in predicted stresses across the vessel wall, with the largest dispersions in stress within the adventitial layer. Variability in stress was most sensitive to uncertainties in the anisotropic component of the strain energy function. Moreover, unary and binary interactions within the adventitial layer were the main contributors to stress variance, and the leading factor in stress variability was uncertainty in the stress-like material parameter that describes the contribution of the embedded fibers to the overall artery stiffness. Results from a patient-specific coronary model confirmed many of these findings. Collectively, these data highlight the impact of material property variation on uncertainty in predicted artery stresses and present a pipeline to explore and characterize forward model uncertainty in computational biomechanics.
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Affiliation(s)
- Caleb C Berggren
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - David Jiang
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Y F Jack Wang
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Lindsay C Rupp
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Zexin Liu
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Mathematics, University of Utah, Salt Lake City, UT, USA
| | - Rob S MacLeod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Akil Narayan
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Mathematics, University of Utah, Salt Lake City, UT, USA
| | - Lucas H Timmins
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
- School of Engineering Medicine, Texas A&M University, 1020 Holcombe Blvd., Houston, TX, USA.
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA.
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2
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Gu SZ, Ahmed ME, Huang Y, Hakim D, Maynard C, Cefalo NV, Coskun AU, Costopoulos C, Maehara A, Stone GW, Stone PH, Bennett MR. Comprehensive biomechanical and anatomical atherosclerotic plaque metrics predict major adverse cardiovascular events: A new tool for clinical decision making. Atherosclerosis 2024; 390:117449. [PMID: 38262275 PMCID: PMC10939719 DOI: 10.1016/j.atherosclerosis.2024.117449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND AIMS Anatomical imaging alone of coronary atherosclerotic plaques is insufficient to identify risk of future adverse events and guide management of non-culprit lesions. Low endothelial shear stress (ESS) and high plaque structural stress (PSS) are associated with events, but individually their predictive value is insufficient for risk prediction. We determined whether combining multiple complementary, biomechanical and anatomical plaque characteristics improves outcome prediction sufficiently to inform clinical decision-making. METHODS We examined baseline ESS, ESS gradient (ESSG), PSS, and PSS heterogeneity index (HI), and plaque burden in 22 lesions that developed subsequent events and 64 control lesions that remained quiescent from the PROSPECT study. RESULTS 86 fibroatheromas were analysed from 67 patients. Lesions with events showed higher PSS HI (0.32 vs. 0.24, p<0.001), lower local ESS (0.56Pa vs. 0.91Pa, p = 0.007), and higher ESSG (3.82 Pa/mm vs. 1.96 Pa/mm, p = 0.007), while high PSS HI (hazard ratio [HR] 3.9, p = 0.006), high ESSG (HR 3.4, p = 0.007) and plaque burden>70 % (HR 2.6, p = 0.02) were independent outcome predictors in multivariate analysis. Combining low ESS, high ESSG, and high PSS HI gave both high positive predictive value (80 %), which increased further combined with plaque burden>70 %, and negative predictive value (81.6 %). Low ESS, high ESSG, and high PSS HI co-localised spatially within 1 mm in lesions with events, and importantly, this cluster was distant from the minimum lumen area site. CONCLUSIONS Combining complementary biomechanical and anatomical metrics significantly improves risk-stratification of individual coronary lesions. If confirmed from larger prospective studies, our results may inform targeted revascularisation vs. conservative management strategies.
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Affiliation(s)
- Sophie Z Gu
- Section of Cardiorespiratory Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mona E Ahmed
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Molecular Medicine and Surgery, Karolinska Institutet Karolinska University Hospital Solna, 171 76, Stockholm, Sweden
| | - Yuan Huang
- Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, Cambridge, UK; Department of Radiology, University of Cambridge, Cambridge, UK
| | - Diaa Hakim
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles Maynard
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Nicholas V Cefalo
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York City, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, Department of Medicine, University of Cambridge, Cambridge, UK.
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Huang M, Maehara A, Tang D, Zhu J, Wang L, Lv R, Zhu Y, Zhang X, Matsumura M, Chen L, Ma G, Mintz GS. Comparison of multilayer and single-layer coronary plaque models on stress/strain calculations based on optical coherence tomography images. Front Physiol 2023; 14:1251401. [PMID: 37608838 PMCID: PMC10440539 DOI: 10.3389/fphys.2023.1251401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Mechanical stress and strain conditions are closely related to atherosclerotic plaque progression and rupture and have been under intensive investigations in recent years. It is well known that arteries have a three-layer structure: intima, media and adventitia. However, in vivo image-based multilayer plaque models are not available in the current literature due to lack of multilayer image segmentation data. A multilayer segmentation and repairing technique was introduced to segment coronary plaque optical coherence tomography (OCT) image to obtain its three-layer vessel structure. A total of 200 OCT slices from 20 patients (13 male; 7 female) were used to construct multilayer and single-layer 3D thin-slice models to calculate plaque stress and strain and compare model differences. Our results indicated that the average maximum plaque stress values of 20 patients from multilayer and single-layer models were 385.13 ± 110.09 kPa and 270.91 ± 95.86 kPa, respectively. The relative difference was 42.2%, with single-layer stress serving as the base value. The average mean plaque stress values from multilayer and single-layer models were 129.59 ± 32.77 kPa and 93.27 ± 18.20 kPa, respectively, with a relative difference of 38.9%. The maximum and mean plaque strain values obtained from the multilayer models were 11.6% and 19.0% higher than those from the single-layer models. Similarly, the maximum and mean cap strains showed increases of 9.6% and 12.9% over those from the single-layer models. These findings suggest that use of multilayer models could improve plaque stress and strain calculation accuracy and may have large impact on plaque progression and vulnerability investigation and potential clinical applications. Further large-scale studies are needed to validate our findings.
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Affiliation(s)
- Mengde Huang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Rui Lv
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Yanwen Zhu
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Mitsuaki Matsumura
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Lijuan Chen
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Gary S. Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
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Ghorbannia A, LaDisa JF. Intravascular imaging of angioplasty balloon under-expansion during pre-dilation predicts hyperelastic behavior of coronary artery lesions. Front Bioeng Biotechnol 2023; 11:1192797. [PMID: 37284239 PMCID: PMC10240066 DOI: 10.3389/fbioe.2023.1192797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction: Stent-induced mechanical stimuli cause pathophysiological responses in the coronary artery post-treatment. These stimuli can be minimized through choice of stent, size, and deployment strategy. However, the lack of target lesion material characterization is a barrier to further personalizing treatment. A novel ex-vivo angioplasty-based intravascular imaging technique using optical coherence tomography (OCT) was developed to characterize local stiffness of the target lesion. Methods: After proper institutional oversight, atherosclerotic coronary arteries (n = 9) were dissected from human donor hearts for ex vivo material characterization <48 h post-mortem. Morphology was imaged at the diastolic blood pressure using common intravascular OCT protocols and at subsequent pressures using a specially fabricated perfusion balloon that accommodates the OCT imaging wire. Balloon under-expansion was quantified relative to the nominal balloon size at 8 ATM. Correlation to a constitutive hyperelastic model was empirically investigated (n = 13 plaques) using biaxial extension results fit to a mixed Neo-Hookean and Exponential constitutive model. Results and discussion: The average circumferential Cauchy stress was 66.5, 130.2, and 300.4 kPa for regions with <15, 15-30, and >30% balloon under-expansion at a 1.15 stretch ratio. Similarly, the average longitudinal Cauchy stress was 68.1, 172.6, and 412.7 kPa, respectively. Consequently, strong correlation coefficients >0.89 were observed between balloon under-expansion and stress-like constitutive parameters. These parameters allowed for visualization of stiffness and material heterogeneity for a range of atherosclerotic plaques. Balloon under-expansion is a strong predictor of target lesion stiffness. These findings are promising as stent deployment could now be further personalized via target lesion material characterization obtained pre-operatively.
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Affiliation(s)
- Arash Ghorbannia
- Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, WI, United States
| | - John F. LaDisa
- Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physiology, Milwaukee, WI, United States
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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5
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Gu SZ, Huang Y, Costopoulos C, Jessney B, Bourantas C, Teng Z, Losdat S, Maehara A, Räber L, Stone GW, Bennett MR. Heterogeneous plaque-lumen geometry is associated with major adverse cardiovascular events. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead038. [PMID: 37143612 PMCID: PMC10152392 DOI: 10.1093/ehjopen/oead038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
Aims Prospective studies show that only a minority of plaques with higher risk features develop future major adverse cardiovascular events (MACE), indicating the need for more predictive markers. Biomechanical estimates such as plaque structural stress (PSS) improve risk prediction but require expert analysis. In contrast, complex and asymmetric coronary geometry is associated with both unstable presentation and high PSS, and can be estimated quickly from imaging. We examined whether plaque-lumen geometric heterogeneity evaluated from intravascular ultrasound affects MACE and incorporating geometric parameters enhances plaque risk stratification. Methods and results We examined plaque-lumen curvature, irregularity, lumen aspect ratio (LAR), roughness, PSS, and their heterogeneity indices (HIs) in 44 non-culprit lesions (NCLs) associated with MACE and 84 propensity-matched no-MACE-NCLs from the PROSPECT study. Plaque geometry HI were increased in MACE-NCLs vs. no-MACE-NCLs across whole plaque and peri-minimal luminal area (MLA) segments (HI curvature: adjusted P = 0.024; HI irregularity: adjusted P = 0.002; HI LAR: adjusted P = 0.002; HI roughness: adjusted P = 0.004). Peri-MLA HI roughness was an independent predictor of MACE (hazard ratio: 3.21, P < 0.001). Inclusion of HI roughness significantly improved the identification of MACE-NCLs in thin-cap fibroatheromas (TCFA, P < 0.001), or with MLA ≤ 4 mm2 (P < 0.001), or plaque burden (PB) ≥ 70% (P < 0.001), and further improved the ability of PSS to identify MACE-NCLs in TCFA (P = 0.008), or with MLA ≤ 4 mm2 (P = 0.047), and PB ≥ 70% (P = 0.003) lesions. Conclusion Plaque-lumen geometric heterogeneity is increased in MACE vs. no-MACE-NCLs, and inclusion of geometric heterogeneity improves the ability of imaging to predict MACE. Assessment of geometric parameters may provide a simple method of plaque risk stratification.
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Affiliation(s)
- Sophie Z Gu
- Section of CardioRespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
| | - Yuan Huang
- Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, 20 Clarkson Road, Cambridge CB3 0EH, UK
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Charis Costopoulos
- Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge CB2 0AY, UK
| | - Benn Jessney
- Section of CardioRespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
| | - Christos Bourantas
- Institute of Cardiovascular Sciences, University College London, 62 Huntley Street, London WC1E 6DD, UK
| | - Zhongzhao Teng
- Tenoke Ltd., Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0AH, UK
- Nanjing Jingsan Medical Science and Technology Ltd., 6 Shui You Gang, Nanjing, Jiangsu 210013, China
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, NY 10029, USA
| | - Martin R Bennett
- Section of CardioRespiratory Medicine, University of Cambridge, Heart & Lung Research Institute, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
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Warren JL, Yoo JE, Meyer CA, Molony DS, Samady H, Hayenga HN. Automated finite element approach to generate anatomical patient-specific biomechanical models of atherosclerotic arteries from virtual histology-intravascular ultrasound. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:1008540. [PMID: 36523426 PMCID: PMC9745200 DOI: 10.3389/fmedt.2022.1008540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2023] Open
Abstract
Despite advancements in early detection and treatment, atherosclerosis remains the leading cause of death across all cardiovascular diseases (CVD). Biomechanical analysis of atherosclerotic lesions has the potential to reveal biomechanically instable or rupture-prone regions. Treatment decisions rarely consider the biomechanics of the stenosed lesion due in-part to difficulties in obtaining this information in a clinical setting. Previous 3D FEA approaches have incompletely incorporated the complex curvature of arterial geometry, material heterogeneity, and use of patient-specific data. To address these limitations and clinical need, herein we present a user-friendly fully automated program to reconstruct and simulate the wall mechanics of patient-specific atherosclerotic coronary arteries. The program enables 3D reconstruction from patient-specific data with heterogenous tissue assignment and complex arterial curvature. Eleven arteries with coronary artery disease (CAD) underwent baseline and 6-month follow-up angiographic and virtual histology-intravascular ultrasound (VH-IVUS) imaging. VH-IVUS images were processed to remove background noise, extract VH plaque material data, and luminal and outer contours. Angiography data was used to orient the artery profiles along the 3D centerlines. The resulting surface mesh is then resampled for uniformity and tetrahedralized to generate the volumetric mesh using TetGen. A mesh convergence study revealed edge lengths between 0.04 mm and 0.2 mm produced constituent volumes that were largely unchanged, hence, to save computational resources, a value of 0.2 mm was used throughout. Materials are assigned and finite element analysis (FEA) is then performed to determine stresses and strains across the artery wall. In a representative artery, the highest average effective stress was in calcium elements with 235 kPa while necrotic elements had the lowest average stress, reaching as low as 0.79 kPa. After applying nodal smoothening, the maximum effective stress across 11 arteries remained below 288 kPa, implying biomechanically stable plaques. Indeed, all atherosclerotic plaques remained unruptured at the 6-month longitudinal follow up diagnosis. These results suggest our automated analysis may facilitate assessment of atherosclerotic plaque stability.
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Affiliation(s)
- Jeremy L. Warren
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - John E. Yoo
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Clark A. Meyer
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - David S. Molony
- Northeast Georgia Health System, Georgia Heart Institute, Gainesville, GA, United States
| | - Habib Samady
- Northeast Georgia Health System, Georgia Heart Institute, Gainesville, GA, United States
| | - Heather N. Hayenga
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
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7
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Tokgoz A, Wang S, Sastry P, Sun C, Figg NL, Huang Y, Bennett MR, Sinha S, Gillard JH, Sutcliffe MPF, Teng Z. Association of Collagen, Elastin, Glycosaminoglycans, and Macrophages With Tissue Ultimate Material Strength and Stretch in Human Thoracic Aortic Aneurysms: A Uniaxial Tension Study. J Biomech Eng 2022; 144:101001. [PMID: 35274123 DOI: 10.1115/1.4054060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Indexed: 11/08/2022]
Abstract
Fiber structures and pathological features, e.g., inflammation and glycosaminoglycan (GAG) deposition, are the primary determinants of aortic mechanical properties which are associated with the development of an aneurysm. This study is designed to quantify the association of tissue ultimate strength and extensibility with the structural percentage of different components, in particular, GAG, and local fiber orientation. Thoracic aortic aneurysm (TAA) tissues from eight patients were collected. Ninety-six tissue strips of thickened intima, media, and adventitia were prepared for uni-extension tests and histopathological examination. Area ratios of collagen, elastin, macrophage and GAG, and collagen fiber dispersion were quantified. Collagen, elastin, and GAG were layer-dependent and the inflammatory burden in all layers was low. The local GAG ratio was negatively associated with the collagen ratio (r2 = 0.173, p < 0.05), but positively with elastin (r2 = 0.037, p < 0.05). Higher GAG deposition resulted in larger local collagen fiber dispersion in the media and adventitia, but not in the intima. The ultimate stretch in both axial and circumferential directions was exclusively associated with elastin ratio (axial: r2 = 0.186, p = 0.04; circumferential: r2 = 0.175, p = 0.04). Multivariate analysis showed that collagen and GAG contents were both associated with ultimate strength in the circumferential direction, but not with the axial direction (collagen: slope = 27.3, GAG: slope = -18.4, r2 = 0.438, p = 0.002). GAG may play important roles in TAA material strength. Their deposition was found to be associated positively with the local collagen fiber dispersion and negatively with ultimate strength in the circumferential direction.
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Affiliation(s)
- Aziz Tokgoz
- Department of Engineering, University of Cambridge, Cambridge CB2 1TN, UK
| | - Shuo Wang
- Department of Radiology, University of Cambridge, Cambridge CB2 1TN, UK; Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai 200437, China; Shanghai Key Laboratory of MICCAI, Shanghai, China
| | - Priya Sastry
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Chang Sun
- Department of Radiology, University of Cambridge, Cambridge CB2 1TN, UK
| | - Nichola L Figg
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai 200437, China
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge CB2 1TN, UK; Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging, University of Cambridge, Cambridge CB2 1TN, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Sanjay Sinha
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | | | - Michael P F Sutcliffe
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
| | - Zhongzhao Teng
- Department of Engineering, University of Cambridge, Cambridge CB2 1TN, UK; Department of Radiology, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100083, China; Nanjing Jingsan Medical Science and Technology, Ltd., Jiangsu, China
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8
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Adhesion Molecules and Vulnerable Plaques – Promoters of Acute Coronary Syndromes. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
Biological factors that characterize extrinsic plaque vulnerability include various pro- and anti-inflammatory cytokines that contribute to the development and progression of atherosclerosis. Adhesion molecules are among the initiators of the atherosclerotic process, by mediation of endothelial inflammation. The soluble forms of these adhesion molecules have been identified in the circulatory blood, with an increased level in case of subjects with atherosclerotic lesions and higher levels in patients with acute coronary syndromes or vulnerable plaques. In addition, several authors have found a significant predictive capacity of these molecules in case of patients presenting with acute coronary and cerebrovascular events. The aim of this manuscript is to provide a short description of the role of adhesion molecules in the development and progression of atherosclerotic lesions towards acute coronary syndromes, as well as their capacity for predicting major adverse cardiovascular events in vulnerable cardiovascular patients.
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9
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Gu SZ, Bennett MR. Plaque Structural Stress: Detection, Determinants and Role in Atherosclerotic Plaque Rupture and Progression. Front Cardiovasc Med 2022; 9:875413. [PMID: 35872913 PMCID: PMC9300846 DOI: 10.3389/fcvm.2022.875413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/10/2022] [Indexed: 12/02/2022] Open
Abstract
Atherosclerosis remains a major cause of death worldwide, with most myocardial infarctions being due to rupture or erosion of coronary plaques. Although several imaging modalities can identify features that confer risk, major adverse cardiovascular event (MACE) rates attributable to each plaque are low, such that additional biomarkers are required to improve risk stratification at plaque and patient level. Coronary arteries are exposed to continual mechanical forces, and plaque rupture occurs when plaque structural stress (PSS) exceeds its mechanical strength. Prospective studies have shown that peak PSS is correlated with acute coronary syndrome (ACS) presentation, plaque rupture, and MACE, and provides additional prognostic information to imaging. In addition, PSS incorporates multiple variables, including plaque architecture, plaque material properties, and haemodynamic data into a defined solution, providing a more detailed overview of higher-risk lesions. We review the methods for calculation and determinants of PSS, imaging modalities used for modeling PSS, and idealized models that explore structural and geometric components that affect PSS. We also discuss current experimental and clinical data linking PSS to the natural history of coronary artery disease, and explore potential for refining treatment options and predicting future events.
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Affiliation(s)
- Sophie Z Gu
- Section of Cardiorespiratory Medicine, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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10
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Qin Z, Cao M, Xi X, Zhang Y, Wang Z, Zhao S, Tian Y, Xu Q, Yu H, Tian J, Yu B. Cholesterol crystals in non-culprit plaques of STEMI patients: A 3-vessel OCT study. Int J Cardiol 2022; 364:162-168. [PMID: 35705168 DOI: 10.1016/j.ijcard.2022.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cholesterol crystals (CCs) are regular microstructures found within the necrotic core of atherosclerotic plaques and have been hypothesized to be related to plaque destabilization. We attempted to investigate the potential association between CCs and non-culprit plaque vulnerability in patients with ST-segment elevated myocardial infarction (STEMI) and study morphological features of CCs in ruptured non-culprit plaques. METHODS A total of 261 patients with ST-segment elevation myocardial infarction who underwent 3-vessel optical coherence tomography (OCT) imaging were included. Non-culprit plaques were divided into two groups according to the presence or absence of CCs in the plaque to compare the morphological characteristics of the plaques. The differences in parameters of the non-culprit plaque CCs were explored between ruptured plaques and unruptured plaques. RESULTS Totally, 530 non-culprit plaques (29 ruptured plaques and 501 unruptured plaques) were identified by OCT. The incidence of CCs was 21.1%. Compared with non-culprit plaques without CCs, those with CCs had a larger lipid burden. Macrophages (p < 0.001) and spotty calcification (p = 0.002) were more frequently observed in non-culprit plaques with CCs. The frequency of CCs was significantly higher (p = 0.001) and the CCs were larger (p = 0.046) and more superficial (p = 0.005) in ruptured non-culprit plaques than in unruptured non-culprit plaques. The maximum lipid arc and fibrous cap thickness were independent predictors of plaque rupture, but the presence of CCs was not. CONCLUSIONS Non-culprit plaques with CCs have more vulnerable features. CCs are more frequently found in ruptured non-culprit plaques and larger and more superficial CCs are associated with plaque rupture.
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Affiliation(s)
- Zhifeng Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Xiangwen Xi
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Yanwen Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Zhuozhong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Suhong Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Yanan Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Qinglu Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China.
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin, China.
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11
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Jin C, Torii R, Ramasamy A, Tufaro V, Little CD, Konstantinou K, Tan YY, Yap NAL, Cooper J, Crake T, O’Mahony C, Rakhit R, Egred M, Ahmed J, Karamasis G, Räber L, Baumbach A, Mathur A, Bourantas CV. Morphological and Physiological Characteristics of Ruptured Plaques in Native Arteries and Neoatherosclerotic Segments: An OCT-Based and Computational Fluid Dynamics Study. Front Cardiovasc Med 2022; 9:890799. [PMID: 35722127 PMCID: PMC9204481 DOI: 10.3389/fcvm.2022.890799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intravascular imaging has been used to assess the morphology of lesions causing an acute coronary syndrome (ACS) in native vessels (NV) and identify differences between plaques that ruptured (PR) and caused an event and those that ruptured without clinical manifestations. However, there is no data about the morphological and physiological characteristics of neoatherosclerotic plaques that ruptured (PR-NA) which constitute a common cause of stent failure. Methods We retrospectively analyzed data from patients admitted with an acute myocardial infarction that had optical coherence tomography (OCT) imaging of the culprit vessel before balloon pre-dilation. OCT pullbacks showing PR were segmented at every 0.4 mm. The extent of the formed cavity, lipid and calcific tissue, thrombus, and macrophages were measured, and the fibrous cap thickness (FCT) and the incidence of micro-channels and cholesterol crystals were reported. These data were used to reconstruct a representative model of the native and neoatherosclerotic lesion geometry that was processed with computational fluid dynamics (CFD) techniques to estimate the distribution of the endothelial shear stress and plaque structural stress. Result Eighty patients were included in the present analysis: 56 had PR in NV (PR-NV group) and 24 in NA segments (PR-NA group). The PR-NV group had a larger minimum lumen area (2.93 ± 2.03 vs. 2.00 ± 1.26 mm2, p = 0.015) but similar lesion length and area stenosis compared to PR-NA group. The mean FCT (186 ± 65 vs. 232 ± 80 μm, p = 0.009) and the lipid index was smaller (16.7 ± 13.8 vs. 25.9 ± 14.1, p = 0.008) while the of calcific index (8.3 ± 9.5 vs. 2.2 ± 1.6%, p = 0.002) and the incidence of micro-channels (41.4 vs. 12.5%, p = 0.013) was higher in the PR-NV group. Conversely, there was no difference in the incidence of cholesterol crystals, thrombus burden or the location of the rupture site between groups. CFD analysis revealed higher maximum endothelial shear stress (19.1 vs. 11.0 Pa) and lower maximum plaque structural stress (38.8 vs. 95.1 kPa) in the PR-NA compared to the PR-NV model. Conclusion We reported significant morphological and physiological differences between culprit ruptured plaques in native and stented segments. Further research is needed to better understand the causes of these differences and the mechanisms regulating neoatherosclerotic lesion destabilization.
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Affiliation(s)
- Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Callum D. Little
- Royal Free Hospital, University College London, London, United Kingdom
| | - Klio Konstantinou
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Yi Ying Tan
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Nathan A. L. Yap
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Jackie Cooper
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Tom Crake
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Constantinos O’Mahony
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Roby Rakhit
- Royal Free Hospital, University College London, London, United Kingdom
| | - Mohaned Egred
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Javed Ahmed
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grigoris Karamasis
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Lorenz Räber
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Yale University School of Medicine, New Haven, CT, United States
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- *Correspondence: Christos V. Bourantas,
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12
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Huang J, Yang F, Gutiérrez-Chico JL, Xu T, Wu J, Wang L, Lv R, Lai Y, Liu X, Onuma Y, Tang D, Serruys PW, Wijns W, Tu S. Optical Coherence Tomography-Derived Changes in Plaque Structural Stress Over the Cardiac Cycle: A New Method for Plaque Biomechanical Assessment. Front Cardiovasc Med 2021; 8:715995. [PMID: 34805298 PMCID: PMC8600113 DOI: 10.3389/fcvm.2021.715995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Cyclic plaque structural stress has been hypothesized as a mechanism for plaque fatigue and eventually plaque rupture. A novel approach to derive cyclic plaque stress in vivo from optical coherence tomography (OCT) is hereby developed. Materials and Methods: All intermediate lesions from a previous OCT study were enrolled. OCT cross-sections at representative positions within each lesion were selected for plaque stress analysis. Detailed plaque morphology, including plaque composition, lumen and internal elastic lamina contours, were automatically delineated. OCT-derived vessel and plaque morphology were included in a 2-dimensional finite element analysis, loaded with patient-specific intracoronary pressure tracing data, to calculate the changes in plaque structural stress (ΔPSS) on vessel wall over the cardiac cycle. Results: A total of 50 lesions from 41 vessels were analyzed. A significant ΔPSS gradient was observed across the plaque, being maximal at the proximal shoulder (45.7 [32.3, 78.6] kPa), intermediate at minimal lumen area (MLA) (39.0 [30.8, 69.1] kPa) and minimal at the distal shoulder (35.1 [28.2, 72.3] kPa; p = 0.046). The presence of lipidic plaques were observed in 82% of the diseased segments. Larger relative lumen deformation and ΔPSS were observed in diseased segments, compared with normal segments (percent diameter change: 8.2 ± 4.2% vs. 6.3 ± 2.3%, p = 0.04; ΔPSS: 59.3 ± 48.2 kPa vs. 27.5 ± 8.2 kPa, p < 0.001). ΔPSS was positively correlated with plaque burden (r = 0.37, p < 0.001) and negatively correlated with fibrous cap thickness (r = -0.25, p = 0.004). Conclusions: ΔPSS provides a feasible method for assessing plaque biomechanics in vivo from OCT images, consistent with previous biomechanical and clinical studies based on different methodologies. Larger ΔPSS at proximal shoulder and MLA indicates the critical sites for future biomechanical assessment.
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Affiliation(s)
- Jiayue Huang
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China.,The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - Fan Yang
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Luis Gutiérrez-Chico
- Cardiology Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianxiao Xu
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jigang Wu
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Rui Lv
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Yan Lai
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yoshinobu Onuma
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Patrick W Serruys
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
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13
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An inverse method for mechanical characterization of heterogeneous diseased arteries using intravascular imaging. Sci Rep 2021; 11:22540. [PMID: 34795350 PMCID: PMC8602310 DOI: 10.1038/s41598-021-01874-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/27/2021] [Indexed: 11/08/2022] Open
Abstract
The increasing prevalence of finite element (FE) simulations in the study of atherosclerosis has spawned numerous inverse FE methods for the mechanical characterization of diseased tissue in vivo. Current approaches are however limited to either homogenized or simplified material representations. This paper presents a novel method to account for tissue heterogeneity and material nonlinearity in the recovery of constitutive behavior using imaging data acquired at differing intravascular pressures by incorporating interfaces between various intra-plaque tissue types into the objective function definition. Method verification was performed in silico by recovering assigned material parameters from a pair of vessel geometries: one derived from coronary optical coherence tomography (OCT); one generated from in silico-based simulation. In repeated tests, the method consistently recovered 4 linear elastic (0.1 ± 0.1% error) and 8 nonlinear hyperelastic (3.3 ± 3.0% error) material parameters. Method robustness was also highlighted in noise sensitivity analysis, where linear elastic parameters were recovered with average errors of 1.3 ± 1.6% and 8.3 ± 10.5%, at 5% and 20% noise, respectively. Reproducibility was substantiated through the recovery of 9 material parameters in two more models, with mean errors of 3.0 ± 4.7%. The results highlight the potential of this new approach, enabling high-fidelity material parameter recovery for use in complex cardiovascular computational studies.
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14
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Jansen S, Doyle B, Lawrence-Brown M. Arterial tissue stress and the geography of atheroma. ANZ J Surg 2021; 91:2237-2238. [PMID: 34766687 DOI: 10.1111/ans.16965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,Medical School, Curtin University Bentley Campus, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Barry Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.,British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
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15
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Gu SZ, Costopoulos C, Huang Y, Bourantas C, Woolf A, Sun C, Teng Z, Losdat S, Räber L, Samady H, Bennett MR. High-intensity statin treatment is associated with reduced plaque structural stress and remodelling of artery geometry and plaque architecture. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab039. [PMID: 35919883 PMCID: PMC9242039 DOI: 10.1093/ehjopen/oeab039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022]
Abstract
Aims Plaque structural stress (PSS) is a major cause of atherosclerotic plaque rupture and major adverse cardiovascular events (MACE). We examined the predictors of changes in peak and mean PSS (ΔPSSpeak, ΔPSSmean) in three studies of patients receiving either standard medical or high-intensity statin (HIS) treatment. Methods and results We examined changes in PSS, plaque size, and composition between 7348 co-registered baseline and follow-up virtual-histology intravascular ultrasound images in patients receiving standard medical treatment (controls, n = 18) or HIS (atorvastatin 80 mg, n = 20, or rosuvastatin 40 mg, n = 22). The relationship between changes in PSSpeak and plaque burden (PB) differed significantly between HIS and control groups (P < 0.001). Notably, PSSpeak increased significantly in control lesions with PB >60% (P = 0.04), but not with HIS treatment. However, ΔPSSpeak correlated poorly with changes in lumen and plaque area or PB, plaque composition, or lipid lowering. In contrast, ΔPSSpeak correlated significantly with changes in lumen curvature, irregularity, and roughness (P < 0.05), all of which were reduced in HIS patients. ΔPSSmean correlated with changes in lumen area, PA, PB, and circumferential calcification, and was unchanged with either treatment. Conclusion Our observational study shows that PSSpeak changes over time were associated with baseline disease severity and treatment. The PSSpeak increase seen in advanced lesions with standard treatment was associated with remodelling artery geometry and plaque architecture, but this was not seen after HIS treatment. Smoothing plaques by reducing plaque/lumen roughness, irregularity, and curvature represents a novel mechanism whereby HIS may reduce PSS and, thus may protect against plaque rupture and MACE.
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Affiliation(s)
- Sophie Z Gu
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Charis Costopoulos
- Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge CB2 0AY, UK
| | - Yuan Huang
- Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, 20 Clarkson Road, Cambridge CB3 0EH, UK
- Department of Radiology, University of Cambridge, Hills Road, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Christos Bourantas
- Institute of Cardiovascular Sciences, University College London, 62 Huntley Street, London WC1E 6DD, UK
- Department of Cardiology, Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Adam Woolf
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Chang Sun
- Department of Radiology, University of Cambridge, Hills Road, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Hills Road, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Hochschulstrasse 6, Bern 3012, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
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16
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Noble C, Carlson K, Neumann E, Lewis B, Dragomir-Daescu D, Lerman A, Erdemir A, Young M. Finite element analysis in clinical patients with atherosclerosis. J Mech Behav Biomed Mater 2021; 125:104927. [PMID: 34740008 PMCID: PMC8665142 DOI: 10.1016/j.jmbbm.2021.104927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/31/2020] [Accepted: 10/25/2021] [Indexed: 01/03/2023]
Abstract
Endovascular plaque composition is strongly related to stent strut stress and is responsible for strut fatigue, stent failure, and possible in-stent restenosis. To evaluate the effect of plaque on artery wall resistance to expansion we performed in silico analysis of atherosclerotic vessels. We generated finite element models from in vivo intravascular ultrasound virtual histology images to determine local artery surface stiffness and determined which plaque structures have the greatest influence. We validated the predictive capacity of our modeling approach by testing an atherosclerotic peripheral artery ex vivo with pressure-inflation testing at physiological pressures ranging from 10 to 200 mmHg. For this purpose, the in silico deformation of the arterial wall was compared to that observed ex vivo. We found that calcification had a positive effect on surface stiffness with fibrous plaque and necrotic core having negative effects. Additionally, larger plaque structures demonstrated significantly higher average surface stiffness and calcification located nearer the lumen was also shown to increase surface stiffness. Therefore, more developed plaques will have greater resistance to expansion and higher stent strut stress, with calcification located near the lumen further increasing stress in localized areas. Thus, it may be expected that such plaque structures may increase the likelihood of localized stent strut fracture.
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Affiliation(s)
- Christopher Noble
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent Carlson
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Erica Neumann
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Lewis
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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17
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Kadry K, Olender ML, Marlevi D, Edelman ER, Nezami FR. A platform for high-fidelity patient-specific structural modelling of atherosclerotic arteries: from intravascular imaging to three-dimensional stress distributions. J R Soc Interface 2021; 18:20210436. [PMID: 34583562 DOI: 10.1098/rsif.2021.0436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The pathophysiology of atherosclerotic lesions, including plaque rupture triggered by mechanical failure of the vessel wall, depends directly on the plaque morphology-modulated mechanical response. The complex interplay between lesion morphology and structural behaviour can be studied with high-fidelity computational modelling. However, construction of three-dimensional (3D) and heterogeneous models is challenging, with most previous work focusing on two-dimensional geometries or on single-material lesion compositions. Addressing these limitations, we here present a semi-automatic computational platform, leveraging clinical optical coherence tomography images to effectively reconstruct a 3D patient-specific multi-material model of atherosclerotic plaques, for which the mechanical response is obtained by structural finite-element simulations. To demonstrate the importance of including multi-material plaque components when recovering the mechanical response, a computational case study was conducted in which systematic variation of the intraplaque lipid and calcium was performed. The study demonstrated that the inclusion of various tissue components greatly affected the lesion mechanical response, illustrating the importance of multi-material formulations. This platform accordingly provides a viable foundation for studying how plaque micro-morphology affects plaque mechanical response, allowing for patient-specific assessments and extension into clinically relevant patient cohorts.
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Affiliation(s)
- Karim Kadry
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Laboratory of Hemodynamics and Cardiovascular Technology, Swiss Federal Institute of Technology, MED 3.2922, 1015 Lausanne, Switzerland
| | - Max L Olender
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Farhad R Nezami
- Thoracic and Cardiac Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Evaluating the Impact of Calcification on Plaque Vulnerability from the Aspect of Mechanical Interaction Between Blood Flow and Artery Based on MRI. Ann Biomed Eng 2020; 49:1169-1182. [PMID: 33079320 DOI: 10.1007/s10439-020-02655-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/08/2020] [Indexed: 01/31/2023]
Abstract
Acute cerebral ischemic events and thrombosis are associated with the rupture/erosion of carotid atherosclerotic plaques. The aim of the present study was to determine the impact of calcification deposition on the wall shear stress (WSS) and stresses within the plaques using 3D fluid-structure interaction (FSI) models. Six patients with calcified carotid atherosclerosis underwent multisequence magnetic resonance imaging (MRI) and were divided into three groups according to the calcification volume. To evaluate the role of the calcification deposition on the stresses, the calcification content was replaced by lipids and arterial tissue, respectively. By comparing the results from the simulation with calcification, and when changing it to lipids there was a significant increment in the stresses at the fibrous cap (p = 0.004). Instead, by changing it to arterial tissue, there was no significant difference (p = 0.07). The calcification shapes that presented the highest stresses were thin concave arc-shaped (AS1) and thin convex arc-shaped (AS3), with mean stress values of 107 ± 54.2 and 99.6 ± 23.4 kPa, respectively. It was also observed that, the calcification shape has more influence on the level of stress than its distance to the lumen. Higher WSS values were associated with the presence of calcification. Calcification shape plays an important role in producing high stresses in the plaque. This work further clarifies the impact of calcification on plaque vulnerability.
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19
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Qian S, Ma T, Zhang N, Liu X, Zhao P, Li X, Chen D, Hu L, Chang L, Xu L, Deng X, Fan Y. Spatiotemporal transfer of nitric oxide in patient-specific atherosclerotic carotid artery bifurcations with MRI and computational fluid dynamics modeling. Comput Biol Med 2020; 125:104015. [DOI: 10.1016/j.compbiomed.2020.104015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
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20
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Costopoulos C, Timmins LH, Huang Y, Hung OY, Molony DS, Brown AJ, Davis EL, Teng Z, Gillard JH, Samady H, Bennett MR. Impact of combined plaque structural stress and wall shear stress on coronary plaque progression, regression, and changes in composition. Eur Heart J 2020; 40:1411-1422. [PMID: 30907406 PMCID: PMC6503452 DOI: 10.1093/eurheartj/ehz132] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/02/2018] [Accepted: 03/08/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Charis Costopoulos
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Hills Road, Addenbrooke's Hospital, Cambridge, UK
| | - Lucas H Timmins
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA.,Department of Bioengineering, University of Utah, 50 S. Central Campus Drive, Salt Lake City, UT, USA
| | - Yuan Huang
- EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, 20 Clarkson Road, Cambridge, UK.,Department of Radiology, University of Cambridge, Hills Road, Addenbrooke's Hospital, Cambridge, UK
| | - Olivia Y Hung
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA
| | - David S Molony
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Hills Road, Addenbrooke's Hospital, Cambridge, UK
| | - Emily L Davis
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Hills Road, Addenbrooke's Hospital, Cambridge, UK.,Department of Engineering, University of Cambridge, Hills Road, Addenbrooke's Hospital, Cambridge, UK
| | - Jonathan H Gillard
- Department of Radiology, University of Cambridge, Hills Road, Addenbrooke's Hospital, Cambridge, UK
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, USA
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Level 6, ACCI, Hills Road, Addenbrooke's Hospital, Cambridge, UK
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21
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Wang L, Tang D, Maehara A, Wu Z, Yang C, Muccigrosso D, Matsumura M, Zheng J, Bach R, Billiar KL, Stone GW, Mintz GS. Using intravascular ultrasound image-based fluid-structure interaction models and machine learning methods to predict human coronary plaque vulnerability change. Comput Methods Biomech Biomed Engin 2020; 23:1267-1276. [PMID: 32696674 DOI: 10.1080/10255842.2020.1795838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Plaque vulnerability prediction is of great importance in cardiovascular research. In vivo follow-up intravascular ultrasound (IVUS) coronary plaque data were acquired from nine patients to construct fluid-structure interaction models to obtain plaque biomechanical conditions. Morphological plaque vulnerability index (MPVI) was defined to measure plaque vulnerability. The generalized linear mixed regression model (GLMM), support vector machine (SVM) and random forest (RF) were introduced to predict MPVI change (ΔMPVI = MPVIfollow-up‒MPVIbaseline) using ten risk factors at baseline. The combination of mean wall thickness, lumen area, plaque area, critical plaque wall stress, and MPVI was the best predictor using RF with the highest prediction accuracy 91.47%, compared to 90.78% from SVM, and 85.56% from GLMM. Machine learning method (RF) improved the prediction accuracy by 5.91% over that from GLMM. MPVI was the best single risk factor using both GLMM (82.09%) and RF (78.53%) while plaque area was the best using SVM (81.29%).
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Affiliation(s)
- Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Zheyang Wu
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Chun Yang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - David Muccigrosso
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | - Mitsuaki Matsumura
- The Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | - Richard Bach
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristen L Billiar
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Gregg W Stone
- The Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, USA
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22
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Coupling Advanced Imaging With Computational Vascular Diagnostics. JACC Cardiovasc Imaging 2020; 13:1033-1035. [DOI: 10.1016/j.jcmg.2019.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022]
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23
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Gade PS, Tulamo R, Lee KW, Mut F, Ollikainen E, Chuang CY, Jae Chung B, Niemelä M, Rezai Jahromi B, Aziz K, Yu A, Charbel FT, Amin-Hanjani S, Frösen J, Cebral JR, Robertson AM. Calcification in Human Intracranial Aneurysms Is Highly Prevalent and Displays Both Atherosclerotic and Nonatherosclerotic Types. Arterioscler Thromb Vasc Biol 2019; 39:2157-2167. [PMID: 31462093 PMCID: PMC6911659 DOI: 10.1161/atvbaha.119.312922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although the clinical and biological importance of calcification is well recognized for the extracerebral vasculature, its role in cerebral vascular disease, particularly, intracranial aneurysms (IAs), remains poorly understood. Extracerebrally, 2 distinct mechanisms drive calcification, a nonatherosclerotic, rapid mineralization in the media and a slower, inflammation driven, atherosclerotic mechanism in the intima. This study aims to determine the prevalence, distribution, and type (atherosclerotic, nonatherosclerotic) of calcification in IAs and assess differences in occurrence between ruptured and unruptured IAs. Approach and Results: Sixty-five 65 IA specimens (48 unruptured, 17 ruptured) were resected perioperatively. Calcification and lipid pools were analyzed nondestructively in intact samples using high resolution (0.35 μm) microcomputed tomography. Calcification is highly prevalent (78%) appearing as micro (<500 µm), meso (500 µm-1 mm), and macro (>1 mm) calcifications. Calcification manifests in IAs as both nonatherosclerotic (calcification distinct from lipid pools) and atherosclerotic (calcification in the presence of lipid pools) with 3 wall types: Type I-only calcification, no lipid pools (20/51, 39%), Type II-calcification and lipid pools, not colocalized (19/51, 37%), Type III-calcification colocalized with lipid pools (12/51, 24%). Ruptured IAs either had no calcifications or had nonatherosclerotic micro- or meso-calcifications (Type I or II), without macro-calcifications. CONCLUSIONS Calcification in IAs is substantially more prevalent than previously reported and presents as both nonatherosclerotic and atherosclerotic types. Notably, ruptured aneurysms had only nonatherosclerotic calcification, had significantly lower calcification fraction, and did not contain macrocalcifications. Improved understanding of the role of calcification in IA pathology should lead to new therapeutic targets.
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Affiliation(s)
- Piyusha S Gade
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA
| | - Riikka Tulamo
- Department of Vascular Surgery (R.T.), Helsinki University Hospital, University of Helsinki, Finland
| | - Kee-Won Lee
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, VA (F.M., J.R.C.)
| | - Eliisa Ollikainen
- Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA.,Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Chih-Yuan Chuang
- Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, NJ (B.J.C.)
| | - Mika Niemelä
- Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Khaled Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA (K.A., A.Y.)
| | - Alexander Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA (K.A., A.Y.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C., S.A.-H.)
| | | | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Finland (J.F.)
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, VA (F.M., J.R.C.)
| | - Anne M Robertson
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA.,Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA
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24
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Costopoulos C, Maehara A, Huang Y, Brown AJ, Gillard JH, Teng Z, Stone GW, Bennett MR. Heterogeneity of Plaque Structural Stress Is Increased in Plaques Leading to MACE: Insights From the PROSPECT Study. JACC Cardiovasc Imaging 2019; 13:1206-1218. [PMID: 31326476 PMCID: PMC7198978 DOI: 10.1016/j.jcmg.2019.05.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/17/2019] [Accepted: 05/03/2019] [Indexed: 11/25/2022]
Abstract
Objectives This study sought to determine if plaque structural stress (PSS) and other plaque stress parameters are increased in plaques that cause future major adverse cardiovascular event(s) (MACE) and if incorporating these parameters improves predictive capability of intravascular ultrasonography (IVUS). Background Less than 10% of coronary plaques identified as high-risk by intravascular imaging result in subsequent MACE. Thus, more specific measurements of plaque vulnerability are required for effective risk stratification. Methods Propensity score matching in the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study plaque cohort resulted in 35 nonculprit lesions (NCL) associated with future MACE and 66 matched NCL that remained clinically silent. PSS was calculated by finite element analysis as the mechanical loading within the plaque structure in the periluminal region. Results PSS was increased in the minimal luminal area (MLA) regions of NCL MACE versus no MACE plaques for all plaques (PSS: 112.1 ± 5.5 kPa vs. 90.4 ± 3.3 kPa, respectively; p = 0.001) and virtual histology thin-cap fibroatheromas (VH-TCFAs) (PSS: 119.2 ± 6.6 kPa vs. 95.8 ± 5.0 kPa, respectively; p = 0.005). However, PSS was heterogeneous over short segments, and PSS heterogeneity index (HI) was markedly greater in NCL MACE than in no-MACE VH-TCFAs (HI: 0.43 ± 0.05 vs. 0.29 ± 0.03, respectively; p = 0.01). Inclusion of PSS in plaque assessment improved the identification of NCLs that led to MACE, including in VH-TCFAs (p = 0.03) and plaques with MLA ≤4 mm2 (p = 0.03). Incorporation of an HI further improved the ability of PSS to identify MACE NCLs in a variety of plaque subtypes including VH-TCFA (p = 0.001) and plaques with MLA ≤4 mm2 (p = 0.002). Conclusions PSS and variations in PSS are increased in the peri-MLA regions of plaques that lead to MACE. Moreover, longitudinal heterogeneity in PSS is markedly increased in MACE plaques, especially VH-TCFAs, potentially predisposing to plaque rupture. Incorporation of PSS and heterogeneity in PSS may improve the ability of IVUS to predict MACE.
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Affiliation(s)
- Charis Costopoulos
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York City, New York
| | - Yuan Huang
- Department of Engineering and Physical Sciences Research Council, Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, Cambridge, United Kingdom; Department of Radiology, University of Cambridge, Cambridge, United Kingdom; Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan H Gillard
- Department of Engineering and Physical Sciences Research Council, Centre for Mathematical and Statistical Analysis of Multimodal Imaging, University of Cambridge, Cambridge, United Kingdom
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom; Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York City, New York
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
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25
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Barrett HE, Van der Heiden K, Farrell E, Gijsen FJH, Akyildiz AC. Calcifications in atherosclerotic plaques and impact on plaque biomechanics. J Biomech 2019; 87:1-12. [PMID: 30904335 DOI: 10.1016/j.jbiomech.2019.03.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/09/2019] [Indexed: 12/13/2022]
Abstract
The catastrophic mechanical rupture of an atherosclerotic plaque is the underlying cause of the majority of cardiovascular events. The infestation of vascular calcification in the plaques creates a mechanically complex tissue composite. Local stress concentrations and plaque tissue strength properties are the governing parameters required to predict plaque ruptures. Advanced imaging techniques have permitted insight into fundamental mechanisms driving the initiating inflammatory-driven vascular calcification of the diseased intima at the (sub-) micron scale and up to the macroscale. Clinical studies have potentiated the biomechanical relevance of calcification through the derivation of links between local plaque rupture and specific macrocalcification geometrical features. The clinical implications of the data presented in this review indicate that the combination of imaging, experimental testing, and computational modelling efforts are crucial to predict the rupture risk for atherosclerotic plaques. Specialised experimental tests and modelling efforts have further enhanced the knowledge base for calcified plaque tissue mechanical properties. However, capturing the temporal instability and rupture causality in the plaque fibrous caps remains elusive. Is it necessary to move our experimental efforts down in scale towards the fundamental (sub-) micron scales in order to interpret the true mechanical behaviour of calcified plaque tissue interactions that is presented on a macroscale in the clinic and to further optimally assess calcified plaques in the context of biomechanical modelling.
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Affiliation(s)
- Hilary E Barrett
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Kim Van der Heiden
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ali C Akyildiz
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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26
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Coronary Atherosclerotic Plaque Vulnerability Rather than Stenosis Predisposes to Non-ST Elevation Acute Coronary Syndromes. Cardiol Res Pract 2019; 2019:2642740. [PMID: 30984422 PMCID: PMC6432700 DOI: 10.1155/2019/2642740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/26/2018] [Accepted: 02/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background Non-ST elevation acute coronary syndromes (NSTE-ACS) may arise from moderately stenosed atherosclerotic lesions that suddenly undergo transformation to vulnerable plaques complicated by rupture and thrombosis. Objective Assessment and tissue characterization of the coronary atherosclerotic lesions among NSTE-ACS patients compared to those with stable angina. Methodology Evaluation of IVUS studies of 312 coronary lesions was done by 2 different experienced IVUS readers, 216 lesions in 66 patients with NSTE-ACS (group I) versus 96 lesions in 50 patients with stable angina (group II). Characterization of coronary plaques structure was done using colored-coded iMap technique. Results The Syntax score was significantly higher in group I compared to group II (18.7 ± 7.8 vs. 8.07 ± 2.5, p=0.001). Body mass index (BMI) was significantly higher in group II while triglycerides levels were higher in group I (P=0.01 & P=0.04, respectively). History of previous MI and PCI was significantly higher in group I (P=0.016 & P=0.001, respectively). The coronary lesions of NSTE-ACS patients had less vessel area (9.86 ± 3.8 vs 11.36 ± 2.9, p=0.001), stenosis percentage (54.7 ± 14.9% vs 68.6 ± 8.7%, p=0.001), and plaque burden (54.4 ± 14.7 vs 67.8 ± 9.8, p=0.001) with negative remodeling index (0.95 ± 20 vs 1.02 ± 0.14, p=0.008) compared to the stable angina group. On the other hand, they had more lipid content (21.8 ± 7.03% vs 7.26 ± 3.47%, p=0.001), necrotic core (18.08 ± 10.19% vs 15.83 ± 4.9%, p=0.02), and calcifications (10.4 ± 5.2% vs 4.19 ± 3.29%, p=0.001) while less fibrosis (51.67 ± 7.07% vs 70.37 ± 11.7%, p=0.001) compared to the stable angina patients. Syntax score and core composition especially calcification and lipid content were significant predictors to NSTE-ACS. Conclusions The vulnerability rather than the stenotic severity is the most important factor that predisposes to non-ST segment elevation acute coronary syndromes. The vulnerability is related to the lesion characteristics especially lipidic core and calcification while lesion fibrosis favours lesion stability.
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27
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Neumann EE, Young M, Erdemir A. A pragmatic approach to understand peripheral artery lumen surface stiffness due to plaque heterogeneity. Comput Methods Biomech Biomed Engin 2019; 22:396-408. [PMID: 30712373 DOI: 10.1080/10255842.2018.1560427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The goal of this study was to develop a pragmatic approach to build patient-specific models of the peripheral artery that are aware of plaque inhomogeneity. Patient-specific models using element-specific material definition (to understand the role of plaque composition) and homogeneous material definition (to understand the role of artery diameter and thickness) were automatically built from intravascular ultrasound images of three artery segments classified with low, average, and high calcification. The element-specific material models had average surface stiffness values of 0.0735, 0.0826, and 0.0973 MPa/mm, whereas the homogeneous material models had average surface stiffness values of 0.1392, 0.1276, and 0.1922 MPa/mm for low, average, and high calcification, respectively. Localization of peak lumen stiffness and differences in patient-specific average surface stiffness for homogeneous and element-specific models suggest the role of plaque composition on surface stiffness in addition to local arterial diameter and thickness.
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Affiliation(s)
- Erica E Neumann
- a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA.,b Computational Biomodeling (CoBi) Core, Lerner Research Institute , Cleveland Clinic , Cleveland , OH , USA
| | - Melissa Young
- c Division of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Ahmet Erdemir
- a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA.,b Computational Biomodeling (CoBi) Core, Lerner Research Institute , Cleveland Clinic , Cleveland , OH , USA
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28
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Stone PH, Coskun AU, Croce KJ. Evolving insights into the role of local shear stress in late stent failure from neoatherosclerosis formation and plaque destabilization. Int J Cardiol 2018; 272:45-46. [DOI: 10.1016/j.ijcard.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
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29
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Di Bartolo BA, Psaltis PJ, Bursill CA, Nicholls SJ. Translating Evidence of HDL and Plaque Regression. Arterioscler Thromb Vasc Biol 2018; 38:1961-1968. [DOI: 10.1161/atvbaha.118.307026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Considerable evidence from preclinical and population studies suggests that HDLs (high-density lipoproteins) possess atheroprotective properties. Reports from HDL infusion studies in animals and early clinical imaging trials reported evidence of plaque regression. These findings have stimulated further interest in developing new agents targeting HDL. However, the results of more recent imaging studies in the setting of high-intensity statin use have been disappointing. As the concept of plaque changes with HDL therapeutics evolves and imaging technology to evaluate these effects advances, there will become increasing opportunity to determine the effects of HDL agents on atherosclerotic plaque (Graphic Abstract).
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Affiliation(s)
- Belinda A. Di Bartolo
- From the South Australian Health and Medical Research Institute, University of Adelaide
| | - Peter J. Psaltis
- From the South Australian Health and Medical Research Institute, University of Adelaide
| | - Christina A. Bursill
- From the South Australian Health and Medical Research Institute, University of Adelaide
| | - Stephen J. Nicholls
- From the South Australian Health and Medical Research Institute, University of Adelaide
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30
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Thondapu V, Bourantas CV, Foin N, Jang IK, Serruys PW, Barlis P. Biomechanical stress in coronary atherosclerosis: emerging insights from computational modelling. Eur Heart J 2018; 38:81-92. [PMID: 28158723 DOI: 10.1093/eurheartj/ehv689] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/07/2015] [Accepted: 11/27/2015] [Indexed: 01/13/2023] Open
Abstract
Coronary plaque rupture is the most common cause of vessel thrombosis and acute coronary syndrome. The accurate early detection of plaques prone to rupture may allow prospective, preventative treatment; however, current diagnostic methods remain inadequate to detect these lesions. Established imaging features indicating vulnerability do not confer adequate specificity for symptomatic rupture. Similarly, even though experimental and computational studies have underscored the importance of endothelial shear stress in progressive atherosclerosis, the ability of shear stress to predict plaque progression remains incremental. This review examines recent advances in image-based computational modelling that have elucidated possible mechanisms of plaque progression and rupture, and potentially novel features of plaques most prone to symptomatic rupture. With further study and clinical validation, these markers and techniques may improve the specificity of future culprit plaque detection.
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Affiliation(s)
- Vikas Thondapu
- Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria, Australia,Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria, Australia
| | - Christos V Bourantas
- University College London Hospitals, National Health Service Foundation Trust, London, UK
| | - Nicolas Foin
- National Heart Centre, Singapore, Singapore,Duke-National University Singapore Medical School, Singapore
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Peter Barlis
- Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria, Australia,Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria, Australia
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31
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Wu X, von Birgelen C, Muramatsu T, Li Y, Holm NR, Reiber JHC, Tu S. A novel four-dimensional angiographic approach to assess dynamic superficial wall stress of coronary arteries in vivo: initial experience in evaluating vessel sites with subsequent plaque rupture. EUROINTERVENTION 2018; 13:e1099-e1103. [PMID: 28262624 DOI: 10.4244/eij-d-16-01020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Repetitive, fluctuating stress is an important biomechanical mechanism that underlies the rupture of atherosclerotic plaques. We developed a novel coronary angiography-based method for in vivo four-dimensional analysis of dynamic superficial wall stress (SWS) in coronary plaques and applied it for the first time in two clinical cases. Our aim was to investigate the potential relationship between dynamic stress concentration at baseline and plaque rupture during acute coronary syndrome (ACS) several months later. METHODS AND RESULTS Three-dimensional angiographic reconstructions of the interrogated arteries were performed at several phases of the cardiac cycle, followed by finite element analysis to obtain the dynamic SWS data. The peak stress at baseline was found at the distal and proximal lesion longitudinal shoulders, being 121.8 kPa and 98.0 kPa, respectively. Intriguingly, in both cases, the sites with the highest SWS concentration at baseline co-registered with the location of plaque rupture during ACS, respectively six and 18 months after the baseline angiographic assessment. CONCLUSIONS A novel angiography-based analysis method for four-dimensional evaluation of dynamic SWS was feasible for investigating plaque biomechanical behaviour in vivo. Initial experience suggests that this technique could be useful in exploring mechanisms of future plaque rupture.
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Affiliation(s)
- Xinlei Wu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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32
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Superficial wall stress: the long awaited comprehensive biomechanical parameter to objectify and quantify our intuition. Int J Cardiovasc Imaging 2018; 34:863-865. [DOI: 10.1007/s10554-018-1386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
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33
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Wu X, von Birgelen C, Li Z, Zhang S, Huang J, Liang F, Li Y, Wijns W, Tu S. Assessment of superficial coronary vessel wall deformation and stress: validation of in silico models and human coronary arteries in vivo. Int J Cardiovasc Imaging 2018; 34:849-861. [PMID: 29397475 DOI: 10.1007/s10554-018-1311-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
Cyclic biomechanical stress at the lumen-intima interface plays a crucial role in the rupture of coronary plaque. We performed a comprehensive assessment of a novel angiography-based method for four-dimensional (4D) dynamic assessment of superficial wall stress (SWS) and deformation with a total of 32 analyses in virtual stenosis models with equal lumen dimensions and 16 analyses in human coronary arteries in vivo. The in silico model analyses demonstrated that the SWS, derived by the proposed global displacement method without knowledge of plaque components or blood pressure, was comparable with the result calculated by traditional finite element method. Cardiac contraction-induced vessel deformation increased SWS. Softer plaque and positive arterial remodeling, associated with a greater plaque burden, showed more variation in mean lumen diameter within the cardiac cycle and resulted in higher SWS. In vivo patient analyses confirmed the accuracy of computed superficial wall deformation. The centerlines predicted by our method at random selected time instant matched well with the actual one in angiograms by Procrustes analysis (scaling: 0.995 ± 0.018; dissimilarity: 0.007 ± 0.014). Over 50% of the maximum SWS occurred at proximal plaque shoulders. This novel 4D approach could be successfully to predict superficial wall deformation of coronary artery in vivo. The dynamic SWS might be more realistic to evaluate the risk of plaque rupture.
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Affiliation(s)
- Xinlei Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiayue Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yingguang Li
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland.,Saolta University Healthcare Group, Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China. .,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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34
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Nerlekar N, Ha FJ, Cheshire C, Rashid H, Cameron JD, Wong DT, Seneviratne S, Brown AJ. Computed Tomographic Coronary Angiography–Derived Plaque Characteristics Predict Major Adverse Cardiovascular Events. Circ Cardiovasc Imaging 2018; 11:e006973. [DOI: 10.1161/circimaging.117.006973] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/01/2017] [Indexed: 12/26/2022]
Abstract
Background—
Computed tomographic coronary angiography is a noninvasive imaging modality that permits identification and characterization of coronary plaques. Despite consensus statements supporting routine reporting of computed tomographic coronary angiography plaque characteristics, there remains uncertainty whether these data convey prognostic information. We performed a systematic review and meta-analysis assessing the strength of association between computed tomographic coronary angiography–derived plaque characterization and major adverse cardiovascular events (MACE).
Methods and Results—
Electronic databases were searched for studies reporting computed tomographic coronary angiography plaque characterization and MACE. Data were gathered on plaque morphology (noncalcified, partially calcified, and calcified) and high-risk plaque (HRP) features, including low-attenuation plaque, napkin-ring sign, spotty calcification, and positive remodeling. Of 5496 citations, 13 studies met inclusion criteria. Five hundred fifty-two (3.9%) MACE occurred in 13 977 patients with mean follow-up ranging between 1.3 and 8.2 years. In terms of plaque morphology, the strongest association was observed for noncalcified plaque (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.24–1.70;
P
<0.001), with weaker associations found for partially calcified (HR, 1.37; 95% CI, 1.18–1.60;
P
<0.001) and calcified plaques (HR, 1.23; 95% CI, 1.16–1.30;
P
<0.001). All HRP features were strongly associated with MACE, including napkin-ring sign (HR, 5.06; 95% CI, 3.23–7.94;
P
<0.001), low-attenuation plaque (HR, 2.95; 95% CI, 2.03–4.29;
P
<0.001), positive remodeling (HR, 2.58; 95% CI, 1.84–3.61;
P
<0.001), and spotty calcification (HR, 2.25; 95% CI, 1.26–4.04;
P
=0.006). The presence of ≥2 HRP features had highest risk of MACE (HR, 9.17; 95% CI, 4.10–20.50;
P
<0.001).
Conclusions—
These data demonstrate that HRP is most likely an independent predictor of MACE, which supports the inclusion of HRP reporting in clinical practice. However, at this point, it remains unclear whether HRP reporting has clinical implications.
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Affiliation(s)
- Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Francis J. Ha
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Caitlin Cheshire
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul Rashid
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D. Cameron
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Dennis T. Wong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Adam J. Brown
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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35
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Costopoulos C, Huang Y, Brown AJ, Calvert PA, Hoole SP, West NEJ, Gillard JH, Teng Z, Bennett MR. Plaque Rupture in Coronary Atherosclerosis Is Associated With Increased Plaque Structural Stress. JACC Cardiovasc Imaging 2017; 10:1472-1483. [PMID: 28734911 PMCID: PMC5725311 DOI: 10.1016/j.jcmg.2017.04.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to identify the determinants of plaque structural stress (PSS) and the relationship between PSS and plaques with rupture. BACKGROUND Plaque rupture is the most common cause of myocardial infarction, occurring particularly in higher risk lesions such as fibroatheromas. However, prospective intravascular ultrasound-virtual histology studies indicate that <10% higher risk plaques cause clinical events over 3 years, indicating that other factors also determine plaque rupture. Plaque rupture occurs when PSS exceeds its mechanical strength; however, the determinants of PSS and its association with plaques with proven rupture are not known. METHODS We analyzed plaque structure and composition in 4,053 virtual histology intravascular ultrasound frames from 32 fibroatheromas with rupture from the intravascular ultrasound-virtual histology in Vulnerable Atherosclerosis study and 32 fibroatheromas without rupture on optical coherence tomography from a stable angina cohort. Mechanical loading in the periluminal region was estimated by calculating maximum principal PSS by finite element analysis. RESULTS PSS increased with increasing lumen area (r = 0.46; p = 0.001), lumen eccentricity (r = 0.32; p = 0.001), and necrotic core ≥10% (r = 0.12; p = 0.001), but reduced when dense calcium was ≥10% (r = -0.12; p = 0.001). Ruptured fibroatheromas showed higher PSS (133 kPa [quartiles 1 to 3: 90 to 191 kPa] vs. 104 kPa [quartiles 1 to 3: 75 to 142 kPa]; p = 0.002) and variation in PSS (55 kPa [quartiles 1 to 3: 37 to 75 kPa] vs. 43 kPa [quartiles 1 to 3: 34 to 59 kPa]; p = 0.002) than nonruptured fibroatheromas, with rupture primarily occurring either proximal or immediately adjacent to the minimal luminal area (87.5% vs. 12.5%; p = 0.001). PSS was higher in segments proximal to the rupture site (143 kPa [quartiles 1 to 3: 101 to 200 kPa] vs. 120 kPa [quartiles 1 to 3: 78 to 180 kPa]; p = 0.001) versus distal segments, associated with increased necrotic core (19.1% [quartiles 1 to 3: 11% to 29%] vs. 14.3% [quartiles 1 to 3: 8% to 23%]; p = 0.001) but reduced fibrous/fibrofatty tissue (63.6% [quartiles 1 to 3: 46% to 78%] vs. 72.7% [quartiles 1 to 3: 54% to 86%]; p = 0.001). PSS >135 kPa was a good predictor of rupture in higher risk regions. CONCLUSIONS PSS is determined by plaque composition, plaque architecture, and lumen geometry. PSS and PSS variability are increased in plaques with rupture, particularly at proximal segments. Incorporating PSS into plaque assessment may improve identification of rupture-prone plaques.
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Affiliation(s)
- Charis Costopoulos
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Patrick A Calvert
- Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom
| | - Stephen P Hoole
- Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom
| | - Nick E J West
- Department of Interventional Cardiology, Papworth Hospital NHS Trust, United Kingdom
| | - Jonathan H Gillard
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom; Department of Engineering, University of Cambridge, Cambridge, United Kingdom.
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
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36
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Samady H, Molony DS. The Ongoing Quest to Predict Plaque Rupture. JACC Cardiovasc Imaging 2017; 10:1484-1486. [DOI: 10.1016/j.jcmg.2017.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 11/26/2022]
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37
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Wang L, Zhu J, Samady H, Monoly D, Zheng J, Guo X, Maehara A, Yang C, Ma G, Mintz GS, Tang D. Effects of Residual Stress, Axial Stretch, and Circumferential Shrinkage on Coronary Plaque Stress and Strain Calculations: A Modeling Study Using IVUS-Based Near-Idealized Geometries. J Biomech Eng 2017; 139:2580756. [PMID: 27814429 DOI: 10.1115/1.4034867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 11/08/2022]
Abstract
Accurate stress and strain calculations are important for plaque progression and vulnerability assessment. Models based on in vivo data often need to form geometries with zero-stress/strain conditions. The goal of this paper is to use IVUS-based near-idealized geometries and introduce a three-step model construction process to include residual stress, axial shrinkage, and circumferential shrinkage and investigate their impacts on stress and strain calculations. In Vivo intravascular ultrasound (IVUS) data of human coronary were acquired for model construction. In Vivo IVUS movie data were acquired and used to determine patient-specific material parameter values. A three-step modeling procedure was used to make our model: (a) wrap the zero-stress vessel sector to obtain the residual stress; (b) stretch the vessel axially to its length in vivo; and (c) pressurize the vessel to recover its in vivo geometry. Eight models were constructed for our investigation. Wrapping led to reduced lumen and cap stress and increased out boundary stress. The model with axial stretch, circumferential shrink, but no wrapping overestimated lumen and cap stress by 182% and 448%, respectively. The model with wrapping, circumferential shrink, but no axial stretch predicted average lumen stress and cap stress as 0.76 kPa and -15 kPa. The same model with 10% axial stretch had 42.53 kPa lumen stress and 29.0 kPa cap stress, respectively. Skipping circumferential shrinkage leads to overexpansion of the vessel and incorrect stress/strain calculations. Vessel stiffness increase (100%) leads to 75% lumen stress increase and 102% cap stress increase.
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Affiliation(s)
- Liang Wang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307
| | - David Monoly
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110
| | - Xiaoya Guo
- Department of Mathematics, Southeast University, Nanjing 210096, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10022
| | - Chun Yang
- Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing 100140, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10022
| | - Dalin Tang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609;Department of Mathematics, Southeast University, Nanjing 210096, China
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38
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Stone PH, Maehara A, Coskun AU, Maynard CC, Zaromytidou M, Siasos G, Andreou I, Fotiadis D, Stefanou K, Papafaklis M, Michalis L, Lansky AJ, Mintz GS, Serruys PW, Feldman CL, Stone GW. Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study. JACC Cardiovasc Imaging 2017; 11:462-471. [PMID: 28917684 DOI: 10.1016/j.jcmg.2017.01.031] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe. BACKGROUND Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients. METHODS In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined. RESULTS A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (<1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p < 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mm2, or TCFA), high anatomic risk, and low ESS were prognostically synergistic: 3-year nc-MACE rates were 52.1% versus 14.4% versus 0.0% in high-anatomic risk/low-ESS, low-anatomic risk/low-ESS, and physiological/high-ESS lesions, respectively (p < 0.0001). No lesion without low ESS led to nc-MACE during follow-up, regardless of PB, MLA, or lesion phenotype at baseline. CONCLUSIONS Local low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology.
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Affiliation(s)
- Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts.
| | - Akiko Maehara
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York
| | - Ahmet Umit Coskun
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
| | - Charles C Maynard
- Department of Health Services, University of Washington, Seattle, Washington
| | - Marina Zaromytidou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
| | - Gerasimos Siasos
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
| | - Dimitris Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Kostas Stefanou
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Michail Papafaklis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Alexandra J Lansky
- Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Gary S Mintz
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York
| | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, United Kingdom
| | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts
| | - Gregg W Stone
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York, New York
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39
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Akyildiz AC, Chai CK, Oomens CWJ, van der Lugt A, Baaijens FPT, Strijkers GJ, Gijsen FJH. 3D Fiber Orientation in Atherosclerotic Carotid Plaques. J Struct Biol 2017; 200:28-35. [PMID: 28838817 DOI: 10.1016/j.jsb.2017.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/18/2017] [Accepted: 08/20/2017] [Indexed: 11/26/2022]
Abstract
Atherosclerotic plaque rupture is the primary trigger of fatal cardiovascular events. Fibrillar collagen in atherosclerotic plaques and their directionality are anticipated to play a crucial role in plaque rupture. This study aimed assessing 3D fiber orientations and architecture in atherosclerotic plaques for the first time. Seven carotid plaques were imaged ex-vivo with a state-of-the-art Diffusion Tensor Imaging (DTI) technique, using a high magnetic field (9.4Tesla) MRI scanner. A 3D spin-echo sequence with uni-polar diffusion sensitizing pulsed field gradients was utilized for DTI and fiber directions were assessed from diffusion tensor measurements. The distribution of the 3D fiber orientations in atherosclerotic plaques were quantified and the principal fiber orientations (circumferential, longitudinal or radial) were determined. Overall, 52% of the fiber orientations in the carotid plaque specimens were closest to the circumferential direction, 34% to the longitudinal direction, and 14% to the radial direction. Statistically no significant difference was measured in the amount of the fiber orientations between the concentric and eccentric plaque sites. However, concentric plaque sites showed a distinct structural organization, where the principally longitudinally oriented fibers were closer to the luminal side and the principally circumferentially oriented fibers were located more abluminally. The acquired unique information on 3D plaque fiber direction will help understanding pathobiological mechanisms of atherosclerotic plaque progression and pave the road to more realistic biomechanical plaque modeling for rupture assessment.
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Affiliation(s)
- Ali C Akyildiz
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Chen-Ket Chai
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Cees W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank P T Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands
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40
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Asymmetric Longitudinal Lesion Geometry. JACC Cardiovasc Imaging 2017; 10:689-691. [DOI: 10.1016/j.jcmg.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 11/22/2022]
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41
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Brown AJ, Teng Z, Calvert PA, Rajani NK, Hennessy O, Nerlekar N, Obaid DR, Costopoulos C, Huang Y, Hoole SP, Goddard M, West NEJ, Gillard JH, Bennett MR. Plaque Structural Stress Estimations Improve Prediction of Future Major Adverse Cardiovascular Events After Intracoronary Imaging. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004172. [PMID: 27307548 DOI: 10.1161/circimaging.115.004172] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although plaque rupture is responsible for most myocardial infarctions, few high-risk plaques identified by intracoronary imaging actually result in future major adverse cardiovascular events (MACE). Nonimaging markers of individual plaque behavior are therefore required. Rupture occurs when plaque structural stress (PSS) exceeds material strength. We therefore assessed whether PSS could predict future MACE in high-risk nonculprit lesions identified on virtual-histology intravascular ultrasound. METHODS AND RESULTS Baseline nonculprit lesion features associated with MACE during long-term follow-up (median: 1115 days) were determined in 170 patients undergoing 3-vessel virtual-histology intravascular ultrasound. MACE was associated with plaque burden ≥70% (hazard ratio: 8.6; 95% confidence interval, 2.5-30.6; P<0.001) and minimal luminal area ≤4 mm(2) (hazard ratio: 6.6; 95% confidence interval, 2.1-20.1; P=0.036), although absolute event rates for high-risk lesions remained <10%. PSS derived from virtual-histology intravascular ultrasound was subsequently estimated in nonculprit lesions responsible for MACE (n=22) versus matched control lesions (n=22). PSS showed marked heterogeneity across and between similar lesions but was significantly increased in MACE lesions at high-risk regions, including plaque burden ≥70% (13.9±11.5 versus 10.2±4.7; P<0.001) and thin-cap fibroatheroma (14.0±8.9 versus 11.6±4.5; P=0.02). Furthermore, PSS improved the ability of virtual-histology intravascular ultrasound to predict MACE in plaques with plaque burden ≥70% (adjusted log-rank, P=0.003) and minimal luminal area ≤4 mm(2) (P=0.002). Plaques responsible for MACE had larger superficial calcium inclusions, which acted to increase PSS (P<0.05). CONCLUSIONS Baseline PSS is increased in plaques responsible for MACE and improves the ability of intracoronary imaging to predict events. Biomechanical modeling may complement plaque imaging for risk stratification of coronary nonculprit lesions.
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Affiliation(s)
- Adam J Brown
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Zhongzhao Teng
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Patrick A Calvert
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Nikil K Rajani
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Orla Hennessy
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Nitesh Nerlekar
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Daniel R Obaid
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Charis Costopoulos
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Yuan Huang
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Stephen P Hoole
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Martin Goddard
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Nick E J West
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Jonathan H Gillard
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom
| | - Martin R Bennett
- From the Division of Cardiovascular Medicine (A.J.B., P.A.C., N.K.R., O.H., D.R.O., C.C., M.R.B.), Department of Radiology (Z.T., Y.H., J.H.G.), and Department of Engineering (Z.T.), University of Cambridge, United Kingdom; MonashHEART, Monash Medical Centre, Clayton, Australia (N.N.); and Department of Interventional Cardiology (P.A.C., S.P.H., N.E.J.W.) and Department of Pathology (M.G.), Papworth Hospital NHS Trust, United Kingdom.
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Douglas GR, Brown AJ, Gillard JH, Bennett MR, Sutcliffe MPF, Teng Z. Impact of Fiber Structure on the Material Stability and Rupture Mechanisms of Coronary Atherosclerotic Plaques. Ann Biomed Eng 2017; 45:1462-1474. [PMID: 28361184 PMCID: PMC5415591 DOI: 10.1007/s10439-017-1827-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/22/2017] [Indexed: 12/19/2022]
Abstract
The rupture of an atherosclerotic plaque in the coronary circulation remains the main cause of heart attack. As a fiber-oriented structure, the fiber structure, in particular in the fibrous cap (FC), may affect both loading and material strength in the plaque. However, the role of fiber orientation and dispersion in plaque rupture is unclear. Local orientation and dispersion of fibers were calculated for the shoulder regions, mid FC, and regions with intimal thickening (IT) from histological images of 16 human coronary atherosclerotic lesions. Finite element analysis was performed to assess the effect of these properties on mechanical conditions. Fibers in shoulder regions had markedly reduced alignment (Median [interquartile range] 12.9° [6.6, 18.0], p < 0.05) compared with those in mid FC (6.1° [5.5, 9.0]) and IT regions (6.7° [5.1, 8.6]). Fiber dispersion was highest in shoulders (0.150 [0.121, 0.192]), intermediate in IT (0.119 [0.103, 0.144]), and lowest in mid FC regions (0.093 [0.081, 0.105], p < 0.05). When anisotropic properties were considered, stresses were significantly higher for the mid FC (p = 0.030) and IT regions (p = 0.002) and no difference was found for the shoulder or global regions. Shear (sliding) stress between fibers in each region and their proportion of maximum principal stress were: shoulder (25.8 kPa [17.1, 41.2], 12.4%), mid FC (13.9 kPa [5.8, 29.6], 13.8%), and IT (36.5 kPa [25.9, 47.3], 15.5%). Fiber structure within the FC has a marked effect on principal stresses, resulting in considerable shear stress between fibers. Fiber structure including orientation and dispersion may determine mechanical strength and thus rupture of atherosclerotic plaques.
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Affiliation(s)
- Graeham R Douglas
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan H Gillard
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Michael P F Sutcliffe
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK.
| | - Zhongzhao Teng
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK. .,Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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43
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Stefanadis C, Antoniou CK, Tsiachris D, Pietri P. Coronary Atherosclerotic Vulnerable Plaque: Current Perspectives. J Am Heart Assoc 2017; 6:JAHA.117.005543. [PMID: 28314799 PMCID: PMC5524044 DOI: 10.1161/jaha.117.005543] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Dimitrios Tsiachris
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
| | - Panagiota Pietri
- National and Kapodistrian University of Athens and Athens Heart Center, Athens, Greece
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44
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Nicoll R, Henein M. Arterial calcification: A new perspective? Int J Cardiol 2017; 228:11-22. [DOI: 10.1016/j.ijcard.2016.11.099] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
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45
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Shang S, Chen Z, Zhao Y, Yang S, Xing D. Simultaneous imaging of atherosclerotic plaque composition and structure with dual-mode photoacoustic and optical coherence tomography. OPTICS EXPRESS 2017; 25:530-539. [PMID: 28157944 DOI: 10.1364/oe.25.000530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The composition of plaque is a major determinant of coronary-related clinical syndromes. By combining photoacoustic tomography (PAT) and optical coherence tomography (OCT), the optical absorption and scattering properties of vascular plaque can be revealed and subsequently used to distinguish the plaque composition and structure. The feasibility and capacity of the dual-mode PAT-OCT technique for resolving vascular plaque was first testified by plaque composition mimicking experiment. PAT obtained lipid information due to optical absorption differences, while owing to scattering differences, OCT achieved imaging of collagen. Furthermore, by combining PAT and OCT, the morphological characteristic and scattering difference of normal and lipid-rich plaque in the ex vivo rabbit aorta was distinguished simultaneously. The experiments demonstrated that the combined PAT and OCT technique is a potential feasible method for detecting the composition and structure of lipid core and fibrous cap in atherosclerosis.
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46
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Eshtehardi P, Brown AJ, Bhargava A, Costopoulos C, Hung OY, Corban MT, Hosseini H, Gogas BD, Giddens DP, Samady H. High wall shear stress and high-risk plaque: an emerging concept. Int J Cardiovasc Imaging 2017; 33:1089-1099. [PMID: 28074425 DOI: 10.1007/s10554-016-1055-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
Abstract
In recent years, there has been a significant effort to identify high-risk plaques in vivo prior to acute events. While number of imaging modalities have been developed to identify morphologic characteristics of high-risk plaques, prospective natural-history observational studies suggest that vulnerability is not solely dependent on plaque morphology and likely involves additional contributing mechanisms. High wall shear stress (WSS) has recently been proposed as one possible causative factor, promoting the development of high-risk plaques. High WSS has been shown to induce specific changes in endothelial cell behavior, exacerbating inflammation and stimulating progression of the atherosclerotic lipid core. In line with experimental and autopsy studies, several human studies have shown associations between high WSS and known morphological features of high-risk plaques. However, despite increasing evidence, there is still no longitudinal data linking high WSS to clinical events. As the interplay between atherosclerotic plaque, artery, and WSS is highly dynamic, large natural history studies of atherosclerosis that include WSS measurements are now warranted. This review will summarize the available clinical evidence on high WSS as a possible etiological mechanism underlying high-risk plaque development.
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Affiliation(s)
- Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Ankit Bhargava
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Charis Costopoulos
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Olivia Y Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Michel T Corban
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Hossein Hosseini
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Bill D Gogas
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA
| | - Don P Giddens
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
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Kang SJ, Ha H, Lee JG, Han SB, Mintz GS, Kweon J, Chang M, Roh JH, Lee PH, Yoon SH, Ahn JM, Park DW, Lee SW, Lee CW, Park SW, Park SJ, Kim YH. Plaque structural stress assessed by virtual histology-intravascular ultrasound predicts dynamic changes in phenotype and composition of untreated coronary artery lesions. Atherosclerosis 2016; 254:85-92. [DOI: 10.1016/j.atherosclerosis.2016.09.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/20/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
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48
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Lee JM, Choi G, Hwang D, Park J, Kim HJ, Doh JH, Nam CW, Na SH, Shin ES, Taylor CA, Koo BK. Impact of Longitudinal Lesion Geometry on Location of Plaque Rupture and Clinical Presentations. JACC Cardiovasc Imaging 2016; 10:677-688. [PMID: 27665158 DOI: 10.1016/j.jcmg.2016.04.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/16/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to investigate the impact of longitudinal lesion geometry on the location of plaque rupture and clinical presentation and its mechanism. BACKGROUND The relationships among lesion geometry, external hemodynamic forces acting on the plaque, location of plaque rupture, and clinical presentation have not been comprehensively investigated. METHODS This study enrolled 125 patients with plaque rupture documented by intravascular ultrasound. Longitudinal locations of plaque rupture were identified and categorized by intravascular ultrasound. Patients' clinical presentations and TIMI (Thrombolysis In Myocardial Infarction) flow grade in an initial angiogram were compared according to the location of plaque rupture. Longitudinal lesion asymmetry was quantitatively assessed by the luminal radius change over the segment length (radius gradient [RG]). Lesions with a steeper radius change in the upstream segment compared with the downstream segment (RGupstream > RGdownstream) were defined as upstream-dominant lesions. RESULTS On the basis of the site of maximum rupture aperture, 56.0%, 16.0%, and 28.0% of the patients had upstream, minimal lumen area, and downstream rupture, respectively. Patients with upstream rupture more frequently presented with ST-segment elevation myocardial infarction (45.7%, 40.0%, 22.9%; p = 0.030) and with TIMI flow grade <3 (32.9%, 20.0%, 17.1%; p = 0.042). According to the ratio of upstream and downstream RG, 69.5% of lesions were classified as upstream-dominant lesions, and 30.5% were classified as downstream-dominant lesions. Among the 66 upstream-dominant lesions, 65 cases (98.5%) had upstream rupture, and the RG ratio (RGupstream/RGdownstream) was an independent predictor of upstream rupture (odds ratio: 1.481; 95% confidence interval: 1.035 to 2.120; p = 0.032). Upstream-dominant lesions more frequently manifested with ST-segment elevation myocardial infarction than did downstream-dominant lesions (48.5% vs. 24.1%; p = 0.026). CONCLUSIONS Both clinical presentation and degree of flow limitation were associated with the location of plaque rupture. Longitudinal lesion asymmetry assessed by RG, which can affect regional distribution of hemodynamic stress, was associated with the location of rupture and with clinical presentation.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gilwoo Choi
- HeartFlow, Inc., Redwood City, California; Department of Surgery, Stanford University Medical Center, Stanford, California
| | - Doyeon Hwang
- Department of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonghanne Park
- Department of Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Sang-Hoon Na
- Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, South Korea; Institute of Aging, Seoul National University, Seoul, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
| | - Charles A Taylor
- HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California
| | - Bon-Kwon Koo
- Department of Medicine, Seoul National University Hospital, Seoul, South Korea; Institute of Aging, Seoul National University, Seoul, South Korea.
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Abstract
Advances in atherosclerosis imaging technology and research have provided a range of diagnostic tools to characterize high-risk plaque in vivo; however, these important vascular imaging methods additionally promise great scientific and translational applications beyond this quest. When combined with conventional anatomic- and hemodynamic-based assessments of disease severity, cross-sectional multimodal imaging incorporating molecular probes and other novel noninvasive techniques can add detailed interrogation of plaque composition, activity, and overall disease burden. In the catheterization laboratory, intravascular imaging provides unparalleled access to the world beneath the plaque surface, allowing tissue characterization and measurement of cap thickness with micrometer spatial resolution. Atherosclerosis imaging captures key data that reveal snapshots into underlying biology, which can test our understanding of fundamental research questions and shape our approach toward patient management. Imaging can also be used to quantify response to therapeutic interventions and ultimately help predict cardiovascular risk. Although there are undeniable barriers to clinical translation, many of these hold-ups might soon be surpassed by rapidly evolving innovations to improve image acquisition, coregistration, motion correction, and reduce radiation exposure. This article provides a comprehensive review of current and experimental atherosclerosis imaging methods and their uses in research and potential for translation to the clinic.
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Affiliation(s)
- Jason M Tarkin
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Marc R Dweck
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Nicholas R Evans
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Richard A P Takx
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Adam J Brown
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Ahmed Tawakol
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - James H F Rudd
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.).
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Jiang Y, Peng W, Teng Z, Gillard JH, Hong B, Liu Q, Lu J. Local blood pressure associates with the degree of luminal stenosis in patients with atherosclerotic disease in the middle cerebral artery. Biomed Eng Online 2016; 15:67. [PMID: 27349223 PMCID: PMC4924238 DOI: 10.1186/s12938-016-0202-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
The mechanism underlying atherosclerotic ischemic events within the middle cerebral artery (MCA) is unclear. High structural stress induced by blood pressure might be a potential aetiology as plaque rupture occurs when such mechanical loading exceeds its material strength. To perform reliable analyses quantifying the mechanical loading within a plaque, the local blood pressure is needed. However, data on MCA blood pressure is currently lacking. In this study, the arterial pressure proximal to the stenotic site in the MCA was measured in 15 patients scheduled for intervention. The relationships between these local measurements and pre-intervention and intra-intervention non-invasive arm measurements were assessed. The impact of luminal stenosis on the local blood pressure was quantified. Compared with the pre-intervention arm measurement, the intra-intervention arm pressure decreased significantly by 23.9 ± 11.8 and 9.3 ± 14.7 % at diastole and systole, respectively. The pressure proximal to the stenosis was much lower than the pre-intervention arm measurement (diastole: 65.3 ± 15.7 vs 82.0 ± 9.7, p < 0.01; systole: 81.1 ± 15.9 vs 133.9 ± 18.7, p < 0.01; unit: mmHg). The systolic pressure in the MCA in patients with stenosis <70 % (n = 6) was significantly higher than the value in patients with stenosis ≥70 % (n = 9) (92.0 ± 7.3 vs 73.9 ± 16.1, p = 0.02; unit: mmHg), as was pulse pressure (22.8 ± 6.4 vs 11.1 ± 8.3, p = 0.01; unit: mmHg). However, diastolic pressure remained unaffected (69.2 ± 9.3 vs 62.8 ± 19.0, p = 0.58; unit: mmHg). In conclusion, the obtained results are helpful in understanding the local hemodynamic environment modulated by the presence of atherosclerosis. The local pressure measurements can be used for computational analysis to quantify the critical mechanical condition within an MCA lesion.
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Affiliation(s)
- Yuanliang Jiang
- Department of Radiology, Changhai Hospital, Shanghai, 200433, China
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital, Shanghai, 200433, China.,Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK. .,Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Jonathan H Gillard
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, 200433, China.
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