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Ueda Y. Slow-Flow Phenomenon Caused by Distal Embolization Should Be Predicted and Prevented to Maximize the Efficacy of Coronary Intervention. Circ J 2024; 88:980-981. [PMID: 37866909 DOI: 10.1253/circj.cj-23-0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
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2
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Ozaki Y, Kitabata H, Takahata M, Katayama Y, Wada T, Hikida R, Taruya A, Shiono Y, Kuroi A, Yamano T, Tanimoto T, Tanaka A. Intracoronary Near-Infrared Spectroscopy to Predict No-Reflow Phenomenon During Percutaneous Coronary Intervention in Acute Coronary Syndrome. Am J Cardiol 2024; 219:17-24. [PMID: 38490338 DOI: 10.1016/j.amjcard.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) can identify the lipid-rich lesions, described as high lipid-core burden index (LCBI). The aim of this study was to investigate the relation between lipid-core plaque (LCP) in the infarct-related lesion detected using NIRS-IVUS and no-reflow phenomenon during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). We investigated 371 patients with ACS who underwent NIRS-IVUS in the infarct-related lesions before PCI. The extent of LCP in the infarct-related lesion was calculated as the maximum LCBI for each of the 4-mm longitudinal segments (maxLCBI4mm) measured by NIRS-IVUS. The patients were divided into 2 groups using a maxLCBI4mm cut-off value of 400. The overall incidence of no-reflow phenomenon was 53 of 371 (14.3%). No-reflow phenomenon more frequently occurred in patients with maxLCBI4mm ≥400 compared with those with maxLCBI4mm<400 (17.5% vs 2.5%, p <0.001). After propensity score matching, multivariable logistic regression analysis demonstrated that maxLCBI4mm (odds ratio: 1.008; 95% confidence interval: 1.005 to 1.012, p <0.001) was independently associated with the no-reflow phenomenon. The maxLCBI4mm of 719 in the infarct-related lesion had the highest combined sensitivity (69.8%) and specificity (72.1%) for the identification of no-reflow phenomenon. In conclusion, in patients with ACS, maxLCBI4mm in the infarct-related lesion assessed by NIRS-IVUS was independently associated with the no-reflow phenomenon during PCI.
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Affiliation(s)
- Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yosuke Katayama
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryo Hikida
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Los J, Mensink FB, Mohammadnia N, Opstal TSJ, Damman P, Volleberg RHJA, Peeters DAM, van Royen N, Garcia-Garcia HM, Cornel JH, El Messaoudi S, van Geuns RJM. Invasive coronary imaging of inflammation to further characterize high-risk lesions: what options do we have? Front Cardiovasc Med 2024; 11:1352025. [PMID: 38370159 PMCID: PMC10871865 DOI: 10.3389/fcvm.2024.1352025] [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: 12/07/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Coronary atherosclerosis remains a leading cause of morbidity and mortality worldwide. The underlying pathophysiology includes a complex interplay of endothelial dysfunction, lipid accumulation and inflammatory pathways. Multiple structural and inflammatory features of the atherosclerotic lesions have become targets to identify high-risk lesions. Various intracoronary imaging devices have been developed to assess the morphological, biocompositional and molecular profile of the intracoronary atheromata. These techniques guide interventional and therapeutical management and allow the identification and stratification of atherosclerotic lesions. We sought to provide an overview of the inflammatory pathobiology of atherosclerosis, distinct high-risk plaque features and the ability to visualize this process with contemporary intracoronary imaging techniques.
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Affiliation(s)
- Jonathan Los
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frans B. Mensink
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Tjerk S. J. Opstal
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Denise A. M. Peeters
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jan H. Cornel
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
- Dutch Network for Cardiovascular Research (WCN), Utrecht, Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
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Nakagawa I, Kotsugi M, Yokoyama S, Maeoka R, Furuta T, Tanaka H, Takeshima Y, Matsuda R, Yamada S, Nakase H. Dual-layered stents reduce cerebral embolism compared with first-generation stents during carotid stenting of high lipid core plaque lesions. J Neurointerv Surg 2023; 16:67-72. [PMID: 36944492 DOI: 10.1136/jnis-2023-020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Periprocedural lipid core plaque (LCP) has been detected in carotid arteries assessed by catheter-based near-infrared spectroscopy (NIRS). High LCP is associated with cerebral embolism after carotid artery stenting (CAS) using a first-generation stent. We aimed to evaluate whether dual-layered stents reduce embolic infarcts in patients with high LCP and change of lipid signal as assessed by NIRS during CAS. METHODS Participants comprised 210 consecutive patients undergoing CAS. The study was divided into two distinct periods, with first-generation closed-cell stents used in the earlier period and dual-layered stents used in the later period. NIRS was performed at baseline, after stent implantation, and after balloon post-dilatation to analyze maximal lipid core burden index at minimal luminal area (max-LCBIMLA). RESULTS The ipsilateral cerebral embolism rate was significantly lower with dual-layered stents (9%) than with first-generation stents (33%, p<0.001), particularly with highly lipidic lesions (12% vs 60%, p<0.001). On multivariate logistic regression analysis, high LCP and first-generation stent usage were factors related to ipsilateral cerebral embolism (both p<0.001; OR 8.28 (95% CI 3.49 to 19.64) and OR 8.07 (95% CI 2.33 to 27.93), respectively). Max-LCBIMLA decreased significantly after stenting in both groups (both p<0.01) and max-LCBIMLA after balloon post-dilatation was significantly lower with dual-layered stents (22.4±65.6) than with first-generation stents (124.2±208.2; p=0.006). CONCLUSIONS Dual-layered stents reduce embolic infarcts in patients with highly lipidic plaque lesions as assessed by NIRS who undergo CAS. Dual-layered stents significantly reduced NIRS-derived lipid signals after stenting.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ryosuke Maeoka
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Haku Tanaka
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Irie D, Matsumoto H, Isodono K, Higuchi S, Tanisawa H, Ohya H, Kitamura R, Shinke T. Complementary Roles of Near-Infrared Spectroscopy and Intravascular Ultrasound in the Prediction of Periprocedural Myocardial Injury. Can J Cardiol 2023; 39:1502-1509. [PMID: 37321347 DOI: 10.1016/j.cjca.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Lipid-rich plaque detected by near-infrared spectroscopy (NIRS) and attenuated plaque detected by intravascular ultrasound (IVUS) predict periprocedural myocardial injury (MI) following percutaneous coronary intervention (PCI). Although echolucent plaque detected by IVUS was reported to be associated with a no-reflow phenomenon in acute myocardial infarction, it remains unclear whether echolucent plaque is predictive of periprocedural MI following elective PCI. We aimed to elucidate whether echolucent plaque is independently associated with periprocedural MI after elective PCI and whether the predictive ability for periprocedural MI is improved by the combination of NIRS and IVUS. METHODS This retrospective study included 121 lesions of 121 patients who underwent elective NIRS-IVUS-guided stent implantation. Periprocedural MI was defined as post-PCI cardiac troponin T > 70 ng/L. A maximum 4-mm lipid core burden index > 457 was regarded as lipid-rich plaque. Echolucent plaque was defined as the presence on IVUS of an echolucent zone and attenuated plaque as an attenuation arc > 90°. RESULTS Periprocedural MI occurred in 39 lesions. In multivariable analysis, echolucent plaque, attenuated plaque, and lipid-rich plaque were independent predictors of periprocedural MI. Adding echolucent plaque and attenuated plaque to lipid-rich plaque improved the predictive performance (C statistic 0.825 vs 0.688; P = 0.001). Periprocedural MI increased with the number of predictors: 3% [1/39], 29% [10/34], 47% [14/30], and 78% [14/18] for 0, 1, 2, and 3 predictors, respectively (P < 0.001). CONCLUSIONS Echolucent plaque is a major predictor of periprocedural MI, independently from lipid-rich plaque and attenuated plaque. Compared with NIRS alone, the combination of NIRS with IVUS signatures improves the predictive ability.
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Affiliation(s)
- Daisuke Irie
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
| | - Koji Isodono
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Satoshi Higuchi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroki Tanisawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidefumi Ohya
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Ryoji Kitamura
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
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6
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Hosoda H, Kataoka Y, Nicholls SJ, Puri R, Murai K, Kitahara S, Mitsui K, Sugane H, Sawada K, Iwai T, Matama H, Honda S, Takagi K, Fujino M, Yoneda S, Otsuka F, Takamisawa I, Nishihira K, Asaumi Y, Kawai K, Noguchi T. Calcified plaque harboring lipidic materials associates with no-reflow phenomenon after PCI in stable CAD. Int J Cardiovasc Imaging 2023; 39:1927-1941. [PMID: 37378706 PMCID: PMC10589149 DOI: 10.1007/s10554-023-02905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
Calcified atheroma has been viewed conventionally as stable lesion which less likely increases no-reflow phenomenon. Given that lipidic materials triggers the formation of calcification, lipidic materials could exist within calcified lesion, which may cause no-reflow phenomenon after PCI. The REASSURE-NIRS registry (NCT04864171) employed near-infrared spectroscopy and intravascular ultrasound imaging to evaluate maximum 4-mm lipid-core burden index (maxLCBI4mm) at target lesions containing small (maximum calcification arc < 180°: n = 272) and large calcification (maximum calcification arc ≥ 180°: n = 189) in stable CAD patients. The associations of maxLCBI4mm with corrected TIMI frame count (CTFC) and no-reflow phenomenon after PCI were analyzed in patients with target lesions containing small and large calcification, respectively. No-reflow phenomenon occurred in 8.0% of study population. Receiver-operating characteristics curve analyses revealed that optimal cut-off values of maxLCBI4mm for predicting no-reflow phenomenon were 585 at small calcification (AUC = 0.72, p < 0.001) and 679 at large calcification (AUC = 0.76, p = 0.001). Target lesions containing small calcification with maxLCBI4mm ≥ 585 more likely exhibited a greater CTFC (p < 0.001). In those with large calcification, 55.6% of them had maxLCBI4mm ≥ 400 [vs. 56.2% (small calcification), p = 0.82]. Furthermore, a higher CTFC (p < 0.001) was observed in association with maxLCBI4mm ≥ 679 at large calcification. On multivariable analysis, maxLCBI4mm at large calcification still independently predicted no-reflow phenomenon (OR = 1.60, 95%CI = 1.32-1.94, p < 0.001). MaxLCBI4mm at target lesions exhibiting large calcification elevated a risk of no-reflow phenomenon after PCI. Calcified plaque containing lipidic materials is not necessarily stable lesion, but could be active and high-risk one causing no-reflow phenomenon.
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Affiliation(s)
- Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital, Kochi, India
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | | | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Satoshi Kitahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kentaro Mitsui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroki Sugane
- Department of Cardiovascular Medicine, Chikamori Hospital, Kochi, India
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Itaru Takamisawa
- Department of Cardiovascular Medicine, Sakakibara Heart Institute, Fuchyu, Tokyo, Japan
| | - Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kazuya Kawai
- Department of Cardiovascular Medicine, Chikamori Hospital, Kochi, India
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Kanaji Y, Hoshino M, Hada M, Ozcan I, Sugiyama T, Matsuda K, Sayama K, Nogami K, Nagamine T, Teng Y, Misawa T, Araki M, Usui E, Murai T, Yonetsu T, Sasano T, Kakuta T. Prognostic implications of unrecognized myocardial infarction and periprocedural myocardial injury on cardiac magnetic resonance imaging in patients with chronic coronary syndrome. Sci Rep 2023; 13:13567. [PMID: 37604987 PMCID: PMC10442331 DOI: 10.1038/s41598-023-40883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
This study sought to evaluate the prognostic implications of the presence of preprocedural unrecognized myocardial infarction (UMI) and periprocedural myocardial injury (PMI) evaluated by delayed gadolinium enhancement cardiac magnetic resonance (DE-CMR) in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI). We enrolled 250 CCS patients scheduled for elective PCI. UMI was defined as the presence of late gadolinium enhancement (LGE) detected by pre-PCI CMR in the region without medical history of revascularization and/or MI. Periprocedural new occurrence or increased volume of LGE in the target territory detected by post-PCI CMR (PPL) were used to assess PMI. In the final analysis of 235 patients, UMI and PPL were detected in 43 patients (18.3%) and 45 patients (19.1%), respectively. During follow-up for a median of 2.2 years, major adverse cardiac events (MACE) occurred in 31 (13.2%) patients. On multivariable analysis, UMI and PPL remained as significant predictors of MACE after adjusting confounding factors (HR 4.62, 95% CI 2.24-9.54, P < 0.001, HR 2.33, 95% CI 1.11-4.91, P = 0.026). In patients with CCS who underwent elective PCI, UMI and PPL were independent predictors of worse outcomes. UMI and PPL on DE-CMR might provide additional potential insight for the risk stratification of patients undergoing elective PCI.
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Affiliation(s)
- Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kazuki Matsuda
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kodai Sayama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yun Teng
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
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8
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Nardin M, Verdoia M, Laera N, Cao D, De Luca G. New Insights into Pathophysiology and New Risk Factors for ACS. J Clin Med 2023; 12:jcm12082883. [PMID: 37109221 PMCID: PMC10146393 DOI: 10.3390/jcm12082883] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiovascular disease still represents the main cause of mortality worldwide. Despite huge improvements, atherosclerosis persists as the principal pathological condition, both in stable and acute presentation. Specifically, acute coronary syndromes have received substantial research and clinical attention in recent years, contributing to improve overall patients' outcome. The identification of different evolution patterns of the atherosclerotic plaque and coronary artery disease has suggested the potential need of different treatment approaches, according to the mechanisms and molecular elements involved. In addition to traditional risk factors, the finer portrayal of other metabolic and lipid-related mediators has led to higher and deep knowledge of atherosclerosis, providing potential new targets for clinical management of the patients. Finally, the impressive advances in genetics and non-coding RNAs have opened a wide field of research both on pathophysiology and the therapeutic side that are extensively under investigation.
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Affiliation(s)
- Matteo Nardin
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- Third Medicine Division, Department of Medicine, ASST Spedali Civili, 25123 Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, 13900 Biella, Italy
- Department of Translational Medicine, Eastern Piedmont University, 13100 Novara, Italy
| | - Nicola Laera
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
| | - Giuseppe De Luca
- Division of Cardiology, AOU "Policlinico G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98166 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
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9
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Golovynskyi S, Golovynska I, Roganova O, Golovynskyi A, Qu J, Ohulchanskyy TY. Hyperspectral imaging of lipids in biological tissues using near-infrared and shortwave infrared transmission mode: A pilot study. JOURNAL OF BIOPHOTONICS 2023:e202300018. [PMID: 37021842 DOI: 10.1002/jbio.202300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Label-free hyperspectral imaging (HSI) of lipids was demonstrated in the near-infrared (NIR) and shortwave infrared (SWIR) regions (950-1800 nm) using porcine tissue. HSI was performed in the transmission light-pass configuration, using a NIR-SWIR camera coupled with a liquid crystal tunable filter. The transmittance spectra of the regions of interest (ROIs), which correspond to the lipid and muscle areas in the specimen, were utilized for the spectrum unmixing. The transmittance spectra in ROIs were compared with those recorded by a spectrophotometer using samples of adipose and muscle. The lipid optical absorption bands at 1210 and 1730 nm were first used for the unmixing and mapping. Then, we performed the continuous multiband unmixing over the entire available spectral range, thereby, considering a combination of characteristic absorption bands of lipids, proteins, and water. The enhanced protocol demonstrates the ability to visualize small adipose inclusions of 1-10 μm size.
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Affiliation(s)
- Sergii Golovynskyi
- Shenzhen Key Laboratory of Photonics and Biophotonics, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, People's Republic of China
| | - Iuliia Golovynska
- Shenzhen Key Laboratory of Photonics and Biophotonics, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, People's Republic of China
| | - Olena Roganova
- V.M. Glushkov Institute of Cybernetics, National Academy of Sciences, Kyiv, Ukraine
| | - Andrii Golovynskyi
- V.M. Glushkov Institute of Cybernetics, National Academy of Sciences, Kyiv, Ukraine
| | - Junle Qu
- Shenzhen Key Laboratory of Photonics and Biophotonics, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, People's Republic of China
| | - Tymish Y Ohulchanskyy
- Shenzhen Key Laboratory of Photonics and Biophotonics, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, People's Republic of China
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Shahandeh N, Parikh RV. Invasive Intracoronary Imaging of Cardiac Allograft Vasculopathy: Established Modalities and Emerging Technologies. Interv Cardiol Clin 2023; 12:269-280. [PMID: 36922067 DOI: 10.1016/j.iccl.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Despite advances in the care of heart transplant recipients during the past 5 decades, cardiac allograft vasculopathy (CAV) continues to be a major barrier to long-term survival. The early diagnosis and treatment of CAV is crucial for improving long-term outcomes. Coronary angiography, the current gold standard for CAV screening, has low sensitivity for detecting early CAV. Increasingly, invasive intracoronary imaging modalities that provide a more detailed analysis of vessel anatomy and allow for plaque characterization are being used to detect CAV earlier after transplant and uncover mechanistic insights. Studies validating these emerging imaging platforms are needed before their widespread adoption.
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Affiliation(s)
- Negeen Shahandeh
- Division of Cardiology, University of California, 100 Medical Plaza, Suite 630 East, Los Angeles, CA 90095, USA
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, 100 Medical Plaza, Suite 630 West, Los Angeles, CA 90095, USA.
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Parikh MJ, Madder RD. Near-Infrared Spectroscopy-Guided Percutaneous Coronary Intervention: Practical Applications and Available Evidence. Interv Cardiol Clin 2023; 12:257-268. [PMID: 36922066 DOI: 10.1016/j.iccl.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Intracoronary near-infrared spectroscopy (NIRS) has been extensively validated against the gold standard of histopathology to identify lipid-rich plaque. NIRS is currently in clinical use as a combined multimodality imaging catheter with intravascular ultrasonography. When used before PCI, NIRS has clinical utility in determining the mechanism underlying acute coronary syndromes and can be used to guide stent length selection and identify the risk of periprocedural myocardial infarction. When used after PCI, NIRS can identify vulnerable patients at increased risk of future patient-level cardiovascular events and can detect vulnerable plaques at increased risk of future site-specific coronary events.
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Affiliation(s)
- Malav J Parikh
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA.
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12
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Ota H, Matsuo H, Imai S, Nakashima Y, Kawase Y, Okubo M, Takahashi H, Kawai H, Sobue Y, Kawasaki M, Kondo T, Muramatsu T, Izawa H. Multimodality imaging to identify lipid-rich coronary plaques and predict periprocedural myocardial injury: Association between near-infrared spectroscopy and coronary computed tomography angiography. Front Cardiovasc Med 2023; 10:1127121. [PMID: 37077746 PMCID: PMC10108678 DOI: 10.3389/fcvm.2023.1127121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThis study compares the efficacy of coronary computed tomography angiography (CCTA) and near-infrared spectroscopy intravascular ultrasound (NIRS–IVUS) in patients with significant coronary stenosis for predicting periprocedural myocardial injury during percutaneous coronary intervention (PCI).MethodsWe prospectively enrolled 107 patients who underwent CCTA before PCI and performed NIRS–IVUS during PCI. Based on the maximal lipid core burden index for any 4-mm longitudinal segments (maxLCBI4mm) in the culprit lesion, we divided the patients into two groups: lipid-rich plaque (LRP) group (maxLCBI4mm ≥ 400; n = 48) and no-LRP group (maxLCBI4mm < 400; n = 59). Periprocedural myocardial injury was a postprocedural cardiac troponin T (cTnT) elevation of ≥5 times the upper limit of normal.ResultsThe LRP group had a significantly higher cTnT (p = 0.026), lower CT density (p < 0.001), larger percentage atheroma volume (PAV) by NIRS–IVUS (p = 0.036), and larger remodeling index measured by both CCTA (p = 0.020) and NIRS–IVUS (p < 0.001). A significant negative linear correlation was found between maxLCBI4mm and CT density (rho = −0.552, p < 0.001). Multivariable logistic regression analysis identified maxLCBI4mm [odds ratio (OR): 1.006, p = 0.003] and PAV (OR: 1.125, p = 0.014) as independent predictors of periprocedural myocardial injury, while CT density was not an independent predictor (OR: 0.991, p = 0.22).ConclusionCCTA and NIRS–IVUS correlated well to identify LRP in culprit lesions. However, NIRS–IVUS was more competent in predicting the risk of periprocedural myocardial injury.
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Affiliation(s)
- Hideaki Ota
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
- Correspondence: Hideaki Ota
| | - Hitoshi Matsuo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Shunsuke Imai
- Department of Radiology, Gifu Heart Center, Gifu, Japan
| | | | | | - Munenori Okubo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshihiro Sobue
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | - Takeshi Kondo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
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13
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Gurgoglione FL, Denegri A, Russo M, Calvieri C, Benatti G, Niccoli G. Intracoronary Imaging of Coronary Atherosclerotic Plaque: From Assessment of Pathophysiological Mechanisms to Therapeutic Implication. Int J Mol Sci 2023; 24:ijms24065155. [PMID: 36982230 PMCID: PMC10049285 DOI: 10.3390/ijms24065155] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality worldwide. Several cardiovascular risk factors are implicated in atherosclerotic plaque promotion and progression and are responsible for the clinical manifestations of coronary artery disease (CAD), ranging from chronic to acute coronary syndromes and sudden coronary death. The advent of intravascular imaging (IVI), including intravascular ultrasound, optical coherence tomography and near-infrared diffuse reflectance spectroscopy has significantly improved the comprehension of CAD pathophysiology and has strengthened the prognostic relevance of coronary plaque morphology assessment. Indeed, several atherosclerotic plaque phenotype and mechanisms of plaque destabilization have been recognized with different natural history and prognosis. Finally, IVI demonstrated benefits of secondary prevention therapies, such as lipid-lowering and anti-inflammatory agents. The purpose of this review is to shed light on the principles and properties of available IVI modalities along with their prognostic significance.
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Affiliation(s)
| | - Andrea Denegri
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
| | - Michele Russo
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, 31015 Conegliano, Italy
| | - Camilla Calvieri
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University, 00185 Rome, Italy
| | - Giorgio Benatti
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
| | - Giampaolo Niccoli
- Cardiology Department, University of Parma, 43126 Parma, Italy
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-702070; Fax: +39-0521-702189
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14
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Seguchi M, Aytekin A, Lenz T, Nicol P, Klosterman GR, Beele A, Sabic E, Utsch L, Alyaqoob A, Gorpas D, Ntziachristos V, Jaffer FA, Rauschendorfer P, Joner M. Intravascular molecular imaging: translating pathophysiology of atherosclerosis into human disease conditions. Eur Heart J Cardiovasc Imaging 2022; 24:e1-e16. [PMID: 36002376 DOI: 10.1093/ehjci/jeac163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/31/2022] [Indexed: 12/25/2022] Open
Abstract
Progression of atherosclerotic plaque in coronary arteries is characterized by complex cellular and non-cellular molecular interactions. Within recent years, atherosclerosis has been recognized as inflammation-driven disease condition, where progressive stages are characterized by morphological changes in plaque composition but also relevant molecular processes resulting in increased plaque vulnerability. While existing intravascular imaging modalities are able to resolve key morphological features during plaque progression, they lack capability to characterize the molecular profile of advanced atherosclerotic plaque. Because hybrid imaging modalities may provide incremental information related to plaque biology, they are expected to provide synergistic effects in detecting high risk patients and lesions. The aim of this article is to review existing literature on intravascular molecular imaging approaches, and to provide clinically oriented proposals of their application. In addition, we assembled an overview of future developments in this field geared towards detection of patients at risk for cardiovascular events.
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Affiliation(s)
- Masaru Seguchi
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Alp Aytekin
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Tobias Lenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Philipp Nicol
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Grace R Klosterman
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Alicia Beele
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Emina Sabic
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Léa Utsch
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Aseel Alyaqoob
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany
| | - Dimitris Gorpas
- Chair of Biological Imaging and TranslaTUM, Technical University of Munich, Munich 80333, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München GmbH, Neuherberg 85764, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging and TranslaTUM, Technical University of Munich, Munich 80333, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München GmbH, Neuherberg 85764, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich 80336, Germany
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Philipp Rauschendorfer
- Chair of Biological Imaging and TranslaTUM, Technical University of Munich, Munich 80333, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München GmbH, Neuherberg 85764, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich 80336, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich 80636, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich 80336, Germany
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15
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Epicardial Adipose Tissue Thickness Is Related to Plaque Composition in Coronary Artery Disease. Diagnostics (Basel) 2022; 12:diagnostics12112836. [PMID: 36428896 PMCID: PMC9689801 DOI: 10.3390/diagnostics12112836] [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: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: Currently, limited data are available regarding the relationship between epicardial fat and plaque composition. The aim of this study was to assess the relationship between visceral fat surrounding the heart and the lipid core burden in patients with coronary artery diseases; (2) Methods: Overall, 331 patients undergoing coronary angiography with combined near-infrared spectroscopy and intravascular ultrasound imaging were evaluated for epicardial adipose tissue (EAT) thickness using transthoracic echocardiography. Patients were divided into thick EAT and thin EAT groups according to the median value; (3) Results: There was a positive correlation between EAT thickness and maxLCBI4mm, and maxLCBI4mm was significantly higher in the thick EAT group compared to the thin EAT group (437 vs. 293, p < 0.001). EAT thickness was an independent predictor of maxLCBI4mm ≥ 400 along with age, low-density lipoprotein-cholesterol level, acute coronary syndrome presentation, and plaque burden in a multiple linear regression model. Receiver operating characteristic curve analysis showed that EAT thickness was a predictor for maxLCBI4mm ≥ 400; (4) Conclusions: In the present study, EAT thickness is related to the lipid core burden assessed by NIRS-IVUS in patients with CAD which suggests that EAT may affect the stability of the plaques in coronary arteries.
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Legutko J, Bryniarski KL, Kaluza GL, Roleder T, Pociask E, Kedhi E, Wojakowski W, Jang IK, Kleczynski P. Intracoronary Imaging of Vulnerable Plaque-From Clinical Research to Everyday Practice. J Clin Med 2022; 11:jcm11226639. [PMID: 36431116 PMCID: PMC9699515 DOI: 10.3390/jcm11226639] [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: 10/18/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
The introduction into clinical practice of intravascular imaging, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and their derivatives, allowed for the in vivo assessment of coronary atherosclerosis in humans, including insights into plaque evolution and progression process. Intravascular ultrasound, the most commonly used intravascular modality in many countries, due to its low resolution cannot assess many features of vulnerable plaque such as lipid plaque or thin-cap fibroatheroma. Thus, novel methods were introduced to facilitate this problem including virtual histology intravascular ultrasound and later on near-infrared spectroscopy and OCT. Howbeit, none of the currently used modalities can assess all known characteristics of plaque vulnerability; hence, the idea of combining different intravascular imaging methods has emerged including NIRS-IVUS or OCT-IVUS imaging. All of those described methods may allow us to identify the most vulnerable plaques, which are prone to cause acute coronary syndrome, and thus they may allow us to introduce proper treatment before plaque destabilization.
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Affiliation(s)
- Jacek Legutko
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Krzysztof L. Bryniarski
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Grzegorz L. Kaluza
- Skirball Center for Innovation, Cardiovascular Research Foundation, Orangeburg, NY 10019, USA
| | - Tomasz Roleder
- Department of Cardiology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Elzbieta Pociask
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Kraków, Poland
| | - Elvin Kedhi
- Clinique Hopitaliere Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, Boston, MA 02115, USA
- Division of Cardiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Pawel Kleczynski
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
- Correspondence: ; Tel.: +48-12-614-35-01
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17
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Lim S, Cha JJ, Hong SJ, Kim JH, Joo HJ, Park JH, Yu CW, Ahn TH, Lim DS. Association between High Lipid Burden of Target Lesion and Slow TIMI Flow in Coronary Interventions. J Clin Med 2022; 11:jcm11185401. [PMID: 36143046 PMCID: PMC9502085 DOI: 10.3390/jcm11185401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Decreased thrombolysis in myocardial infarction (TIMI) flow is associated with poor clinical outcomes. However, its predictors are not fully known. A combination of near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) could be used to detect lesions at high risk of slow TIMI flow. This study evaluated 636 consecutive patients undergoing target-lesion NIRS-IVUS imaging prior to percutaneous coronary intervention (PCI). The maximal lipid core burden index over 4-mm segments (maxLCBI4mm) per target vessel was calculated. The primary endpoint was the association between maxLCBI4mm and post-interventional TIMI flow. A high lipid core burden index (LCBI) cut-off point was determined using receiver-operating characteristic analysis. Decreased TIMI flow (TIMI less than 3) occurred in 90 patients and normal TIMI flow in 546 patients. The decreased TIMI flow group showed significantly higher incidence of cardiovascular events (5.6% vs. 1.5%, log-rank p = 0.010) in three months of composite events including cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization. In multivariable analysis, a high LCBI (≥354) was independently associated with slow TIMI flow (OR, 2.59 (95% CI, 1.33–5.04), p = 0.005). High LCBI measured using NIRS-IVUS imaging was an independent predictor of decreased post-PCI TIMI flow. Performing PCI for high-LCBI lesions may necessitate adjunctive measures to prevent suboptimal post-PCI reperfusion.
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Affiliation(s)
- Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence:
| | - Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Heart and Brain Institute, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si 14353, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
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18
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Potential of optical frequency domain imaging for differentiation between early and advanced coronary atherosclerosis. Int J Cardiovasc Imaging 2022; 38:2791-2799. [DOI: 10.1007/s10554-022-02600-4] [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: 10/25/2021] [Accepted: 03/13/2022] [Indexed: 11/05/2022]
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19
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The Residual Lipid-rich Coronary Atheroma behind the Implanted Newer-generation Drug-eluting Stent and Future Stent-related Event's Risks. Can J Cardiol 2022; 38:1504-1515. [PMID: 35840020 DOI: 10.1016/j.cjca.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Lipid-rich plaque is an important substrate that causes future coronary events. However, the clinical implications of underlying plaque characteristics in coronary lesions after newer-generation drug-eluting stent (DES) implantation remain unknown. METHODS The current study analyzed 445 target lesions after newer-generation DES implantation in 416 patients with CAD (CCS/ACS=264/181) from the REASSURE-NIRS multi-center registry. Near-infrared spectroscopy (NIRS) imaging was used to evaluate maximum lipid core burden index after stent implantation in target lesions (residual maxLCBI4mm). The primary and secondary outcomes were 3-year lesion-oriented clinical outcomes (LOCO; cardiac death, non-fatal target lesion-related MI, or ischemia-driven TLR) and patient-oriented clinical outcomes (POCO; all-cause death, non-fatal MI, or ischemia-driven unplanned revascularization). Outcomes were compared by residual maxLCBI4mm tertile. RESULTS Median residual maxLCBI4mm was 183; 16% of lesions had residual maxLCBI4mm >400. Higher residual maxLCBI4mm was not associated with a greater likelihood of LOCO or POCO during the observational period (LOCO, log-rank p=0.76; POCO, log-rank p=0.84). Mixed-effects logistic regression demonstrated that residual maxLCBI4mm does not predict LOCO (odds ratio=1.000, 95% CI=0.997-1.003, p=0.95). There was no significant relationship between residual maxLCBI4mm and POCO (odds ratio=1.001, 95% CI=0.999-1.002, p=0.30). CONCLUSIONS Residual maxLCBI4mm is not associated with LOCO or POCO in patients with CAD after newer-generation DES implantation. Our findings suggest that NIRS-derived underlying lipid-rich plaque is not associated with the risk of stent-related events and patient-based outcomes in patients with CAD who have received a newer-generation DES.
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20
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Mattesini A, Demola P, Shlofmitz R, Shlofmitz E, Waksman R, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near‐Infrared Spectroscopy, and Near‐Infrared Fluorescence Molecular Imaging. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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21
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Usui E, Yonetsu T, Ohmori M, Kanno Y, Nakao M, Niida T, Matsuda Y, Matsuda J, Umemoto T, Misawa T, Hada M, Hoshino M, Kanaji Y, Sugiyama T, Kakuta T, Sasano T. Predictors of Near-Infrared Spectroscopy-Detected Lipid-Rich Plaques by Optical Coherence Tomography-Defined Morphological Features in Patients With Acute Coronary Syndrome. Front Cardiovasc Med 2022; 9:842914. [PMID: 35265688 PMCID: PMC8899395 DOI: 10.3389/fcvm.2022.842914] [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: 12/24/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNear-infrared spectroscopy (NIRS) provides the localization of lipid-rich components in coronary plaques. However, morphological features in NIRS-detected lipid-rich plaques (LRP) are unclear.MethodsA total of 140 de novo culprit lesions in 140 patients with the acute coronary syndrome (ACS) who underwent NIRS and optical coherence tomography (OCT) examinations for the culprit lesions at the time of percutaneous coronary interventions were investigated. We defined a NIRS-LRP as a lesion with a maximum lipid core burden index of 4 mm [LCBI4mm] > 500 in the culprit plaque. Clinical demographics, angiographic, and OCT findings were compared between the patients with NIRS-LRP (n = 54) vs. those without NIRS-LRP (n = 86). Uni- and multivariable logistic regression analyses were performed to examine the independent OCT morphological predictors for NIRS-LRP.ResultsClinical demographics showed no significant differences between the two groups. The angiographic minimum lumen diameter was smaller in the NIRS-LRP group than in the non- NIRS-LRP group. In OCT analysis, the minimum flow area was smaller; lipid angle, lipid length, the prevalence of thin-cap fibroatheroma, and cholesterol crystals were greater in the NIRS-LRP group than in the non-NIRS-LRP group. Plaque rupture and thrombi were more frequent in the NIRS-LRP group, albeit not significant. In a multivariable logistic regression analysis, presence of thin-cap fibroatheroma [odds ratio (OR): 2.56; 95% CI: 1.12 to 5.84; p = 0.03] and cholesterol crystals (OR: 2.90; 95% CI: 1.20 to 6.99; p = 0.02) were independently predictive of NIRS-LRP.ConclusionsIn ACS culprit lesions, OCT-detected thin-cap fibroatheroma and cholesterol crystals rather than plaque rupture and thrombi were closely associated with a great lipid-core burden.
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Affiliation(s)
- Eisuke Usui
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Taishi Yonetsu
| | - Mari Ohmori
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Kanno
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Nakao
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takayuki Niida
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Matsuda
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junji Matsuda
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Umemoto
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Misawa
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tetsuo Sasano
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Terada K, Kubo T, Madder R, Ino Y, Takahata M, Shimamura K, Shiono Y, Nishi T, Emori H, Higashioka D, Khalifa A, Wada T, Akasaka T. Near-infrared spectroscopy to predict microvascular obstruction after primary percutaneous coronary intervention. EUROINTERVENTION 2021; 17:e999-e1006. [PMID: 34105512 PMCID: PMC9724955 DOI: 10.4244/eij-d-20-01421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Successful restoration of epicardial coronary artery patency by primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) does not always lead to adequate reperfusion at the microvascular level. AIMS This study sought to investigate the association between lipid-rich coronary plaque identified by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) and microvascular obstruction (MVO) detected by cardiac magnetic resonance imaging (MRI) after PPCI for STEMI. METHODS We investigated 120 patients with STEMI undergoing PPCI. NIRS-IVUS was used to measure the maximum lipid core burden index in 4 mm (maxLCBI4 mm) in the infarct-related lesions before PPCI. Delayed contrast-enhanced cardiac MRI was performed to evaluate MVO one week after PPCI. RESULTS MVO was identified in 40 (33%) patients. MaxLCBI4 mm in the infarct-related lesion was significantly larger in the MVO group compared with the no-MVO group (median [interquartile range]: 745 [522-853] vs 515 [349-698], p<0.001). A multivariable logistic regression model showed that maxLCBI4 mm was an independent predictor of MVO (odds ratio: 24.7 [95% confidence interval: 2.5-248.0], p=0.006). Receiver operating characteristic curve analysis demonstrated that maxLCBI4 mm >600 was the optimal cut-off value to predict MVO (Youden index=0.44 and area under the curve=0.71) with a sensitivity of 75% and a specificity of 69%. CONCLUSIONS Lipid content measured by NIRS in the infarct-related lesions was associated with the occurrence of MVO after PPCI in STEMI.
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Affiliation(s)
- Kosei Terada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan. E-mail:
| | - Ryan Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Nishi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Higashioka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Amir Khalifa
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Plaque Rupture, Compared With Plaque Erosion, Is Associated With a Higher Level of Pancoronary Inflammation. JACC Cardiovasc Imaging 2021; 15:828-839. [PMID: 34876381 DOI: 10.1016/j.jcmg.2021.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to compare the level of coronary inflammation between plaque rupture and plaque erosion using pericoronary adipose tissue (PCAT) attenuation. BACKGROUND Vascular inflammation plays a key role in plaque rupture, while the role of inflammation in plaque erosion remains less well defined. PCAT attenuation determined using computed tomography has emerged as a marker specific for coronary artery inflammation. METHODS Patients with non-ST-segment elevation acute coronary syndromes who underwent preintervention coronary computed tomographic angiography and optical coherence tomographic culprit lesion imaging were enrolled. PCAT attenuation was measured around the culprit lesion and in the proximal 40 mm of all coronary arteries. RESULTS Among 198 patients, plaque rupture was the underlying mechanism in 107 (54.0%) and plaque erosion in 91 (46.0%). Plaque rupture had higher PCAT attenuation than plaque erosion both at the culprit plaque level (-65.8 ± 7.5 HU vs -69.5 ± 11.4 HU; P = 0.010) and at the culprit vessel level (-67.1 ± 7.1 HU vs -69.6 ± 8.2 HU; P = 0.024). The mean PCAT attenuation of all 3 coronary arteries was also significantly higher in patients with plaque rupture than in plaque erosion, indicating a higher level of inflammation (-67.9 ± 5.7 HU vs -69.9 ± 6.8 HU; P = 0.030). In multivariable analysis, plaque rupture was significantly associated with high PCAT attenuation. CONCLUSIONS PCAT attenuation in culprit plaque, culprit vessel, and all 3 coronary arteries was higher in plaque rupture than in plaque erosion. The results suggest that pancoronary inflammation plays a more significant role in plaque rupture than in plaque erosion. (Massachusetts General Hospital and Tsuchiura Kyodo General Hospital Coronary Imaging Collaboration; NCT04523194).
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Matsuoka T, Kitahara H, Saito K, Mori N, Tateishi K, Fujimoto Y, Kobayashi Y. Utility of near-infrared spectroscopy to detect the extent of lipid core plaque leading to periprocedural myocardial infarction. Catheter Cardiovasc Interv 2021; 98:E695-E704. [PMID: 34415682 DOI: 10.1002/ccd.29927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether lipid core plaque (LCP) in the entire stented segment detected by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) could predict procedural myocardial infarction (PMI) in patients undergoing percutaneous coronary artery intervention (PCI). BACKGROUND NIRS-IVUS can identify LCP, described as high lipid core burden index (LCBI). Previously, the highest LCBI contained only in the 4-mm segment (maxLCBI4mm ) was reported to predict PMI. METHODS Patients who underwent NIRS-IVUS examination during PCI for coronary artery disease at Chiba University Hospital were included. The extent of LCP in the stented segment derived from NIRS-IVUS analysis was presented as LCBI, maxLCBI4mm , and LCP area index (LAI), reflecting the total amount of LCP in the entire stented segment calculated as LCBI×lesion length. PMI was defined as an elevation of creatine kinase MB > 3 times upper reference level (URL), and periprocedural myocardial injury (PMInj) was defined as an elevation of troponin I>5 times URL within 12 to 24 h after PCI. RESULTS Out of 141 enrolled patients, PMI occurred in 20 (14.2%) and PMInj occurred in 62 (44.0%) patients. Receiver-operating characteristic curve analysis revealed LAI was the strongest predictor for both PMI and PMInj (area under curve 0.771, p < 0.001, and 0.717, p < 0.001, respectively). Multiple logistic regression analysis determined high LAI value as the independent predictor of both PMI and PMInj. CONCLUSIONS Greater extent of LCP in the entire stented segment detected by NIRS-IVUS was significantly associated with PMI as well as PMInj in patients undergoing PCI.
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Affiliation(s)
- Takaaki Matsuoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kan Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Naoto Mori
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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25
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Nakagawa I, Kotsugi M, Park H, Furuta T, Sato F, Myochin K, Nishimura F, Yamada S, Motoyama Y, Nakase H. Near-infrared spectroscopy carotid plaque characteristics and cerebral embolism in carotid artery stenting. EUROINTERVENTION 2021; 17:599-606. [PMID: 33283761 PMCID: PMC9725057 DOI: 10.4244/eij-d-20-01050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Perioperative thromboembolism is the main consideration in carotid artery stenting (CAS). Precise evaluation of carotid plaque components is clinically important to reduce ischaemic complications since CAS mechanically pushes plaque outwards, which releases plaque debris into the bloodstream. AIMS This study aimed to determine whether high lipid core plaque (LCP) assessed by catheter-based near-infrared spectroscopy (NIRS) is associated with ipsilateral cerebral embolism by diffusion-weighted magnetic resonance imaging during CAS using a first-generation stent. METHODS Carotid stenosis magnetic resonance (MR) T1-weighted plaque signal intensity ratio (T1W-SIR) followed by NIRS assessment at the time of CAS (using the carotid artery Wallstent) was performed in 117 consecutive patients. RESULTS The maximum lipid core burden index (max-LCBI) at minimal luminal areas (MLA; max-LCBIMLA) and the max-LCBI for any 4 mm segment in a target lesion defined as max-LCBIarea were significantly higher for the post-procedural new ipsilateral diffusion-weighted magnetic resonance imaging (DWI)-positive than negative patients (p<0.001 for all). There was a significant linear correlation between max-LCBIarea and the number of new emboli (r=0.544, p<0.0001). We also found that the second quantile (Q2) of T1W-SIRMLA had a significantly higher max-LCBIMLA and a higher incidence of DWI positivity than Q1 and Q3 (p<0.001 for all). Furthermore, max-LCBIMLA appeared to distinguish between patients with and without postoperative new ipsilateral DWI positivity (AUC 0.91, 95% CI: 0.86-0.96; p<0.0001). CONCLUSIONS High LCP assessed by NIRS is associated with cerebral embolism by diffusion-weighted imaging in CAS using a first-generation stent.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hun Park
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Fumiya Sato
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Kaoru Myochin
- Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Syuichi Yamada
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Oh PC, Jang AY, Ha K, Kim M, Moon J, Suh SY, Lee K, Han SH, Kang WC. Effect of Atorvastatin (10 mg) and Ezetimibe (10 mg) Combination Compared to Atorvastatin (40 mg) Alone on Coronary Atherosclerosis. Am J Cardiol 2021; 154:22-28. [PMID: 34238445 DOI: 10.1016/j.amjcard.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/20/2022]
Abstract
It remains inconclusive whether the additional low-density lipoprotein cholesterol (LDL-C) lowering effects of ezetimibe added to statin on coronary atherosclerosis and clinical outcomes are similar to those of statin monotherapy in the setting of comparable LDL-C reduction. We aimed to determine whether there were distinguishable differences in their effects on coronary atherosclerosis with intermediate stenosis between the combination of moderate-intensity statin plus ezetimibe and high-intensity statin monotherapy. Forty-one patients with stable angina undergoing percutaneous coronary intervention were randomized to receive either atorvastatin 10 mg plus ezetimibe 10 mg (ATO10/EZE10) or atorvastatin 40 mg alone (ATO40). The intermediate lesions were evaluated using a near-infrared spectroscopy-intravascular ultrasonography at baseline and after 12 months in 37 patients. The primary endpoint was percent atheroma volume (PAV). Mean LDL-C levels were significantly reduced by 40% and 38% from baseline in the ATO10/EZE10 group (n = 18, from 107 mg/dL to 61 mg/dL) and ATO40 group (n = 19, from 101 mg/dL to 58 mg/dL), respectively, without between-group difference. The absolute change of PAV was -2.9% in the ATO10/EZE10 group and -3.2% in the ATO40 group. The mean difference (95% confidence interval) for the absolute change in PAV between the 2 groups was 0.5% (-2.4% to 2.8%), which did not exceed the pre-defined non-inferiority margin of 5%. There was no significant reduction in lipid core burden index in both groups. In conclusion, the combination of atorvastatin 10 mg and ezetimibe 10 mg showed comparable LDL-C lowering and regression of coronary atherosclerosis in the intermediate lesions, compared with atorvastatin 40 mg alone.
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Performance of Integrated Near-Infrared Spectroscopy and Intravascular Ultrasound (NIRS-IVUS) System against Quantitative Flow Ratio (QFR). Diagnostics (Basel) 2021; 11:diagnostics11071148. [PMID: 34201889 PMCID: PMC8305529 DOI: 10.3390/diagnostics11071148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Quantitative flow ratio (QFR) is a new opportunity to analyze functional stenosis during invasive coronary angiography. Together with a well-known intravascular ultrasound (IVUS) and a new player in the field, near-infrared spectroscopy (NIRS), it is gaining a lot of interest. The aim of the study was to compare QFR results with integrated IVUS-NIRS results acquired simultaneously in the same coronary lesion. We retrospectively enrolled 66 patients in whom 66 coronary lesions were assessed by NIRS-IVUS and QFR. Lesions were divided into two groups based on QFR results as QFR-positive group (QFR ≤ 0.8) or QFR-negative group (QFR > 0.8). Based on ROC curve analysis, the best cut-off values of minimal lumen area (MLA), minimal lumen diameter (MLD) and percent diameter stenosis for predicting QFR ≤ 80 were 2.4 (AUC 0.733, 95%CI 0.61, 0.834), 1.6 (AUC 0.768, 95%CI 0.634, 0.872) and 59.5 (AUC 0.918, 95%CI 0.824, 0.971), respectively. In QFR-positive lesions, the maxLCBI4mm was significantly higher than in QFR-negative lesions (450.12 ± 251.0 vs. 329.47 ± 191.14, p = 0.046). The major finding of the present study is that values of IVUS-MLA, IVUS-MLD and percent diameter stenosis show a good efficiency in predicting QFR ≤ 0.80. Moreover, QFR-positive lesions are characterized by higher maxLCBI4mm as compared to the QFR-negative group.
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28
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Nakagawa I, Kotsugi M, Park H, Yokoyama S, Furuta T, Nakase K, Okamoto A, Myouchin K, Yamada S, Nakase H. Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging. Cerebrovasc Dis 2021; 50:597-604. [PMID: 34148038 DOI: 10.1159/000516888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vulnerable plaques are a strong predictor of cerebrovascular ischemic events, and high lipid core plaques (LCPs) are associated with an increased risk of embolic infarcts during carotid artery stenting (CAS). Recent developments in magnetic resonance (MR) plaque imaging have enabled noninvasive assessment of carotid plaque vulnerability, and the lipid component and intraplaque hemorrhage (IPH) are visible as high signal intensity areas on T1-weighted MR images. Recently, catheter-based near-infrared spectroscopy (NIRS) has been shown to accurately distinguish LCPs without IPH. This study aimed to determine whether the results of assessment of high LCPs by catheter-based NIRS correlate with the results of MR plaque imaging. METHODS We recruited 82 consecutive symptomatic carotid artery stenosis patients who were treated with CAS under NIRS and MR plaque assessment. Maximum lipid core burden index (max-LCBI) at minimal luminal areas (MLA), defined as max-LCBIMLA, and max-LCBI for any 4-mm segment in a target lesion, defined as max-LCBIAREA, were assessed by NIRS. Correlations were investigated between max-LCBI and MR T1-weighted plaque signal intensity ratio (T1W-SIR) and MR time-of-flight signal intensity ratio (TOF-SIR) in the same regions as assessed by NIRS. RESULTS Both T1W-SIRMLA and T1W-SIRAREA were significantly lower in the high LCP group (max-LCBI >504, p < 0.001 for both), while TOF-SIRMLA and TOF-SIRAREA were significantly higher in the high LCP group (p < 0.001 and p = 0.004, respectively). A significant linear correlation was present between max-LCBIMLA and both TIW-SIRMLA and TOF-SIRMLA (r = -0.610 and 0.452, respectively, p < 0.0001 for both). Furthermore, logistic regression analysis revealed that T1W-SIRMLA and TOF-SIRMLA were significantly associated with a high LCP assessed by NIRS (OR, 44.19 and 0.43; 95% CI: 6.55-298.19 and 0.19-0.96; p < 0.001 and = 0.039, respectively). CONCLUSIONS A high LCP assessed by NIRS correlates with the signal intensity ratio of MR imaging in symptomatic patients with unstable carotid plaques.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - HunSoo Park
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Takanori Furuta
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Kenta Nakase
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Kaoru Myouchin
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Syuichi Yamada
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
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Chen X, Rong C, Qi P, Bai W, Yao W, Zhang Y, Dang Y. LDL-C and Total Stent Length are Independent Predictors of Periprocedural Myocardial Injury and Infarction for Unstable Angina Patients Undergoing Elective Percutaneous Coronary Intervention. Int J Gen Med 2021; 14:1357-1365. [PMID: 33889016 PMCID: PMC8057801 DOI: 10.2147/ijgm.s302042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the predictive value of low-density lipoprotein cholesterol (LDL-C), total stent length and number of implanted stents in patients with unstable angina (UA) regarding myocardial injury and infarction during perioperative period. Methods Three hundred and fifteen consecutive UA patients between January 2015 and June 2018 were retrospectively recruited from two cardiac centers of Hebei Province, China. These patients had normal preprocedural cardiac troponin I (cTnI) and underwent uneventful revascularizations. The predictive value of baseline LDL-C level and total stent length was investigated by linking to post procedural cTnI value in this cohort. Meanwhile, other related clinical and procedural variables were analyzed. Results Baseline LDL-C level or LDL-C grade was correlated with post percutaneous coronary intervention (PCI) cTnI levels (r = 0.120, P = 0.01; r = 0.157, P = 0.004). LDL-C grade was an independent risk factor of perioperative myocardial injury and infarction (P < 0.05) after multivariable adjustment. The risk increased with the elevation of baseline LDL-C level. Compared to the lowest level group (<70 mg/dl), the group with 70–99 mg/dl carried three times higher risk (OR = 3.318; 95% CI: 1.167–9.436; P < 0.05). And, patients with LDL-C level ≥100 mg/dl had the worst prognosis (OR = 4.783; 95% CI: 1.736–13.180; P = 0.002). Besides, the study also found that the total length of stent was predictive of perioperative myocardial injury and infarction independently (OR = 1.037; 95% CI: 1.017–1.058; P = 0.001). Conclusion Baseline LDL-C level and total stent length were independent predictors of periprocedural myocardial injury and infarction in UA patients undergoing elective PCI.
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Affiliation(s)
- Xuefeng Chen
- Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang, 050000, People's Republic of China
| | - Chunli Rong
- Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang, 050000, People's Republic of China
| | - Peng Qi
- Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang, 050000, People's Republic of China
| | - Wenlou Bai
- Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang, 050000, People's Republic of China
| | - Wenjing Yao
- Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang, 050000, People's Republic of China
| | - Yantao Zhang
- Department of Cardiovascular Internal Medicine, HanDan Central Hospital, Handan, 056001, People's Republic of China
| | - Yi Dang
- Department of Cardiovascular Internal Medicine, Hebei General Hospital, Shijiazhuang, 050000, People's Republic of China
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Small lipid core burden index in patients with stable angina pectoris is also associated with microvascular dysfunction: Insights from intracoronary electrocardiogram. J Thromb Thrombolysis 2021; 52:1-8. [PMID: 33528755 DOI: 10.1007/s11239-021-02380-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 12/22/2022]
Abstract
Near-infrared spectroscopy with intravascular ultrasound (NIRS)-IVUS enables precise detection of lipid core burden. Intracoronary electrocardiography (ECG) can detect slight ischemia during percutaneous coronary intervention (PCI), indicating microvascular dysfunction (MD) by distal embolization, etc. Thus, this study aimed to investigate whether plaques with a low max-lipid core burden index (LCBI) at 4 mm (LCBI4mm) influence MD, using intracoronary ECG. We enrolled 40 consecutive patients who underwent PCI for stable angina pectoris (SAP) due to stenosis of the proximal segment of the left anterior descending artery in this study. Max-LCBI4mm was measured for each culprit lesion. Gray-scale IVUS data including plaque burden were measured. Intracoronary ECG was performed to measure the time from the initiation of ST-segment elevation from the isoelectric baseline after stent balloon inflation to the return of the ST-segment to the isoelectric baseline after the deflation of the stent balloon, which was defined as the severity of the MD. The patients were divided into two groups according to median max-LCBI4mm of 120 as follows: low- [n = 20] and high- [n = 20] LCBI groups. The overall mean Max-LCBI4mm was 120 ± 86. No differences in baseline characteristics, including prevalence of dyslipidemia, were found between both groups, as well as in the gray-scale IVUS parameters. The severity of the MD was greater in the high-LCBI group than in the low-LCBI group (16.6 ± 9.1 vs 4.7 ± 4.8 s, P < 0.01). The no-reflow and slow-flow phenomena were not observed. Even max-LCBI4mm value <400 on NIRS-IVUS was associated with MD during PCI in patients with SAP.
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31
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Montarello NJ, Nelson AJ, Verjans J, Nicholls SJ, Psaltis PJ. The role of intracoronary imaging in translational research. Cardiovasc Diagn Ther 2020; 10:1480-1507. [PMID: 33224769 DOI: 10.21037/cdt-20-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This has helped further our appreciation of the natural history of coronary artery disease (CAD) and the risk for major adverse cardiovascular events (MACE), evaluate the responsiveness to conventional and experimental therapeutic interventions, and assist in guiding percutaneous coronary intervention (PCI). Here we review the use of different imaging modalities for these purposes and the lessons they have provided thus far.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J Nelson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Duke Clinical Research Institute, Durham, NC, USA
| | - Johan Verjans
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Saito Y, Mori N, Murase T, Nakamura T, Akari S, Saito K, Matsuoka T, Tateishi K, Kadohira T, Kitahara H, Fujimoto Y, Kobayashi Y. Greater coronary lipid core plaque assessed by near-infrared spectroscopy intravascular ultrasound in patients with elevated xanthine oxidoreductase: a mechanistic insight. Heart Vessels 2020; 36:597-604. [PMID: 33219412 DOI: 10.1007/s00380-020-01730-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
Elevated serum uric acid level was reportedly associated with greater coronary lipid plaque. Xanthine oxidoreductase (XOR) is a rate-limiting enzyme in purine metabolism and believed to play an important role in coronary atherosclerosis. However, the relation of XOR to coronary lipid plaque and its mechanism are unclear. Patients with stable coronary artery disease undergoing elective percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were prospectively enrolled. They were divided into three groups according to serum XOR activities: low, normal, and high. Coronary lipid core plaques in non-target vessels were evaluated by NIRS-IVUS with lipid core burden index (LCBI) and a maximum LCBI in 4 mm (maxLCBI4mm). Systemic endothelial function and inflammation were assessed with reactive hyperemia index (RHI) and high-sensitivity C-reactive protein, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. Of 68 patients, 26, 31, and 11 were classified as low, normal, and high XOR activity groups. LCBI (474.4 ± 171.6 vs. 347.4 ± 181.6 vs. 294.0 ± 155.9, p = 0.04) and maxLCBI4mm (102.1 ± 56.5 vs. 65.6 ± 48.5 vs. 55.6 ± 37.8, p = 0.04) were significantly higher in high XOR group than in normal and low XOR groups. Although RHI was significantly correlated with body mass index, diabetes, current smoking, and high-density lipoprotein cholesterol, no relation was found between XOR activity and RHI. There were also no relations between XOR activity and C-reactive protein, neutrophil-to-lymphocyte ratio, or platelet-to-lymphocyte ratio. In conclusion, elevated XOR activity was associated with greater coronary lipid core plaque in patients with stable coronary artery disease, without significant relations to systemic endothelial function and inflammation.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan. .,Yale University School of Medicine, New Haven, USA.
| | - Naoto Mori
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | | | | | - Seigo Akari
- Sanwa Kagaku Kenkyusho Co., Ltd, Nagoya, Japan
| | - Kan Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Takaaki Matsuoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Tadayuki Kadohira
- Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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Impact of clinical presentations on lipid core plaque assessed by near-infrared spectroscopy intravascular ultrasound. Int J Cardiovasc Imaging 2020; 37:1151-1158. [PMID: 33205339 DOI: 10.1007/s10554-020-02107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) studies have demonstrated that lipid core plaque (LCP) is frequently observed in the culprit segment of myocardial infarction (MI). However, little is known about the impact of clinical presentations such as chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) including unstable angina (UA), non ST-segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI) on LCP. The present prospective single-center registry included a total of 178 patients who underwent percutaneous coronary intervention under NIRS-IVUS guidance. Patients were divided into CCS and ACS groups, and ACS patients were further sub-divided into the 3 groups according to the clinical presentation. The primary endpoint was coronary LCP in the target lesion assessed by NIRS-IVUS with maximal lipid core burden index over any 4 mm segment (maxLCBI4mm). The study population included 124 and 54 patients with CCS and ACS. MaxLCBI4mm in the target lesion was significantly higher in the ACS group than in the CCS group (503 [284-672] vs. 406 [250-557], p = 0.046). Among ACS patients, MaxLCBI4mm in the target lesion was also significantly different in those with UA (n = 18), NSTEMI (n = 21), and STEMI (n = 15) (288 [162-524] vs. 518 [358-745] vs. 646 [394-848], p = 0.021). In conclusion, LCP assessed by NIRS-IVUS, a surrogate of coronary plaque vulnerability, was significantly different according to the clinical presentations such as CCS, UA, NSTEMI, and STEMI.
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Johnson TW, Räber L, di Mario C, Bourantas C, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas K, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2020; 40:2566-2584. [PMID: 31112213 DOI: 10.1093/eurheartj/ehz332] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
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Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, UK
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Alessio Mattesini
- Department of Cardiology, Barts Heart Centre, Barts Health NHS & Queen Mary University, London, UK
| | - Nieves Gonzalo
- Department of Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation Rome, Italy
| | - Konstantinos Koskinas
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Joner
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Maria D Radu
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Erlinge
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Evelyn Regar
- Department of Cardiovascular Surgery, Zürich University Hospital, Zürich, Switzerland
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Akiko Maehara
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Robert A Byrne
- Deutsches Herzzentrum München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Gary S Mintz
- Cardiovascular Research Foundation, Columbia University, New York, NY, USA
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Wilkinson SE, Madder RD. Intracoronary near-infrared spectroscopy-role and clinical applications. Cardiovasc Diagn Ther 2020; 10:1508-1516. [PMID: 33224770 DOI: 10.21037/cdt.2020.02.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intracoronary near-infrared spectroscopy (NIRS) has been developed and validated for the detection of lipid-rich plaque in the coronary arteries. A combined NIRS and intravascular ultrasound catheter is currently in clinical use and has an emerging role in evaluating plaques both before and after percutaneous coronary intervention. NIRS has recently been shown to positively identify both vulnerable patients and vulnerable plaques. This review focuses on the principles and image interpretation of intracoronary NIRS, as well as its clinical applications, limitations, and future directions.
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Affiliation(s)
- Stephen E Wilkinson
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
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36
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Kotsugi M, Nakagawa I, Hatakeyama K, Park H, Sato F, Furuta T, Nishimura F, Yamada S, Motoyama Y, Park YS, Nakase H. Lipid Core Plaque Distribution Using Near-infrared Spectroscopy Is Consistent with Pathological Evaluation in Carotid Artery Plaques. Neurol Med Chir (Tokyo) 2020; 60:499-506. [PMID: 32879184 PMCID: PMC7555160 DOI: 10.2176/nmc.oa.2020-0154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Carotid artery stenting (CAS) is performed as a treatment for carotid artery stenosis. However, lipid-rich plaques cause embolic complications and sequelae. Near-infrared spectroscopy (NIRS) can identify lipid components by applying a near-infrared absorption pattern, and the distribution of lipid components can be evaluated as the maximum lipid core burden index (maxLCBI). Intravascular ultrasound (IVUS) equipped with NIRS has been clinically applied recently, and its diagnostic usefulness and validation have been reported for coronary arteries; however, its consistency with actual pathological diagnosis in carotid artery lesions has not been validated. In this study, we investigated the consistency between the maxLCBI values and histopathological diagnoses. Patients with cervical carotid artery stenosis who underwent carotid endarterectomy (CEA) were examined in this prospective study. Pathological diagnosis was determined after NIRS evaluation, which was performed on the extracted plaques ex vivo. The histological slices of decalcified and paraffin-embedded sections were stained by hematoxylin–eosin (HE) and Elastica van Gieson (EVG), and for low-density lipoprotein (LDL), C-reactive protein (CRP), CD68, and glycophorin A. The correlation between maxLCBI values and histological findings. Seventy lesions assessed by NIRS were pathologically analyzed. There was a positive linear correlation between maxLCBI values and pathological findings as determined by HE (angle), HE (area%), EVG, CRP, and CD68 staining (respectively, r = 0.624, p <0.001; r = 0.578, p <0.001; r = 0.534, p <0.001; r = 0.723, p <0.001; r = 0.653, p <0.001). In conclusion, the maxLCBI values assessed by NIRS showed a significant positive linear correlation with pathological evaluations in carotid lesions. The maxLCBI values in carotid arteries are consistent with pathological evaluations.
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Affiliation(s)
| | | | | | - HunSoo Park
- Department of Neurosurgery, Nara Medical University
| | - Fumiya Sato
- Department of Neurosurgery, Nara Medical University
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37
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Moriya S, Isoda K, Dohi T, Okazaki S. Significant decrease in lipid core burden index following balloon dilation was associated with the leakage of cholesterol crystals in a patient: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 34151139 PMCID: PMC7780494 DOI: 10.1093/ehjcr/ytaa148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/12/2020] [Accepted: 05/05/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) has been used for analysis the composition of the atherosclerotic plaque in coronary arteries. However, meaning of significant decrease in max lipid core burden index at 4 mm (max LCBI4mm) during percutaneous coronary intervention (PCI) is poorly understood. CASE SUMMARY A 64-year-old male with unstable angina underwent coronary angiography, which demonstrated a hazy tight culprit lesion in the mid-right coronary artery. Pre-intervention NIRS-intravascular ultrasound (NIRS-IVUS) and chemogram showed plaque with high lipid burden at the culprit lesion. Then, we used a distal protection device before PCI because of high max LCBI4mm in the lesion. After pre-dilation with a scoring balloon, repeat NIRS-IVUS interrogation revealed an almost complete disappearance of the yellow signal and decrease in max LCBI4mm (from 537 to 44) significantly, suggesting decrease in the lipid content of the plaque. Finally, a drug-eluting stent deployment followed by inflation of a non-compliant balloon led to an excellent result. After PCI, we detected trapped large amounts of debris on retrieval of the filter. Pathological diagnosis confirmed that trapped material was lipid-rich plaque including cholesterol crystals. DISCUSSION This is the first report directly demonstrated that significant decrease in max LCBI4mm at culprit lesion should be associated with the leakage of cholesterol crystals from lipid-rich plaque during PCI in the clinical patient.
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Affiliation(s)
- Soshi Moriya
- Department of Cardiovascular Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
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38
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Horváth M, Hájek P, Štěchovský C, Honěk J, Veselka J. Carotid artery plaque composition and distribution: near-infrared spectroscopy and intravascular ultrasound analysis. Eur Heart J Suppl 2020; 22:F38-F43. [PMID: 32694952 PMCID: PMC7361666 DOI: 10.1093/eurheartj/suaa097] [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] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
Most atherosclerotic plaques (APs) form in typical predilection areas of low endothelial shear stress (ESS). On the contrary, previous data hinted that plaques rupture in their proximal parts where accelerated blood flow causes high ESS. It was postulated that high ESS plays an important role in the latter stages of AP formation and in its destabilization. Here, we used near-infrared spectroscopy (NIRS) to analyse the distribution of lipid core based on the presumed exposure to ESS. A total of 117 carotid arteries were evaluated using NIRS and intravascular ultrasound (IVUS) prior to carotid artery stenting. The point of minimal luminal area (MLA) was determined using IVUS. A stepwise analysis of the presence of lipid core was then performed using NIRS. The lipid core presence was quantified as the lipid core burden index (LCBI) within 2 mm wide segments both proximally and distally to the MLA. The analysed vessel was then divided into three 20 mm long thirds (proximal, middle, and distal) for further analysis. The maximal value of LCBI (231.9 ± 245.7) was noted in the segment localized just 2 mm proximally to MLA. The mean LCBI in the middle third was significantly higher than both the proximal (121.4 ± 185.6 vs. 47.0 ± 96.5, P < 0.01) and distal regions (121.4 ± 185.6 vs. 32.4 ± 89.6, P < 0.01). Lipid core was more common in the proximal region when compared with the distal region (mean LCBI 47.0 ± 96.5 vs. 32.4 ± 89.6, P < 0.01).
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Affiliation(s)
- Martin Horváth
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Petr Hájek
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Cyril Štěchovský
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Jakub Honěk
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
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39
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Kuku KO, Singh M, Ozaki Y, Dan K, Chezar-Azerrad C, Waksman R, Garcia-Garcia HM. Near-Infrared Spectroscopy Intravascular Ultrasound Imaging: State of the Art. Front Cardiovasc Med 2020; 7:107. [PMID: 32695796 PMCID: PMC7338425 DOI: 10.3389/fcvm.2020.00107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022] Open
Abstract
Acute coronary syndromes (ACS) secondary to coronary vessel plaques represent a major cause of cardiovascular morbidity and mortality worldwide. Advancements in imaging technology over the last 3 decades have continuously enabled the study of coronary plaques via invasive imaging methods like intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The introduction of near-infrared spectroscopy (NIRS) as a modality that could detect the lipid (cholesterol) content of atherosclerotic plaques in the early nineties, opened the potential of studying “vulnerable” or rupture-prone, lipid-rich coronary plaques in ACS patients. Most recently, the ability of NIRS-IVUS to identify patients at risk of future adverse events was shown in a prospective multicenter trial, the Lipid-Rich-plaque Study. Intracoronary NIRS-IVUS imaging offers a unique method of coronary lipid-plaque characterization and could become a valuable clinical diagnostic and treatment monitoring tool.
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Affiliation(s)
- Kayode O Kuku
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Manavotam Singh
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Yuichi Ozaki
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Kazuhiro Dan
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Ron Waksman
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
| | - Hector M Garcia-Garcia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, MedStar Health Research Institute, Washington, DC, United States.,Section of Interventional Cardiology MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States.,Georgetown University Department of Medicine, Washington, DC, United States
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40
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Muller J, Madder R. OCT-NIRS Imaging for Detection of Coronary Plaque Structure and Vulnerability. Front Cardiovasc Med 2020; 7:90. [PMID: 32582767 PMCID: PMC7287010 DOI: 10.3389/fcvm.2020.00090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
A combination optical coherence tomography and near-infrared spectroscopy (OCT-NIRS) coronary imaging system is being developed to improve the care of coronary patients. While stenting has improved, complications continue to occur at the stented site and new events are caused by unrecognized vulnerable plaques. An OCT-NIRS device has potential to improve secondary prevention by optimizing stenting and by identifying vulnerable patients and vulnerable plaques. OCT is already in widespread use world-wide to optimize coronary artery stenting. It provides automated lumen detection and can identify features of coronary plaques not accurately identified by angiography or intravascular ultrasound. The ILUMIEN IV study, to be completed in 2022, will determine if OCT-guided stenting will yield better clinical outcomes than angiographic guidance alone. While the superb spatial resolution of OCT enables the identification of many plaque structural features, the detection by OCT of lipids, an important component of vulnerable plaques, is limited by suboptimal specificity and interobserver agreement. In contrast, NIRS has been extensively validated for lipid-rich plaque detection against the gold-standard of histology and is the only FDA-approved method to identify coronary lipids. Studies in patients have demonstrated that NIRS detects lipid in culprit lesions causing coronary events. In 2019, the positive results of the prospective Lipid-Rich Plaque Study led to FDA approval of NIRS for detection of high-risk plaques and patients. The complementarity of OCT for plaque structure and NIRS for plaque composition led to the sequential performance of NIRS and OCT imaging in patients. NIRS identified lipid while OCT determined the thickness of the cap over the lipid pool. The positive results obtained with OCT and NIRS imaging led to development of a prototype combined OCT-NIRS catheter that can provide co-registered OCT and NIRS data in a single pullback. The data will provide structural and chemical information likely to improve stenting and deliver more accurate identification of vulnerable plaques and vulnerable patients. More precise diagnosis will then lead to OCT-NIRS guided treatment trials to improve secondary prevention. Success in secondary prevention will then facilitate development of improved primary prevention with invasive imaging and effective treatment of patients identified by non-invasive methods.
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Affiliation(s)
- James Muller
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ryan Madder
- Spectrum Health, Grand Rapids, MI, United States
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41
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Abstract
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed toward more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high-quality imaging studies, both invasive and noninvasive, which promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events. We discuss the role of VP imaging in managing atherosclerotic vascular disease.
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42
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Jian W, Guan JH, Zheng WB, Mo CH, Xu YT, Huang QL, Wei CM, Wang C, Yang ZJ, Yang GL, Gui C. Association between serum angiopoietin-2 concentrations and periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention. Aging (Albany NY) 2020; 12:5140-5151. [PMID: 32182213 PMCID: PMC7138571 DOI: 10.18632/aging.102936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/09/2020] [Indexed: 01/10/2023]
Abstract
Angiopoietin-2 (Ang-2) is a proangiogenic factor that mediates inflammation and atherosclerosis. We evaluated the predictive value of circulating Ang-2 levels for periprocedural myocardial injury (PMI) in 145 patients undergoing elective percutaneous coronary intervention (PCI), and investigated whether post-PCI Ang-2 levels are influenced by PMI. PMI was defined as a post-procedural troponin elevation above the 5×99th percentile upper reference limit. Blood samples for Ang-2 analysis were collected at admission and on postoperative days 1 and 3. PMI occurred in 40 patients (28%). At baseline, there was no difference in Ang-2 levels between PMI and non-PMI patients (P=0.554). However, a significant interaction effect between PMI occurrence and time on Ang-2 levels was observed (interaction P=0.036). Although serum Ang-2 levels in non-PMI patients gradually decreased, Ang-2 levels in PMI patients did not change between different time-points. Multiple logistic regression analysis revealed that age, total stent length, and serum levels of N-terminal pro-brain natriuretic peptide were independent PMI predictors. These findings indicate that pre-procedural Ang-2 levels do not impact PMI occurrence after elective PCI. However, changes in Ang-2 levels after the procedure are closely related to PMI.
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Affiliation(s)
- Wen Jian
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Jia-Hui Guan
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People’s Republic of China
| | - Wen-Bo Zheng
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Chang-Hua Mo
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Yu-Tao Xu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Qi-Li Huang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Chun-Mei Wei
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Can Wang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Zhi-Jie Yang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Guo-Liang Yang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
| | - Chun Gui
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning 530021, Guangxi, People's Republic of China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning 530021, Guangxi, People's Republic of China
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Yamamoto MH, Maehara A, Stone GW, Kini AS, Brilakis ES, Rizik DG, Shunk K, Powers ER, Tobis JM, Maini BS, Dixon SR, Goldstein JA, Petersen JL, Généreux P, Shah PR, Crowley A, Nicholls SJ, Mintz GS, Muller JE, Weisz G. 2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques. J Am Coll Cardiol 2020; 75:1371-1382. [DOI: 10.1016/j.jacc.2020.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
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Clinical utility of intravascular ultrasonography-guided therapy in a small-vessel coronary lesion associated with Type 2 diabetes mellitus. Anatol J Cardiol 2020; 22:68-76. [PMID: 31375651 PMCID: PMC6735441 DOI: 10.14744/anatoljcardiol.2019.77009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: It is unknown whether the intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) should be routinely used in small-vessel coronary lesions in patients affected by Type 2 diabetes mellitus (T2DM). This study aimed to assess the clinical significance of the IVUS-guided PCI treatment for small-vessel coronary lesions in T2DM. Methods: This was a prospective interventional trial. A total of 228 patients affected by T2DM with stable angina and a positive stress test in the presence of coronary arteriography (CAG) involving small vessels [online measurement reference vessel diameter ≤3.0 mm by means of quantitative coronary angiography (QCA)] were recruited and divided into two groups: an IVUS-guided group (n=120) and a CAG-guided group (n=108). Follow-up PCIs were performed via CAG or IVUS criteria, respectively. Between-group comparisons were made for the number of stents implanted, length, diameter, and high-pressure balloons used post-dilatation. Major adverse cardiac events (MACEs) defined as cardiac death, nonfatal myocardial infarction, and target lesion revascularization (TLR) were the primary endpoint. The value of late lumen loss and proportion of in-stent restenosis (ISR) were the secondary endpoint, all of which were also evaluated during the follow-up period. Results: There was an increased lesion length observed using the IVUS measurement when compared with QCA measurements in the IVUS-guided group (p≤0.001). The number of implanted stents, diameter, length, percentage of high-pressure balloons used during post-dilatation, value of late lumen loss, and proportion of ISR decreased in the IVUS-guided group when compared with the CAG-guided group (p=0.002, p=0.001, p=0.003, p=0.004, p=0.007, p=0.001, respectively). After a 2-year follow-up, the Kaplan–Meier curves indicated that the incidence of MACEs was significantly lower in the IVUS-guided group (log-rank p=0.029), mainly because of the TLR reduction (log-rank p=0.037). Conclusion: The IVUS-guided PCI treatment improved the event-free survival in small-vessel coronary lesions in patients affected by T2DM.
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Waksman R, Di Mario C, Torguson R, Ali ZA, Singh V, Skinner WH, Artis AK, Cate TT, Powers E, Kim C, Regar E, Wong SC, Lewis S, Wykrzykowska J, Dube S, Kazziha S, van der Ent M, Shah P, Craig PE, Zou Q, Kolm P, Brewer HB, Garcia-Garcia HM. Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study. Lancet 2019; 394:1629-1637. [PMID: 31570255 DOI: 10.1016/s0140-6736(19)31794-5] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can detect lipid-rich plaques (LRPs). LRPs are associated with acute coronary syndromes or myocardial infarction, which can result in revascularisation or cardiac death. In this study, we aimed to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. METHODS In this prospective, cohort study (LRP), patients from 44 medical centres were enrolled in Italy, Latvia, Netherlands, Slovakia, UK, and the USA. Patients with suspected coronary artery disease who underwent cardiac catheterisation with possible ad hoc percutaneous coronary intervention were eligible to be enrolled. Enrolled patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694. FINDINGS Between Feb 21, 2014, and March 30, 2016, 1563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0·4%) patients. 1271 patients (mean age 64 years, SD 10, 883 [69%] men, 388 [31%]women) with analysable maxLCBI4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1·21 (95% CI 1·09-1·35; p=0·0004) for each 100-unit increase maxLCBI4mm) and adjusted HR 1·18 (1·05-1·32; p=0·0043). In patients with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 2·18 (1·48-3·22; p<0·0001) and adjusted HR was 1·89 (1·26-2·83; p=0·0021). At the plaque level, the unadjusted HR was 1·45 (1·30-1·60; p<0·0001) for each 100-unit increase in maxLCBI4mm. For segments with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 4·22 (2·39-7·45; p<0·0001) and adjusted HR was 3·39 (1·85-6·20; p<0·0001). INTERPRETATION NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at higher risk for subsequent NC-MACE. NIRS-intravascular ultrasound imaging adds to the armamentarium as the first diagnostic tool able to detect vulnerable patients and plaques in clinical practice. FUNDING Infraredx.
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Affiliation(s)
- Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA.
| | | | | | - Ziad A Ali
- New York Presbyterian/Columbia University Medical Center, New York, NY & Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | | | - Eric Powers
- Medical University of South Carolina Hospital, Charleston, SC, USA
| | | | | | - S Chiu Wong
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | | | - Sandeep Dube
- Community Heart and Vascular, Indianapolis, IN, USA
| | | | | | | | - Paige E Craig
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Quan Zou
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Paul Kolm
- MedStar Washington Hospital Center, Washington, DC, USA
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Johnson TW, Räber L, Di Mario C, Bourantas CV, Jia H, Mattesini A, Gonzalo N, de la Torre Hernandez JM, Prati F, Koskinas KC, Joner M, Radu MD, Erlinge D, Regar E, Kunadian V, Maehara A, Byrne RA, Capodanno D, Akasaka T, Wijns W, Mintz GS, Guagliumi G. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2019; 15:434-451. [PMID: 31258132 DOI: 10.4244/eijy19m06_02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.
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Affiliation(s)
- Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, BS2 8HW, Bristol, United Kingdom
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Takata K, Honda S, Sidharta SL, Duong M, Shishikura D, Kim SW, Andrews J, Di Bartolo BA, Psaltis PJ, Bursill CA, Worthley MI, Nicholls SJ. Associations of ABCG1-mediated cholesterol efflux capacity with coronary artery lipid content assessed by near-infrared spectroscopy. Cardiovasc Diagn Ther 2019; 9:310-318. [PMID: 31555535 DOI: 10.21037/cdt.2018.11.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Although high-density lipoprotein (HDL) has atheroprotective properties, the association of HDL functionality with coronary plaques remains unclear. Methods We investigated the association between HDL-mediated cholesterol efflux capacity (CEC) and coronary lipid burden in 74 patients who underwent near-infrared spectroscopy (NIRS) imaging for acute coronary syndrome (ACS) or stable ischemic symptoms. We measured baseline HDL-mediated CEC, distinguishing the specific pathways, and stratified patients according to their median CEC values. Coronary lipid burden was assessed as lipid core burden index (LCBI) using NIRS at baseline (n=74) and on serial imaging (n=47). Results Patients with baseline ATP-binding cassette transporter G1 (ABCG1)-mediated CEC > median had a greater baseline LCBI {74 [20, 128] vs. 32 [5, 66]; P=0.04} or change in LCBI {-30 [-89, 0] vs. -3 [-16, 0]; P=0.048}. In addition to a negative association between baseline LCBI and change in LCBI (standardized β=-0.31; P=0.02), multivariable analysis demonstrated a significant interaction effect between clinical presentation of coronary artery disease (CAD) and baseline ABCG1-mediated CEC on change in LCBI (P=0.003), indicating that baseline ABCG1-mediated CEC was inversely associated with change in LCBI in patients with ACS (standardized β=-0.79, P=0.003), but not in those with stable ischemic symptoms (P=0.52). Conclusions In this study, ABCG1-mediated CEC, but not ATP-binding cassette transporter A1 and scavenger receptor B type I, was associated with regression of coronary artery lipid content, especially in patients with high-risk phenotype. Further studies are required to determine the roles of ABCG1 pathway in the development coronary plaques.
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Affiliation(s)
- Kohei Takata
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Satoshi Honda
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Samuel L Sidharta
- Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - MyNgan Duong
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Daisuke Shishikura
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Susan W Kim
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Jordan Andrews
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | | | - Peter J Psaltis
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Christina A Bursill
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Matthew I Worthley
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Stephen J Nicholls
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
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Yang HM, Yoon MH, Lim HS, Seo KW, Choi BJ, Choi SY, Hwang GS, Tahk SJ. Lipid-Core Plaque Assessed by Near-Infrared Spectroscopy and Procedure Related Microvascular Injury. Korean Circ J 2019; 49:1010-1018. [PMID: 31456364 PMCID: PMC6813158 DOI: 10.4070/kcj.2019.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/23/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction. We assessed the lipid-core plaque using near-infrared spectroscopy (NIRS) and microvascular dysfunction invasively with the index of microcirculatory resistance (IMR) and evaluated their relationship. Methods This study is pilot retrospective observational study. We analyzed 39 patients who performed NIRS before and after PCI, while fractional flow reserve, thermo-dilution coronary flow reserve (CFR) and IMR were measured after PCI. The maximum value of lipid core burden index (LCBI) for any of the 4-mm segments at the culprit lesion (culprit LCBI4mm) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit LCBI4mm ≥500. Results Mean pre-PCI LCBI was 333±196 and mean post-PCI IMR was 20±14 U. Post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower (3.7±2.2 vs. 2.1±1.0, p=0.029) in the high LCBI group. Pre-PCI LCBI was positively correlated with post-PCI IMR (ρ=0.358, p=0.025) and negatively correlated with post-PCI CFR (ρ=−0.494, p=0.001). The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high LCBI group (9.4% vs. 85.7%, p<0.001). However, there were no significant differences in the incidences of creatine Kinase-MB (9.4% vs. 14.3%, p=0.563) and troponin-I elevation (12.5% vs. 14.3%, p=1.000). Conclusions A large lipid-core plaque at the ‘culprit’ lesion is observed higher incidence of post-PCI microvascular dysfunction after PCI. Prospective study with adequate subject numbers will be needed.
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Affiliation(s)
- Hyoung Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Myeong Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
| | - Hong Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Byoung Joo Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - So Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Gyo Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
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Role of Near-Infrared Spectroscopy (NIRS) in Intracoronary Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9510-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Štěchovský C, Hájek P, Horváth M, Veselka J. Effect of stenting on the near-infrared spectroscopy-derived lipid core burden index of carotid artery plaque. EUROINTERVENTION 2019; 15:e289-e296. [PMID: 29957596 DOI: 10.4244/eij-d-17-01054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Catheter-based intravascular near-infrared spectroscopy (NIRS) detects a lipid signal from atherosclerotic plaque. The aim of this study was to describe the effect of carotid artery stenting (CAS) on the lipid signal in a carotid stenosis. METHODS AND RESULTS We performed NIRS combined with intravascular ultrasound (IVUS) during 120 CAS procedures. Minimal luminal area (MLA) and plaque burden (PB) at the site of MLA were measured with IVUS and lipid core burden index (LCBI), maximal LCBI in a 4 mm segment of the artery (LCBImax) and LCBI in a 4 mm segment at the site of MLA (LCBImla) with NIRS-derived chemograms. NIRS-IVUS imaging was performed at baseline, after stent implantation and after balloon post-dilatation. The most common lesion type was the fibrocalcific plaque (76%). Lipid-rich plaque (LCBImax ≥400) was present in 33% of carotid stenoses and in 20% at the site of MLA. Median MLA increased significantly from baseline to stent implantation (3.63 mm2 to 5.56 mm2, p<0.001) and to post-dilatation (5.56 mm2 to 12.03 mm2, p<0.001). Median LCBI, LCBImax and LCBImla significantly decreased from baseline to stent implantation: LCBI (60 to 8, p<0.001), LCBImax (294 to 60, p<0.001) and LCBImla (124 to 0, p<0.001). Post-dilatation of the stent had no further significant effect on median LCBI (8 to 5, p=0.890), LCBImax (60 to 50, p=0.690) and LCBImla (0 to 0, p=0.438). CONCLUSIONS Carotid artery stenting significantly reduced the NIRS-derived lipid core burden index at the stented segment.
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Affiliation(s)
- Cyril Štěchovský
- Department of Cardiology, Second Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
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