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Heo JH. Glimpse of Relation between Imaging and Physiology. Korean Circ J 2019; 49:1019-1021. [PMID: 31646770 PMCID: PMC6813159 DOI: 10.4070/kcj.2019.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jung Ho Heo
- Division of Cardiology, Kosin University Gospel Hospital, Busan, Korea
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Shrestha R, Shrestha A, Kan J, Chen S. A review in enormity of OCT and its enduring understanding of vulnerable plaque in coronary bifurcation lesion. Int J Cardiovasc Imaging 2018; 34:1679-1684. [PMID: 29858960 DOI: 10.1007/s10554-018-1384-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/26/2018] [Indexed: 01/03/2023]
Abstract
Optical coherence tomography (OCT) has emerged as one of the most promising tools to assist the optimization of percutaneous coronary intervention (PCI). Its ability to provide unique information on the plaque at high risk for rupture, plaque composition, the thickness of the fibrous cap, the presence of macrophage and thrombi has not only assisted simple PCI but also in many complex bifurcation lesions PCI. OCT has helped to provide valuable anatomic information to optimize stent implantation and adapt PCI strategy in individual patients. This review article summarizes the current role of OCT as an imaging technology and prediction of vulnerable plaque, its site and composition at the coronary bifurcation lesions for supporting the clinical decision.
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Affiliation(s)
| | | | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Abstract
PURPOSE OF REVIEW This short review summarizes the recent development in clinical and experimental imaging techniques for coronary atherosclerosis. RECENT FINDINGS Coronary atherosclerosis is the underlying disease of myocardial infarction, the leading cause of death in the industrialized world. Conventional ways of risk assessment, including evaluation of traditional risk factors and interrogation of luminal stenosis, have proven imprecise for the prediction of major events. Rapid advances in noninvasive imaging techniques including MRI, CT, and PET, as well as catheter-based methods, have opened the doors to more in-depth interrogation of plaque burden, composition, and many crucial pathological processes such as inflammation and hemorrhage. These emerging imaging modalities and methodologies, combined with conventional imaging evidences of anatomy and ischemia, offer the promises to provide comprehensive information of the disease status. There is tremendous clinical potential for imaging to improve the current management of coronary atherosclerosis, including the identification of high-risk patients for aggressive therapies and guiding personalized treatment. In this review, we provide an overview of the state-of-the-art coronary plaque imaging techniques focusing on their respective strengths and weaknesses, as well as their clinical outlook.
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Affiliation(s)
- Yibin Xie
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, 8700 Beverly Blvd., PACT Suite 400, Los Angeles, CA, 90048, USA
| | - Hang Jin
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, 8700 Beverly Blvd., PACT Suite 400, Los Angeles, CA, 90048, USA
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, 8700 Beverly Blvd., PACT Suite 400, Los Angeles, CA, 90048, USA.
- Department of Bioengineering, University of California, Los Angeles, CA, USA.
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Hoang V, Grounds J, Pham D, Virani S, Hamzeh I, Qureshi AM, Lakkis N, Alam M. The Role of Intracoronary Plaque Imaging with Intravascular Ultrasound, Optical Coherence Tomography, and Near-Infrared Spectroscopy in Patients with Coronary Artery Disease. Curr Atheroscler Rep 2017; 18:57. [PMID: 27485540 DOI: 10.1007/s11883-016-0607-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The development of multiple diagnostic intracoronary imaging modalities has increased our understanding of coronary atherosclerotic disease. These imaging modalities, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), have provided a method to study plaques and introduced the concept of plaque vulnerability. They are being increasingly used for percutaneous coronary intervention (PCI) optimization and are invaluable tools in research studying the pathophysiology of acute coronary syndrome (ACS), in-stent thrombosis and in-stent restenosis. IVUS has the ability to visualize the intracoronary lumen and the vessel wall and can be used to detect early atherosclerotic disease even in the setting of positive arterial remodeling. Studies supporting the use of IVUS to optimize stent deployment and apposition have shown a significant reduction in cardiovascular events. OCT provides even higher resolution imaging and near microscopic detail of plaques, restenoses, and thromboses; thus, it can identify the etiology of ACS. Ongoing trials are evaluating the role of OCT in PCI and using OCT to study stent endothelialization and neointimal proliferation. NIRS is a modality capable of localizing and quantifying lipid core burden. It is usually combined with IVUS and is used to characterize plaque composition. The benefits of NIRS in the setting of ACS have been limited to case reports and series. The utilization of all these intracoronary imaging modalities will continue to expand as their indications for clinical use and research grow. Studies to support their use for PCI optimization resulting in improved outcomes with potential to prevent downstream events are ongoing.
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Affiliation(s)
- Vu Hoang
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Jill Grounds
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Don Pham
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Salim Virani
- Department of Internal Medicine, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development and Section of Cardiology, Baylor College of Medicine, Houston, USA
| | - Ihab Hamzeh
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Athar Mahmood Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Childrens Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Nasser Lakkis
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Mahboob Alam
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA.
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Pujol-López M, Ortega-Paz L, Garabito M, Brugaletta S, Sabaté M, Paula Dantas A. miRNA Update: A Review Focus on Clinical Implications of miRNA in Vascular Remodeling. AIMS MEDICAL SCIENCE 2017. [DOI: 10.3934/medsci.2017.1.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Kennedy MW, Hermanides RS, Kaplan E, Hemradj V, Fabris E, Koopmans PC, Dambrink JHE, Gosselink ATM, Van't Hof AWJ, Ottervanger JP, Roolvink V, Remkes WS, van der Sluis A, Suryapranata H, Kedhi E. Fractional Flow Reserve-Guided Deferred Versus Complete Revascularization in Patients With Diabetes Mellitus. Am J Cardiol 2016; 118:1293-1299. [PMID: 27614852 DOI: 10.1016/j.amjcard.2016.07.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022]
Abstract
To assess the safety and efficacy of deferred versus complete revascularization using a fractional flow reserve (FFR)-guided strategy in patients with diabetes mellitus (DM), we analyzed all DM patients who underwent FFR-guided revascularization from January 1, 2010, to December 12, 2013. Patients were divided into 2 groups: those with ≥1 remaining FFR-negative (>0.80) medically treated lesions [FFR(-)MT] and those with only FFR-positive lesions (≤0.80) who underwent complete revascularization [FFR(+)CR] and were followed until July 1, 2015. The primary end point was the incidence of major adverse cardiovascular events (MACE), a composite of death, myocardial infarction (MI), target lesion (FFR assessed) revascularization, and rehospitalization for acute coronary syndrome. A total of 294 patients, 205 (69.7%) versus 89 (30.3%) in FFR(-)MT and FFR(+)CR, respectively, were analyzed. At a mean follow-up of 32.6 ± 18.1 months, FFR(-)MT was associated with higher MACE rate 44.0% versus 26.6% (log-rank p = 0.02, Cox regression-adjusted hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.21 to 3.33, p <0.01), and driven by both safety and efficacy end points: death/MI (HR 2.02, 95% CI 1.06 to 3.86, p = 0.03), rehospitalization for acute coronary syndrome (HR 2.06, 95% CI 1.03 to 4.10, p = 0.04), and target lesion revascularization (HR 3.38, 95% CI 1.19 to 9.64, p = 0.02). Previous MI was a strong effect modifier within the FFR(-)MT group (HR 1.98, 95% CI 1.26 to 3.13, p <0.01), whereas this was not the case in the FFR(+)CR group (HR 0.66, 95% CI 0.27 to 1.62, p = 0.37). Significant interaction for MACE was present between FFR groups and previous MI (p = 0.03). In conclusion, in patients with DM, particularly those with previous MI, deferred revascularization is associated with poor medium-term outcomes. Combining FFR with imaging techniques may be required to guide our treatment strategy in these patients with high-risk, fast-progressing atherosclerosis.
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Affiliation(s)
- Mark W Kennedy
- Isala Hartcentrum, Zwolle, The Netherlands; Diagram CRO, Zwolle, The Netherlands
| | | | | | | | - Enrico Fabris
- Isala Hartcentrum, Zwolle, The Netherlands; Diagram CRO, Zwolle, The Netherlands
| | | | | | | | | | | | | | | | | | - Harry Suryapranata
- Isala Hartcentrum, Zwolle, The Netherlands; Diagram CRO, Zwolle, The Netherlands
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Kedhi E, Kennedy MW, Maehara A, Lansky AJ, McAndrew TC, Marso SP, De Bruyne B, Serruys PW, Stone GW. Impact of TCFA on Unanticipated Ischemic Events in Medically Treated Diabetes Mellitus: Insights From the PROSPECT Study. JACC Cardiovasc Imaging 2016; 10:451-458. [PMID: 27372016 DOI: 10.1016/j.jcmg.2015.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to investigate the relationship between thin-cap fibroatheromas (TCFAs) on major adverse cardiac events (MACEs) arising from medically treated nonculprit lesions (NCLs) in patients with acute coronary syndromes (ACS) with and without diabetes mellitus (DM). BACKGROUND MACEs occur frequently in patients with DM and ACS. The impact of plaque composition on subsequent MACEs in DM patients with ACS is unknown. METHODS In the PROSPECT (Providing Regional Observations Study Predictors of Events in the Coronary Tree) study, using 3-vessel radiofrequency intravascular ultrasound, we analyzed the incidence of NCL-MACE in 2 propensity-matched groups according to the presence of DM and TCFA. RESULTS Among 697 patients, 119 (17.7%) had DM. The 3-year total MACE rate (29.4% vs. 18.8%; p = 0.01) was significantly higher in patients with versus without DM, driven by a higher rate of NCL-MACE in DM (18.7% vs. 10.4%; p = 0.02). Propensity score matching generated 2 balanced groups with and without DM of 82 patients each. Among DM patients, the presence of ≥1 TCFA was associated with higher NCL-MACE at 3 years (27.8% vs. 8.9% in patients without a TCFA, hazard ratio: 3.56; 95% confidence interval: 0.98 to 12.96; p = 0.04). DM patients without a TCFA had a similar 3-year rate of NCL-MACE as patients without DM (8.9% vs. 8.9%; hazard ratio: 1.09; 95% confidence interval: 0.27 to 4.41; p = 0.90). CONCLUSIONS ACS patients with DM and ≥1 TCFA have a high rate of NCL-MACE at 3 years. In contrast, the prognosis of ACS patients with DM but no TCFAs is favorable and similar to patients without DM.
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Affiliation(s)
| | | | - Akiko Maehara
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | | | | | - Steven P Marso
- Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri
| | | | | | - Gregg W Stone
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
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Intracoronary Near-Infrared Spectroscopy (NIRS) Imaging for Detection of Lipid Content of Coronary Plaques: Current Experience and Future Perspectives. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:426-430. [PMID: 24098825 PMCID: PMC3784048 DOI: 10.1007/s12410-013-9224-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute coronary syndromes are frequently caused by “vulnerable” coronary plaques with a lipid-rich core. In 1993 near-infrared spectroscopy (NIRS) was first used to detect the lipid (cholesterol) content of atherosclerotic plaques in an experimental animal study. NIRS was then carefully validated using human atherosclerotic plaques (ex vivo), and has subsequently been developed for intracoronary imaging in humans, for which now an FDA-approved catheter-based NIRS system is available. NIRS provides a “chemogram” of the coronary artery wall and is used to detect lipid-rich plaques. Using this technology, recent studies have shown that lipid-rich plaques are very frequent in the culprit lesion of patients with an acute coronary syndrome, and are also common in non-culprit coronary lesions in these patients as compared to patients with stable coronary disease. First studies are evaluating the impact of statin therapy on coronary NIRS-detected lipid cores. Intracoronary NIRS imaging represents a highly interesting method for coronary plaque characterization in humans and may become a valuable tool for the development of novel therapies aiming to impact on the biology of human coronary artery plaques, likely in combination with other intracoronary imaging techniques, such as optical coherence tomography.
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