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Nie Y, Lu N, Liao L, Liu Z, Gu A, Huang X, Tie C, Liu H, Huang Z, Xie G. Black-Blood Magnetization Prepared 2 Rapid Acquisition Gradient Echoes: A Fast and Three-Dimensional MR Black-Blood T 1 Mapping Technique for Quantitative Assessment of Atherosclerosis and Venous Thrombosis. J Magn Reson Imaging 2024; 60:1148-1162. [PMID: 38009385 DOI: 10.1002/jmri.29156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Blood flow signals may be a confounder in quantifying T1 values of plaque or thrombus and how to realize black-blood T1 mapping remains a challenge task. PURPOSE To develop a fast and three-dimensional black-blood T1 mapping technique for quantitative assessment of atherosclerosis and venous thrombosis. STUDY TYPE Sequence development and optimization via phantoms and volunteers as well as pilot prospective. PHANTOM AND SUBJECTS Numerical simulations, a standard phantom, 8 healthy volunteers (mean age, 22 ± 1 years; 5 males), and 19 patients (mean age, 57 ± 14 years; 13 males) with atherosclerosis or venous thrombosis. FIELD STRENGTH/SEQUENCE 3T/inversion recovery spin-echo sequence (IR-SE), magnetization prepared 2 rapid acquisition gradient echoes (MP2RAGE), and black-blood prepared MP2RAGE (BB-MP2RAGE). ASSESSMENT The black-blood preparation (i.e., delay alternating with nutation for tailored excitation, DANTE) was incorporated into MP2RAGE for black-blood T1 mapping. The BB-MP2RAGE was optimized numerically based on the Bloch equation, and then the phantom study was performed to verify the accuracy of T1 mapping by BB-MP2RAGE against IR-SE and MP2RAGE. Preliminary clinical validation was prospectively performed to assess the flow suppression effect and its potential application in plaque and thrombosis identification. STATISTICAL TESTS Pearson correlation test, Bland-Altman analysis, paired t-test, and intraclass correlation coefficient. A P value <0.05 indicates a statistically significant difference. RESULTS Phantom experiments showed comparable accuracy of T1 maps by BB-MP2RAGE with IR-SE and MP2RAGE (all r2 > 0.99); Compared to MP2RAGE, BB-MP2RAGE effectively nulled the blood flow signals, and had a significant improvement in contrast-to-noise ratio between static tissue and blood (250.5 ± 66.6 vs. 91.9 ± 35.9). BB-MP2RAGE can quantify plaque or thrombus T1 relaxation time with blood flow signal suppression. DATA CONCLUSION Accurate T1 mapping with sufficient blood flow suppression was achieved by BB-MP2RAGE. BB-MP2RAGE has the potential to quantitatively characterize atherosclerosis and venous thrombosis. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Yuhui Nie
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Na Lu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liping Liao
- Department of Radiology, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Zeping Liu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Anyan Gu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Huang
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Changjun Tie
- Paul C. Lauterbur Imaging Center, Shenzhen Institutes Advanced Technology, Shenzhen, Guangdong, China
| | - Hongyan Liu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zehe Huang
- Department of Radiology, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Guoxi Xie
- School of Biomedical Engineering, The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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Hupin D, Oriol M, Laukkanen JA, Abraham P, Dulac N, Laugier S, Trauchessec G, Carmaux A, Haber B, Bertoletti L, Costa AD, Roche F. Screening Sportsmen and Sportswomen Over Age 35: The Relevance of an Exercise Electrocardiogram. Data From the SEEPRED Study. Scand J Med Sci Sports 2024; 34:e14686. [PMID: 38961532 DOI: 10.1111/sms.14686] [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: 12/29/2023] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION The importance of exercise electrocardiogram (ECG) is still controversial in the prevention of cardiovascular events among sportsmen and sportswomen. The aim of this study was to assess the relevance of exercise ECG as a screening tool to prevent cardiovascular events when any cardiovascular disease (CVD) risk factors are present. METHODS The study included leisure time asymptomatic sportsmen and sportswomen over age 35 evaluated from 2011 to 2016 at the University Hospital of Saint-Etienne (France). Major adverse cardiovascular events (MACE) and atrial fibrillation were collected at 3 years. RESULTS Of the cohort of 2457 sportsmen and sportswomen (mean age 50.2 ± 9.4 years), 50 (2%) had a high-risk SCORE2. A total of 256 exercise ECGs (10%) were defined as positive, most of them due to silent myocardial ischemia (SMI) (n = 196; 8%). These 196 SMI cases led to 33 coronary angiograms (1%), which revealed 23 significant coronary stenoses requiring revascularization. In multivariate logistic regression analysis, having at least two CVD risk factors was independently associated with (1) positive exercise ECG (OR = 1.80 [95% CI: 1.29-2.52], p = 0.0006), with (2) suspected SMI (OR = 2.57 [95% CI: 1.10-6.02], p = 0.0304), with (3) confirmed SMI (OR = 8.20 [95% CI: 3.46-19.46], p < 0.0001) and with (4) cardiovascular events (MACE or atrial fibrillation) (OR = 6.95 [95% CI: 3.49-13.81], p < 0.0001) at 3 years (median). CONCLUSIONS The study supports the European recommendations for the use of exercise ECG in evaluation of asymptomatic leisure time sportsmen over age 35. Having at least two CVD risk factors was the best predictor for presence of coronary artery stenosis that may increase the risk for adverse events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06024863.
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Affiliation(s)
- David Hupin
- Univ Jean Monnet, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Mathieu Oriol
- Support and Education Technic Centre of Health Examination Centres, CETAF, Saint-Etienne, France
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pierre Abraham
- IMITOVASC Institute, UMR CNRS 6015 UMR INSERM 1083, University of Angers, Angers, France
- Sports and Exercise Medicine and Vascular Medicine, University Hospital, Angers, France
| | - Nathan Dulac
- Faculty of Medicine, UJM-Saint-Etienne, Saint-Etienne, France
| | - Simon Laugier
- Faculty of Medicine, UJM-Saint-Etienne, Saint-Etienne, France
| | | | - Antoine Carmaux
- Univ Jean Monnet, Department of Cardiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Benjamain Haber
- Univ Jean Monnet, Department of Cardiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Laurent Bertoletti
- Univ Jean Monnet, Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Antoine Da Costa
- Univ Jean Monnet, Department of Cardiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
| | - Frédéric Roche
- Univ Jean Monnet, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Mines Saint-Étienne, INSERM U 1059, Saint-Étienne, France
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Cen K, Huang Y, Xie Y, Liu Y. The guardian of intracranial vessels: Why the pericyte? Biomed Pharmacother 2024; 176:116870. [PMID: 38850658 DOI: 10.1016/j.biopha.2024.116870] [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: 03/02/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
Intracranial atherosclerotic stenosis (ICAS) is a pathological condition characterized by progressive narrowing or complete blockage of intracranial blood vessels caused by plaque formation. This condition leads to reduced blood flow to the brain, resulting in cerebral ischemia and hypoxia. Ischemic stroke (IS) resulting from ICAS poses a significant global public health challenge, especially among East Asian populations. However, the underlying causes of the notable variations in prevalence among diverse populations, as well as the most effective strategies for preventing and treating the rupture and blockage of intracranial plaques, remain incompletely comprehended. Rupture of plaques, bleeding, and thrombosis serve as precipitating factors in the pathogenesis of luminal obstruction in intracranial arteries. Pericytes play a crucial role in the structure and function of blood vessels and face significant challenges in regulating the Vasa Vasorum (VV)and preventing intraplaque hemorrhage (IPH). This review aims to explore innovative therapeutic strategies that target the pathophysiological mechanisms of vulnerable plaques by modulating pericyte biological function. It also discusses the potential applications of pericytes in central nervous system (CNS) diseases and their prospects as a therapeutic intervention in the field of biological tissue engineering regeneration.
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Affiliation(s)
- Kuan Cen
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China
| | - YinFei Huang
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China
| | - Yu Xie
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China
| | - YuMin Liu
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China.
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Sun M, Liu W, Jiang H, Wu X, Zhang S, Liu H. Large-scale, comprehensive plasma metabolomic analyses reveal potential biomarkers for the diagnosis of early-stage coronary atherosclerosis. Clin Chim Acta 2024; 562:119832. [PMID: 38936535 DOI: 10.1016/j.cca.2024.119832] [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: 01/09/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Coronary atherosclerosis (CAS) is a prevalent and chronic life-threatening disease. However, the detection of CAS at an early stage is difficult because of the lack of effective noninvasive diagnostic methods. The present study aimed to characterize the plasma metabolome of early-stage CAS patients to discover metabolomic biomarkers, develop a novel metabolite-based model for accurate noninvasive diagnosis of early-stage CAS, and explore the underlying metabolic mechanisms involved. METHODS A total of 100 patients with early-stage CAS and 120 age- and sex-matched control subjects were recruited from the Chinese Han population and further randomly divided into training (n = 120) and test sets (n = 100). The metabolomic profiles of the plasma samples were analyzed by an integrated untargeted liquid chromatography-mass spectrometry approach, including two separation modes and two ionization modes. Univariate and multivariate statistical analyses were employed to identify potential biomarkers and construct an early-stage CAS diagnostic model. RESULTS The integrated analytical method established herein improved metabolite coverage compared with single chromatographic separation and MS ionization mode. A total of 80 metabolites were identified as potential biomarkers of early-stage CAS, and these metabolites were mainly involved in glycerophospholipid, fatty acid, sphingolipid, and amino acid metabolism. An effective diagnostic model for early-stage CAS was established, incorporating 11 metabolites and achieving areas under the receiver operating characteristic curve (AUCs) of 0.984 and 0.908 in the training and test sets, respectively. CONCLUSIONS Our study not only successfully developed an effective noninvasive diagnostic model for identifying early-stage CAS but also provided novel insights into the pathogenesis of CAS.
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Affiliation(s)
- Meng Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin 150086, PR China
| | - Wei Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin 150086, PR China
| | - Hao Jiang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin 150086, PR China
| | - Xiaoyan Wu
- Department of Epidemiology and Biostatistics, Guilin Medical University, Guilin 514499, PR China
| | - Shuo Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin 150086, PR China.
| | - Haixia Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, and The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin 150086, PR China.
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Li Y, Huo H, Liu H, Zheng Y, Tian Z, Jiang X, Jin S, Hou Y, Yang Q, Teng F, Liu T. Coronary CTA-based radiomic signature of pericoronary adipose tissue predict rapid plaque progression. Insights Imaging 2024; 15:151. [PMID: 38900243 PMCID: PMC11189889 DOI: 10.1186/s13244-024-01731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES To explore the value of radiomic features derived from pericoronary adipose tissue (PCAT) obtained by coronary computed tomography angiography for prediction of coronary rapid plaque progression (RPP). METHODS A total of 1233 patients from two centers were included in this multicenter retrospective study. The participants were divided into training, internal validation, and external validation cohorts. Conventional plaque characteristics and radiomic features of PCAT were extracted and analyzed. Random Forest was used to construct five models. Model 1: clinical model. Model 2: plaque characteristics model. Model 3: PCAT radiomics model. Model 4: clinical + radiomics model. Model 5: plaque characteristics + radiomics model. The evaluation of the models encompassed identification accuracy, calibration precision, and clinical applicability. Delong' test was employed to compare the area under the curve (AUC) of different models. RESULTS Seven radiomic features, including two shape features, three first-order features, and two textural features, were selected to build the PCAT radiomics model. In contrast to the clinical model and plaque characteristics model, the PCAT radiomics model (AUC 0.85 for training, 0.84 for internal validation, and 0.81 for external validation; p < 0.05) achieved significantly higher diagnostic performance in predicting RPP. The separate combination of radiomics with clinical and plaque characteristics model did not further improve diagnostic efficacy statistically (p > 0.05). CONCLUSION Radiomic feature analysis derived from PCAT significantly improves the prediction of RPP as compared to clinical and plaque characteristics. Radiomic analysis of PCAT may improve monitoring RPP over time. CRITICAL RELEVANCE STATEMENT Our findings demonstrate PCAT radiomics model exhibited good performance in the prediction of RPP, with potential clinical value. KEY POINTS Rapid plaque progression may be predictable with radiomics from pericoronary adipose tissue. Fibrous plaque volume, diameter stenosis, and fat attenuation index were identified as risk factors for predicting rapid plaque progression. Radiomics features of pericoronary adipose tissue can improve the predictive ability of rapid plaque progression.
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Affiliation(s)
- Yue Li
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Huaibi Huo
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Hui Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yue Zheng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Zhaoxin Tian
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xue Jiang
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Shiqi Jin
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Teng
- Department of Radiology, Chinese Academy of Medical Sciences Fuwai Hospital Shenzhen Hospital, Shenzhen, China.
| | - Ting Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China.
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Liu Y, Jiang Z, Yang X, Wang Y, Yang B, Fu Q. Engineering Nanoplatforms for Theranostics of Atherosclerotic Plaques. Adv Healthc Mater 2024; 13:e2303612. [PMID: 38564883 DOI: 10.1002/adhm.202303612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/28/2024] [Indexed: 04/04/2024]
Abstract
Atherosclerotic plaque formation is considered the primary pathological mechanism underlying atherosclerotic cardiovascular diseases, leading to severe cardiovascular events such as stroke, acute coronary syndromes, and even sudden cardiac death. Early detection and timely intervention of plaques are challenging due to the lack of typical symptoms in the initial stages. Therefore, precise early detection and intervention play a crucial role in risk stratification of atherosclerotic plaques and achieving favorable post-interventional outcomes. The continuously advancing nanoplatforms have demonstrated numerous advantages including high signal-to-noise ratio, enhanced bioavailability, and specific targeting capabilities for imaging agents and therapeutic drugs, enabling effective visualization and management of atherosclerotic plaques. Motivated by these superior properties, various noninvasive imaging modalities for early recognition of plaques in the preliminary stage of atherosclerosis are comprehensively summarized. Additionally, several therapeutic strategies are proposed to enhance the efficacy of treating atherosclerotic plaques. Finally, existing challenges and promising prospects for accelerating clinical translation of nanoplatform-based molecular imaging and therapy for atherosclerotic plaques are discussed. In conclusion, this review provides an insightful perspective on the diagnosis and therapy of atherosclerotic plaques.
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Affiliation(s)
- Yuying Liu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Zeyu Jiang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xiao Yang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Yin Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Bin Yang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Qinrui Fu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
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Yu MM, Wang ML, Wang JJ, Lin BL, Zhao X, Tao XW, Chen YY, Li PY, Zhang JK, Ge JB, Jin H, Zeng MS. Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque. J Am Coll Cardiol 2024; 83:1743-1755. [PMID: 38692827 DOI: 10.1016/j.jacc.2024.03.367] [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: 01/11/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Lipoprotein(a) (Lp[a]) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association has yet to be fully elucidated. OBJECTIVES This multicenter study aimed to investigate whether association between Lp(a) and MI risk is reinforced by the presence of low-attenuation plaque (LAP) identified by coronary computed tomography angiography (CCTA). METHODS In a derivation cohort, a total of 5,607 patients with stable chest pain suspected of coronary artery disease who underwent CCTA and Lp(a) measurement were prospectively enrolled. In validation cohort, 1,122 patients were retrospectively collected during the same period. High Lp(a) was defined as Lp(a) ≥50 mg/dL. The primary endpoint was a composite of time to fatal or nonfatal MI. Associations were estimated using multivariable Cox proportional hazard models. RESULTS During a median follow-up of 8.2 years (Q1-Q3: 7.2-9.3 years), the elevated Lp(a) levels were associated with MI risk (adjusted HR [aHR]: 1.91; 95% CI: 1.46-2.49; P < 0.001). There was a significant interaction between Lp(a) and LAP (Pinteraction <0.001) in relation to MI risk. When stratified by the presence or absence of LAP, Lp(a) was associated with MI in patients with LAP (aHR: 3.03; 95% CI: 1.92-4.76; P < 0.001). Mediation analysis revealed that LAP mediated 73.3% (P < 0.001) for the relationship between Lp(a) and MI. The principal findings remained unchanged in the validation cohort. CONCLUSIONS Elevated Lp(a) augmented the risk of MI during 8 years of follow-up, especially in patients with LAP identified by CCTA. The presence of LAP could reinforce the relationship between Lp(a) and future MI occurrence.
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Affiliation(s)
- Meng-Meng Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ming-Liang Wang
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin-Jin Wang
- Department of Radiology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Bo-Li Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Zhao
- Department of Cardiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | | | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Peng-Yang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jing-Kun Zhang
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Radiology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China.
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China.
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Ong HT, Chen J. Mental stress, atheroma, myocardial ischaemia and injury: the link is inflammation. Gen Psychiatr 2023; 36:e101282. [PMID: 38155845 PMCID: PMC10753718 DOI: 10.1136/gpsych-2023-101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
Increasing observational and experimental trial data have shown that mental stress can lead to an increase in adverse clinical cardiovascular events. Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction (MI) or direct myocardial injury. Mental stress leads to systemic inflammation. Inflammation is known to cause rapid atheromatous plaque progression, instability and thrombosis-the classic type 1 MI. Inflammation can also lead to type 2 MI or myocarditis and injury. The published data linking systemic inflammation, mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart, thereby highlighting the importance of holistically managing the patient, not only addressing separate organ systems. Finally, recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.
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Affiliation(s)
- Hean Teik Ong
- Cardiology, HT Ong Heart Clinic, Georgetown, Penang, Malaysia
| | - Jinghong Chen
- Editorial Office of General Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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García-Camarero T, Remuzgo-Martínez S, Genre F, López-Mejías R, Pulito-Cueto V, Veiga G, Lee Hwang DH, Sáinz Laso F, Gil Ongay A, González-Gay MÁ, de la Torre Hernández JM. Serum and genetic markers related to rapid clinical progression of coronary artery disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:1013-1020. [PMID: 37201714 DOI: 10.1016/j.rec.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with clinically evident coronary artery disease differ in their rate of progression, which impacts prognosis. We aimed to characterize serum and genetic markers in patients with rapid clinical progression (RCP) of coronary artery disease vs those with long standing stable (LSS) disease. METHODS Retrospective study of cases (RCP) and controls (LSS) (1:2). Patients requiring ≥ 2 revascularizations due to atherosclerotic progression in the 10 years after a first angioplasty were considered to be RCP and those without events during the same period after the first angioplasty were considered to have LSS disease. After patient selection, we analyzed serum values, mRNA expression and genetic polymorphisms of inflammatory markers, including interleukin-6, C-reactive protein, and tumor necrosis factor (TNF)-a, and atherogenic markers consisted of proprotein convertase subtilisin/kexin type 9 (PCSK9), low-density lipoprotein receptor, sterol regulatory element binding transcription factor 2, and apolipoprotein-B. RESULTS The study included 180 patients (58 RCP and 122 LSS). Demographic characteristics, classic risk factors and the extent of coronary disease were similar in the 2 groups. Patients with RCP showed higher serum levels of interleukin-6 and PCSK9 and higher TNF mRNA expression. Interleukin-6 rs180075C, TNF rs3093664 non-G and PCSK9 rs2483205 T alleles conferred a risk of RCP (P<.05 in all cases). Among patients with RCP, 51.7% had all 3 risk alleles vs 18% of those with LSS (P<.001). CONCLUSIONS We suggest the existence of specific phenotypic and genotypic markers associated with RCP of coronary artery disease that could help to individualize the type and intensity of treatment.
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Affiliation(s)
- Tamara García-Camarero
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain.
| | | | - Fernanda Genre
- Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | | | | | - Gabriela Veiga
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Dae-Hyun Lee Hwang
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Fermín Sáinz Laso
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Aritz Gil Ongay
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Miguel Ángel González-Gay
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - José M de la Torre Hernández
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
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Park HB, Arsanjani R, Sung JM, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study. Eur Heart J Cardiovasc Imaging 2023; 24:1536-1543. [PMID: 37232393 DOI: 10.1093/ehjci/jead110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
AIMS To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS We analyzed mild stenosis (25-49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02-3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09-2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07-2.22; P = 0.020). CONCLUSION In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02803411.
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Affiliation(s)
- Hyung-Bok Park
- Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Ran Heo
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sang-Eun Lee
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sanghoon Shin
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Habib Samady
- Department of Cardiology, Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | - Peter H Stone
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY 10029, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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11
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Aktan A, Güzel T. Prognostic value of age, creatinine, and left ventricular ejection fraction risk score in patients evaluated with fractional flow reserve: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230533. [PMID: 37610932 PMCID: PMC10443914 DOI: 10.1590/1806-9282.20230533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE In this study, we investigated the relationship between age, creatinine, and left ventricular ejection fraction risk score and the severity of coronary lesions detected by applying fractional flow reserve in the patient group presenting with chronic coronary syndrome. Also, we presented long-term follow-up results in patients whose age, creatinine, and left ventricular ejection fraction score was evaluated by the fractional flow reserve procedure. METHODS This study was planned retrospectively and in two centers. For this purpose, 114 patients who met the study criteria and who underwent elective fractional flow reserve between January 2014 and January 2019 were included in the study. Age, creatinine, and left ventricular ejection fraction was calculated as age/left ventricular ejection fraction +1 (if estimated glomerular filtration rate<30 mL/min). RESULTS They were divided into two groups according to the cutoff value of the age, creatinine, and left ventricular ejection fraction score. A total of 76 patients had an age, creatinine, and left ventricular ejection fraction score of ≤1.17 (Group I) and 38 patients had an age, creatinine, and left ventricular ejection fraction score of >1.17 (Group II). The number of patients with severe lesions in fractional flow reserve was significantly higher in Group II compared with Group I (60.5 vs. 32.9%, p=0.005). According to the Kaplan-Meier analysis, a significant increase was observed in major adverse cardiac events and mortality during the follow-up period in the group with a high-risk score (Log Rank: 15.01, p<0.001 and Log Rank: 8.51, p=0.004, respectively). CONCLUSION In light of the data we obtained from our study, we found a correlation between the severity of the lesion detected in fractional flow reserve and the age, creatinine, and left ventricular ejection fraction scores. In addition, we found that patients with high age, creatinine, and left ventricular ejection fraction scores had higher mortality and major adverse cardiac events rates during follow-up.
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Affiliation(s)
- Adem Aktan
- Mardin Training and Research Hospital, Department of Cardiology - Mardin, Turkey
| | - Tuncay Güzel
- Health Science University, Gazi Yaşargil Training and Research Hospital, Department of Cardiology - Diyarbakır, Turkey
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12
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Buckler AJ, Doros G, Kinninger A, Lakshmanan S, Le VT, Libby P, May HT, Muhlestein JB, Nelson JR, Nicolaou A, Roy SK, Shaikh K, Shekar C, Tayek JA, Zheng L, Bhatt DL, Budoff MJ. Quantitative imaging biomarkers of coronary plaque morphology: insights from EVAPORATE. Front Cardiovasc Med 2023; 10:1204071. [PMID: 37600044 PMCID: PMC10435977 DOI: 10.3389/fcvm.2023.1204071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
Aims Residual cardiovascular risk persists despite statin therapy. In REDUCE-IT, icosapent ethyl (IPE) reduced total events, but the mechanisms of benefit are not fully understood. EVAPORATE evaluated the effects of IPE on plaque characteristics by coronary computed tomography angiography (CCTA). Given the conclusion that the IPE-treated patients demonstrate that plaque burden decreases has already been published in the primary study analysis, we aimed to demonstrate whether the use of an analytic technique defined and validated in histological terms could extend the primary study in terms of whether such changes could be reliably seen in less time on drug, at the individual (rather than only at the cohort) level, or both, as neither of these were established by the primary study result. Methods and Results EVAPORATE randomized the patients to IPE 4 g/day or placebo. Plaque morphology, including lipid-rich necrotic core (LRNC), fibrous cap thickness, and intraplaque hemorrhage (IPH), was assessed using the ElucidVivo® (Elucid Bioimaging Inc.) on CCTA. The changes in plaque morphology between the treatment groups were analyzed. A neural network to predict treatment assignment was used to infer patient representation that encodes significant morphological changes. Fifty-five patients completed the 18-month visit in EVAPORATE with interpretable images at each of the three time points. The decrease of LRNC between the patients on IPE vs. placebo at 9 months (reduction of 2 mm3 vs. an increase of 41 mm3, p = 0.008), widening at 18 months (6 mm3 vs. 58 mm3 increase, p = 0.015) were observed. While not statistically significant on a univariable basis, reductions in wall thickness and increases in cap thickness motivated multivariable modeling on an individual patient basis. The per-patient response assessment was possible using a multivariable model of lipid-rich phenotype at the 9-month follow-up, p < 0.01 (sustained at 18 months), generalizing well to a validation cohort. Conclusion Plaques in the IPE-treated patients acquired more characteristics of stability. Reliable assessment using histologically validated analysis of individual response is possible at 9 months, with sustained stabilization at 18 months, providing a quantitative basis to elucidate drug mechanism and assess individual patient response.
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Affiliation(s)
- Andrew J. Buckler
- Department of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Elucid Bioimaging Inc., Boston, MA, United States
| | | | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Suvasini Lakshmanan
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Viet T. Le
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, United States
- Rocky Mountain University of Health Profession, Provo, UT, United States
| | - Peter Libby
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, United States
| | - Heidi T. May
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, United States
| | - Joseph B. Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, United States
| | - John R. Nelson
- California Cardiovascular Institute, Fresno, CA, United States
| | | | - Sion K. Roy
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Kashif Shaikh
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Chandana Shekar
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - John A. Tayek
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Luke Zheng
- BAIM Institute, Boston, MA, United States
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, United States
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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13
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Li C, Wang Z, Yang H, Hong H, Li C, Xu R, Wu Y, Zhang F, Qian J, Chen L, Tu S, Ge J. The Association Between Angiographically Derived Radial Wall Strain and the Risk of Acute Myocardial Infarction. JACC Cardiovasc Interv 2023; 16:1039-1049. [PMID: 37164601 DOI: 10.1016/j.jcin.2023.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND The radial wall strain (RWS) is a novel angiography-based method to assess the biomechanical property of the coronary artery and whether it can predict future acute myocardial infarction (AMI) events remains to be elucidated. OBJECTIVES This study aimed to investigate the association between angiography-derived RWS and future AMI events in mild to intermediate lesions. METHODS We performed a matched case-control analysis nested in a retrospective cohort of patients who had received prior angiography (the index procedure) at least 1 month before and were hospitalized again for repeat angiography. Patients with at least 1 de novo mild to intermediate lesion identified at the index procedure and eligible for RWS analysis were enrolled. The study identified cases with target lesion-related AMI diagnosed at the repeat angiography, matching each case to 3 control subjects without AMI. RESULTS Altogether 44 patients with lesion-related AMI and 132 matched controls were enrolled. The median diameter stenosis of the overall interrogated lesions was 34.0%. The baseline maximum RWS (RWSmax), which was defined as the highest RWS in the stenotic segment, was significantly higher in lesions responsible for AMI than those that remained quiescent (median 13% vs 10%; P < 0.001). RWSmax was predictive of lesion-related AMI, with an area under the curve of 0.83 (95% CI: 0.76-0.90; P < 0.001) and an optimal cutoff >12%. RWSmax >12% was found to be independently associated with subsequent AMI events with a risk ratio of 7.25 (95% CI: 3.94-13.37; P < 0.001). CONCLUSIONS Among angiographically mild to intermediate lesions, a high-strain pattern identified by angiography-derived RWS was associated with an increased risk of AMI events.
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Affiliation(s)
- Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhiqing Wang
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Huihong Hong
- Department of Cardiology, the First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Rende Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
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López-Candales A, Sawalha K. Improving diagnostic assessments in the ever-changing landscape of atherosclerosis. J Cardiovasc Med (Hagerstown) 2023; 24:221-229. [PMID: 36952387 DOI: 10.2459/jcm.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagnostic approaches. Emerging data have recently challenged our basic understanding in linking ischemia to its adverse outcomes as well as the need for invasive testing for both diagnosis and treatment. The advent of coronary computed tomography in providing improved visualization of coronary arteries has led to the identification of both subclinical atherosclerosis and high-risk coronary lesions. Recognition of asymptomatic coronary artery disease (CAD) with objective localization of subclinical coronary atherosclerosis improves atherosclerotic cardiovascular risk assessment and allows healthcare providers to take effective primary prevention measures. Therefore, reshaping the diagnostic landscape in proposing new testing modalities would be highly dependent on local resource availability and the reading expertise of each clinical practice and medical institution. The main objective of this Review is to propose a potentially new diagnostic approach of simply using noninvasive stress testing or coronary angiography in the routine assessment of CAD.
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Affiliation(s)
| | - Khalid Sawalha
- Nutrition and Metabolism Fellowship, University of Missouri-Kansas City, Kansas City, Missouri, USA
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15
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Kitada R, Otsuka K, Fukuda D. Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia. Front Cardiovasc Med 2023; 10:1095806. [PMID: 37008333 PMCID: PMC10063905 DOI: 10.3389/fcvm.2023.1095806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/21/2023] [Indexed: 03/19/2023] Open
Abstract
Chronic coronary syndrome (CCS) is a progressive disease, which often first manifests as acute coronary syndrome (ACS). Imaging modalities are clinically useful in making decisions about the management of patients with CCS. Accumulating evidence has demonstrated that myocardial ischemia is a surrogate marker for CCS management; however, its ability to predict cardiovascular death or nonfatal myocardial infarction is limited. Herein, we present a review that highlights the latest knowledge available on coronary syndromes and discuss the role and limitations of imaging modalities in the diagnosis and management of patients with coronary artery disease. This review covers the essential aspects of the role of imaging in assessing myocardial ischemia and coronary plaque burden and composition. Furthermore, recent clinical trials on lipid-lowering and anti-inflammatory therapies have been discussed. Additionally, it provides a comprehensive overview of intracoronary and noninvasive cardiovascular imaging modalities and an understanding of ACS and CCS, with a focus on histopathology and pathophysiology.
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16
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Tan N, Dey D, Marwick TH, Nerlekar N. Pericoronary Adipose Tissue as a Marker of Cardiovascular Risk: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:913-923. [PMID: 36858711 DOI: 10.1016/j.jacc.2022.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 03/03/2023]
Abstract
Vascular inflammation is a key driver in atherosclerotic progression and plaque rupture. Recent evidence has shown that coronary computed tomography provides a noninvasive method of quantifying coronary inflammation by mapping changes in pericoronary adipose tissue (PCAT) radiodensity, which are associated with cardiovascular diseases. However, there are significant knowledge gaps in the performance and measurement of PCAT that complicate its interpretation. In this review the authors aim to summarize the role of PCAT in cardiac imaging and explore the clinical implications and applicability as a novel biomarker of cardiovascular risk, as well as to discuss its limitations and potential pitfalls.
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Affiliation(s)
- Neville Tan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Thomas H Marwick
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Nitesh Nerlekar
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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17
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Virtual pathology: Reaching higher standards for noninvasive CTA tissue characterization capability by using histology as a truth standard. Eur J Radiol 2023; 159:110686. [PMID: 36603478 DOI: 10.1016/j.ejrad.2022.110686] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/01/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
AIMS Despite advances in therapy, reduction in myocardial infarction or death remains elusive. Whereas computed tomography angiography (CTA) is increasingly appreciated, the analyses are often subjective or qualitative. Methods for specific tissue characterization using histopathologic correlates have recently been reported. We extend this here to demonstrate accurate discrimination between, and quantitation of, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrotic tissues. METHODS NCT02143102 collected 576 tissue samples with paired CTA. Cardiovascular pathologists annotated LRNC, IPH, and dense calcification (CALC) regions as a reference standard. Blinded to histology, CTA was analyzed using ElucidVivo (Elucid Bioimaging Inc., Boston, MA USA). Structure and tissue characteristics of atherosclerotic plaque from CTA, accounting for both the imaging acquisition process and the biology, accounting for differences in density distributions that result from the different cellular and molecular level milieu of the relevant tissue types. RESULTS LRNC was tested across a true range of 0-10 mm2, with a difference of 0.15 mm2 and a slope of 0.92. IPH was tested across a true range of 0-18 mm2, with a difference from histology of 1.68 mm2 and a slope of 0.95. CALC was tested across a range of 0-14 mm2, with a difference of -0.06 mm2 and a slope of 0.99. Matrix tissue (MATX) was tested across a range of 4-52 mm2, with a difference of 0.02 mm2 and a slope of 0.91. CONCLUSION LRNC, IPH, CALC, and MATX may be objectively quantified using histopathologic correlates automatically from CTA for use singly or in combination to optimize patient care. The availability of objectively validated quantitative markers that may be followed longitudinally may extend the clinical utility of CTA. Additionally, these measures contribute efficacy variables for developing novel drugs and clinical decision support tools for tailored therapeutics.
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18
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Jonas RA, Crabtree TR, Jennings RS, Marques H, Katz RJ, Chang HJ, Stuijfzand WJ, van Rosendael AR, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Al-Mallah MH, Guglielmo M, Bax JJ, Earls JP, Min JK, Choi AD, Villines TC. Diabetes, Atherosclerosis, and Stenosis by AI. Diabetes Care 2023; 46:416-424. [PMID: 36577120 PMCID: PMC9887618 DOI: 10.2337/dc21-1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study evaluates the relationship between atherosclerotic plaque characteristics (APCs) and angiographic stenosis severity in patients with and without diabetes. Whether APCs differ based on lesion severity and diabetes status is unknown. RESEARCH DESIGN AND METHODS We retrospectively evaluated 303 subjects from the Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia (CREDENCE) trial referred for invasive coronary angiography with coronary computed tomographic angiography (CCTA) and classified lesions as obstructive (≥50% stenosed) or nonobstructive using blinded core laboratory analysis of quantitative coronary angiography. CCTA quantified APCs, including plaque volume (PV), calcified plaque (CP), noncalcified plaque (NCP), low-density NCP (LD-NCP), lesion length, positive remodeling (PR), high-risk plaque (HRP), and percentage of atheroma volume (PAV; PV normalized for vessel volume). The relationship between APCs, stenosis severity, and diabetes status was assessed. RESULTS Among the 303 patients, 95 (31.4%) had diabetes. There were 117 lesions in the cohort with diabetes, 58.1% of which were obstructive. Patients with diabetes had greater plaque burden (P = 0.004). Patients with diabetes and nonobstructive disease had greater PV (P = 0.02), PAV (P = 0.02), NCP (P = 0.03), PAV NCP (P = 0.02), diseased vessels (P = 0.03), and maximum stenosis (P = 0.02) than patients without diabetes with nonobstructive disease. APCs were similar between patients with diabetes with nonobstructive disease and patients without diabetes with obstructive disease. Diabetes status did not affect HRP or PR. Patients with diabetes had similar APCs in obstructive and nonobstructive lesions. CONCLUSIONS Patients with diabetes and nonobstructive stenosis had an association to similar APCs as patients without diabetes who had obstructive stenosis. Among patients with nonobstructive disease, patients with diabetes had more total PV and NCP.
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Affiliation(s)
- Rebecca A. Jonas
- Department of Internal Medicine, Thomas Jefferson University Medical Center; Philadelphia, PA
- Corresponding author: Rebecca A. Jonas,
| | | | | | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Richard J. Katz
- The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J. Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Kang Won National University Hospital, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women’s University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, AL
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | | | - Ryo Nakazato
- Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan
| | | | - Roel S. Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel J. Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | - James J. Jang
- Kaiser Permanente San Jose Medical Center, San Jose, CA
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, NV
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary’s Hospital, Athens, GA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, NJ
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Guus A. de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Marco Guglielmo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Amsterdam, the Netherlands
| | | | | | - Andrew D. Choi
- The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Todd C. Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA
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19
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Stone PH, Libby P, Boden WE. Fundamental Pathobiology of Coronary Atherosclerosis and Clinical Implications for Chronic Ischemic Heart Disease Management-The Plaque Hypothesis: A Narrative Review. JAMA Cardiol 2023; 8:192-201. [PMID: 36515941 PMCID: PMC11016334 DOI: 10.1001/jamacardio.2022.3926] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Recent clinical and imaging studies underscore that major adverse cardiac events (MACE) outcomes are associated not solely with severe coronary obstructions (ischemia hypothesis or stenosis hypothesis), but with the plaque burden along the entire coronary tree. New research clarifies the pathobiologic mechanisms responsible for plaque development/progression/destabilization leading to MACE (plaque hypothesis), but the translation of these insights to clinical management strategies has lagged. This narrative review elaborates the plaque hypothesis and explicates the current understanding of underlying pathobiologic mechanisms, the provocative destabilizing influences, the diagnostic and therapeutic implications, and their actionable clinical management approaches to optimize the management of patients with chronic coronary disease. Observations Clinical trials of management strategies for patients with chronic coronary artery disease demonstrate that while MACE rate increases progressively with the anatomic extent of coronary disease, revascularization of the ischemia-producing obstruction does not forestall MACE. Most severely obstructive coronary lesions often remain quiescent and seldom destabilize to cause a MACE. Coronary lesions that later provoke acute myocardial infarction often do not narrow the lumen critically. Invasive and noninvasive imaging can identify the plaque anatomic characteristics (plaque burden, plaque topography, lipid content) and local hemodynamic/biomechanical characteristics (endothelial shear stress, plaque structural stress, axial plaque stress) that can indicate the propensity of individual plaques to provoke a MACE. Conclusions and Relevance The pathobiologic construct concerning the culprit region of a plaque most likely to cause a MACE (plaque hypothesis), which incorporates multiple convergent plaque features, informs the evolution of a new management strategy capable of identifying the high-risk portion of plaque wherever it is located along the course of the coronary artery. Ongoing investigations of high-risk plaque features, coupled with technical advances to enable prognostic characterization in real time and at the point of care, will soon enable evaluation of the entire length of the atheromatous coronary artery and broaden the target(s) of our therapeutic intervention to include all regions of the plaque (both flow limiting and nonflow limiting).
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Affiliation(s)
- Peter H Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - William E Boden
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, and Boston University School of Medicine, Boston, Massachusetts
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20
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Gao L, Wang Y, Gao M, Chen L. Clinical research progress of myocardial work in assessment and prediction of coronary artery disease in noninvasive pressure-strain loop technique. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:38-45. [PMID: 36069389 DOI: 10.1002/jcu.23326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Early identification and treatment of high-risk coronary artery disease (CAD) is the main goal of current cardiovascular disease treatments. Speckle-tracking ultrasound technology can quantify myocardial work using pressure-strain loops. Because myocardial work takes into account the effect of the left ventricular systolic function afterload, it can more objectively reflect left ventricular myocardial mechanical function than the overall left ventricular longitudinal strain. Therefore, this technique is more widely used in diseases caused by CAD. This article reviews the evaluation and prediction of different CAD types using a variety of myocardial work parameters and provides a new method for clinical research to assess myocardial function, which is expected to become a new prediction method for CAD.
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Affiliation(s)
- Lu Gao
- Department of the Cardiovascular Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Yinghui Wang
- Department of the Cardiovascular Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Ming Gao
- Department of the Cardiovascular Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Liping Chen
- Department of Echocardiography, Cardiovascular Disease Center, The First Hospital of Jilin University, Changchun, People's Republic of China
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21
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Hartman EMJ, De Nisco G, Kok AM, Tomaniak M, Nous FMA, Korteland SA, Gijsen FJH, den Dekker WK, Diletti R, van Mieghem NMDA, Wilschut JM, Zijlstra F, van der Steen AFW, Budde RPJ, Daemen J, Wentzel JJ. Wall shear stress-related plaque growth of lipid-rich plaques in human coronary arteries: an near-infrared spectroscopy and optical coherence tomography study. Cardiovasc Res 2022; 119:1021-1029. [PMID: 36575921 PMCID: PMC10153640 DOI: 10.1093/cvr/cvac178] [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: 02/22/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 12/29/2022] Open
Abstract
AIMS Low wall shear stress (WSS) is acknowledged to play a role in plaque development through its influence on local endothelial function. Also, lipid-rich plaques (LRPs) are associated with endothelial dysfunction. However, little is known about the interplay between WSS and the presence of lipids with respect to plaque progression. Therefore, we aimed to study the differences in WSS-related plaque progression between LRPs, non-LRPs, or plaque-free regions in human coronary arteries. METHODS AND RESULTS In the present single-centre, prospective study, 40 patients who presented with an acute coronary syndrome successfully underwent near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) of at least one non-culprit vessel at baseline and completed a 1-year follow-up. WSS was computed applying computational fluid dynamics to a three-dimensional reconstruction of the coronary artery based on the fusion of the IVUS-segmented lumen with a CT-derived centreline, using invasive flow measurements as boundary conditions. For data analysis, each artery was divided into 1.5 mm/45° sectors. Plaque growth based on IVUS-derived percentage atheroma volume change was compared between LRPs, non-LRPs, and plaque-free wall segments, as assessed by both OCT and NIRS. Both NIRS- and OCT-detected lipid-rich sectors showed a significantly higher plaque progression than non-LRPs or plaque-free regions. Exposure to low WSS was associated with a higher plaque progression than exposure to mid or high WSS, even in the regions classified as a plaque-free wall. Furthermore, low WSS and the presence of lipids had a synergistic effect on plaque growth, resulting in the highest plaque progression in lipid-rich regions exposed to low shear stress. CONCLUSION This study demonstrates that NIRS- and OCT-detected lipid-rich regions exposed to low WSS are subject to enhanced plaque growth over a 1-year follow-up. The presence of lipids and low WSS proves to have a synergistic effect on plaque growth.
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Affiliation(s)
- Eline M J Hartman
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Giuseppe De Nisco
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Torino, Italy
| | - Annette M Kok
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.,First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Fay M A Nous
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, ErasmusMC, 3000 CA Rotterdam, The Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Wijnand K den Dekker
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jeroen M Wilschut
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anton F W van der Steen
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, ErasmusMC, 3000 CA Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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22
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Won KB, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, de Araújo Gonçalves P, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Glycemic control is independently associated with rapid progression of coronary atherosclerosis in the absence of a baseline coronary plaque burden: a retrospective case-control study from the PARADIGM registry. Cardiovasc Diabetol 2022; 21:239. [PMID: 36371222 PMCID: PMC9655903 DOI: 10.1186/s12933-022-01656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The baseline coronary plaque burden is the most important factor for rapid plaque progression (RPP) in the coronary artery. However, data on the independent predictors of RPP in the absence of a baseline coronary plaque burden are limited. Thus, this study aimed to investigate the predictors for RPP in patients without coronary plaques on baseline coronary computed tomography angiography (CCTA) images. METHODS A total of 402 patients (mean age: 57.6 ± 10.0 years, 49.3% men) without coronary plaques at baseline who underwent serial coronary CCTA were identified from the Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry and included in this retrospective study. RPP was defined as an annual change of ≥ 1.0%/year in the percentage atheroma volume (PAV). RESULTS During a median inter-scan period of 3.6 years (interquartile range: 2.7-5.0 years), newly developed coronary plaques and RPP were observed in 35.6% and 4.2% of the patients, respectively. The baseline traditional risk factors, i.e., advanced age (≥ 60 years), male sex, hypertension, diabetes mellitus, hyperlipidemia, obesity, and current smoking status, were not significantly associated with the risk of RPP. Multivariate linear regression analysis showed that the serum hemoglobin A1c level (per 1% increase) measured at follow-up CCTA was independently associated with the annual change in the PAV (β: 0.098, 95% confidence interval [CI]: 0.048-0.149; P < 0.001). The multiple logistic regression models showed that the serum hemoglobin A1c level had an independent and positive association with the risk of RPP. The optimal predictive cut-off value of the hemoglobin A1c level for RPP was 7.05% (sensitivity: 80.0%, specificity: 86.7%; area under curve: 0.816 [95% CI: 0.574-0.999]; P = 0.017). CONCLUSION In this retrospective case-control study, the glycemic control status was strongly associated with the risk of RPP in patients without a baseline coronary plaque burden. This suggests that regular monitoring of the glycemic control status might be helpful for preventing the rapid progression of coronary atherosclerosis irrespective of the baseline risk factors. Further randomized investigations are necessary to confirm the results of our study. TRIAL REGISTRATION ClinicalTrials.gov NCT02803411.
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Affiliation(s)
- Ki-Bum Won
- grid.470090.a0000 0004 1792 3864Department of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea ,grid.15444.300000 0004 0470 5454Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea ,grid.15444.300000 0004 0470 5454Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Byoung Kwon Lee
- grid.15444.300000 0004 0470 5454Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Fay Y. Lin
- grid.5386.8000000041936877XDepartment of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY USA
| | - Martin Hadamitzky
- grid.472754.70000 0001 0695 783XDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- grid.412484.f0000 0001 0302 820XDepartment of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Ji Min Sung
- grid.15444.300000 0004 0470 5454Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea ,grid.15444.300000 0004 0470 5454Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Edoardo Conte
- grid.4708.b0000 0004 1757 2822Ospedale Galeazzi-Sant Ambrogio IRCCS, University of Milan, Milan, Italy
| | - Daniele Andreini
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gianluca Pontone
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Matthew J. Budoff
- grid.239844.00000 0001 0157 6501Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- grid.412480.b0000 0004 0647 3378Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa/Massa, Italy
| | - Hugo Marques
- grid.414429.e0000 0001 0163 5700UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- grid.414429.e0000 0001 0163 5700UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal ,grid.10772.330000000121511713Nova Medical School, Lisbon, Portugal
| | - Jonathon A. Leipsic
- grid.17091.3e0000 0001 2288 9830Department of Medicine and Radiology, University of British Columbia, Vancouver, BC Canada
| | - Sang-Eun Lee
- grid.255649.90000 0001 2171 7754Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Seoul Korea
| | - Sanghoon Shin
- grid.255649.90000 0001 2171 7754Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Seoul Korea
| | - Jung Hyun Choi
- grid.412588.20000 0000 8611 7824Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- grid.417701.40000 0004 0465 0326Department of Pathology, CVPath Institute, Gaithersburg, MD USA
| | - Habib Samady
- grid.189967.80000 0001 0941 6502Department of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | - Kavitha Chinnaiyan
- grid.417118.a0000 0004 0435 1924Department of Cardiology, William Beaumont Hospital, Royal Oak, MI USA
| | - Daniel S. Berman
- grid.50956.3f0000 0001 2152 9905Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA USA
| | - Jagat Narula
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Leslee J. Shaw
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Jeroen J. Bax
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - James K. Min
- grid.5386.8000000041936877XDepartment of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY USA
| | - Hyuk-Jae Chang
- grid.15444.300000 0004 0470 5454Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea ,grid.15444.300000 0004 0470 5454Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea ,grid.15444.300000 0004 0470 5454Department of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, 03722 Seoul, South Korea
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23
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Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci 2022; 23:12906. [PMID: 36361701 PMCID: PMC9658900 DOI: 10.3390/ijms232112906] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation. Recruited monocytes differentiate into macrophages which develop pro- or anti-inflammatory properties according to their microenvironment. Atheroma progression or healing is determined by the balance between these functional phenotypes. Macrophages and smooth muscle cells secrete inflammatory cytokines including interleukins IL-1β, IL-12, and IL-6. Within the arterial wall, low-density lipoprotein cholesterol undergoes an oxidation. Additionally, triglyceride-rich lipoproteins and remnant lipoproteins exert pro-inflammatory effects. Macrophages catabolize the oxidized lipoproteins and coalesce into a lipid-rich necrotic core, encapsulated by a collagen fibrous cap, leading to the formation of fibro-atheroma. In the conditions of chronic inflammation, macrophages exert a catabolic effect on the fibrous cap, resulting in a thin-cap fibro-atheroma which makes the plaque vulnerable. However, their morphology may change over time, shifting from high-risk lesions to more stable calcified plaques. In addition to conventional cardiovascular risk factors, an exposure to acute and chronic psychological stress may increase the risk of cardiovascular disease through inflammation mediated by an increased sympathetic output which results in the release of inflammatory cytokines. Inflammation is also the link between ageing and cardiovascular disease through increased clones of leukocytes in peripheral blood. Anti-inflammatory interventions specifically blocking the cytokine pathways reduce the risk of myocardial infarction and stroke, although they increase the risk of infections.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
- Molecular and Clinical Sciences Research Institute, St. George’s University, London UB8 3PH, UK
| | - Sergio Vancheri
- Interventional Neuroradiology Department, Besançon University Hospital, 25000 Besançon, France
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
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24
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Zhang P, Wang Y, Xing X, Li H, Wang X, Zhang H, Wang X, Li X, Li Y, Wang Q. Electroacupuncture Treats Myocardial Infarction by Influencing the Regulation of Substance P in the Neurovascular to Modulate PGI2/TXA2 Metabolic Homeostasis via PI3K/AKT Pathway: A Bioinformatics-Based Multiomics and Experimental Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5367753. [PMID: 36238480 PMCID: PMC9553354 DOI: 10.1155/2022/5367753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022]
Abstract
Acute myocardial infarction (AMI) is the most severe form of coronary heart disease caused by ischemia and hypoxia. The study is aimed at investigating the role of neuropeptides and the mechanism of electroacupuncture (EA) in acute myocardial infarction (AMI) treatment. Compared with the normal population, a significant increase in substance P (SP) was observed in the serum of patients with AMI. PGI2 expression was increased in the SP-treated AMI mouse model, and TXA2 expression was decreased. And PI3K pathway-related genes, including Pik3ca, Akt, and Mtor, were upregulated in myocardial tissue of SP-treated AMI patients. Human cardiomyocyte cell lines (HCM) treated with SP increased mRNA and protein expression of PI3K pathway-related genes (Pik3ca, Pik3cb, Akt, and Mtor). Compared to MI control and EA-treated MI rat models, Myd88, MTOR, Akt1, Sp, and Irak1 were differentially expressed, consistent with in vivo and in vitro studies. EA treatment significantly enriched PI3K/AKT signaling pathway genes within MI-associated differentially expressed genes (DEGs) according to Kyoto Encyclopedia of Genes and Genomes (KEGG). Furthermore, it was confirmed by molecular docking analysis that PIK3CA, AKT1, and mTOR form stable dockings with neuropeptide SP. PI3K/AKT pathway activity may be affected directly or indirectly by EA via SP, which corrects the PGI2/TXA2 metabolic imbalance in AMI. MI treatment is now better understood as a result of this finding.
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Affiliation(s)
- Ping Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Yanyan Wang
- Taian Traffic Hospital, Taian, 271000, China
| | - Xiaomin Xing
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Hu Li
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Xiaojing Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Hanlin Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Xin Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Xiubin Li
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Yanju Li
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Qian Wang
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
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25
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van den Hoogen IJ, Stuijfzand WJ, Gianni U, van Rosendael AR, Bax AM, Lu Y, Tantawy SW, Hollenberg EJ, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Gonçalves PDA, Hadamitzky M, Kim YJ, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Lee SE, Al'Aref SJ, Baskaran L, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Berman DS, Chang HJ, Narula J, Min JK, Bax JJ, Lin FY, Shaw LJ. Early versus late acute coronary syndrome risk patterns of coronary atherosclerotic plaque. Eur Heart J Cardiovasc Imaging 2022; 23:1314-1323. [PMID: 35904766 DOI: 10.1093/ehjci/jeac114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The temporal instability of coronary atherosclerotic plaque preceding an incident acute coronary syndrome (ACS) is not well defined. We sought to examine differences in the volume and composition of coronary atherosclerosis between patients experiencing an early (≤90 days) versus late ACS (>90 days) after baseline coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicenter study, we enrolled patients who underwent a clinically indicated baseline CCTA and experienced ACS during follow-up. Separate core laboratories performed blinded adjudication of ACS events and quantification of CCTA including compositional plaque volumes by Hounsfield units (HU): calcified plaque >350 HU, fibrous plaque 131-350 HU, fibrofatty plaque 31-130 HU and necrotic core <30 HU. In 234 patients (mean age 62 ± 12 years, 36% women), early and late ACS occurred in 129 and 105 patients after a mean of 395 ± 622 days, respectively. Patients with early ACS had a greater maximal diameter stenosis and maximal cross-sectional plaque burden as compared to patients with late ACS (P < 0.05). Larger total, fibrous, fibrofatty, and necrotic core volumes were observed in the early ACS group (P < 0.05). Findings for total, fibrous, fibrofatty, and necrotic core volumes were reproduced in an external validation cohort (P < 0.05). CONCLUSIONS Volumetric differences in composition of coronary atherosclerosis exist between ACS patients according to their timing antecedent to the acute event. These data support that a large burden of non-calcified plaque on CCTA is strongly associated with near-term plaque instability and ACS risk.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - A Maxim Bax
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Sara W Tantawy
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Faculty of Medicine, Department of Radiology, Ain Shams University, Cairo, Egypt
| | - Emma J Hollenberg
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | - Fabian Plank
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Todd C Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Lohendran Baskaran
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiovascular Medicine, National Heart Centre, Singapore
| | - Ibrahim Danad
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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26
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Li L, Wang M, Ma Q, Ye J, Sun G. Role of glycolysis in the development of atherosclerosis. Am J Physiol Cell Physiol 2022; 323:C617-C629. [DOI: 10.1152/ajpcell.00218.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atherosclerosis is a chronic inflammatory vascular disease associated with atherosclerotic plaques and endothelial dysfunction, inflammation, and plaque formation. Glycolysis is a conservative and rigorous biological process that decomposes glucose into pyruvate. Its function is to provide the body with energy and intermediate products required for life activities. However, abnormalities in glycolytic flux during the progression of atherosclerosis accelerate disease progression. Here, we review the role of glycolysis in the development of atherosclerosis to provide new ideas for developing novel anti-atherosclerosis strategies.
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Affiliation(s)
- Lanfang Li
- Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Min Wang
- Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qiuxiao Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingxue Ye
- Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guibo Sun
- Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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27
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Li MJ, Yan SB, Dong H, Huang ZG, Li DM, Tang YL, Pan YF, Yang Z, Pan HB, Chen G. Clinical assessment and molecular mechanism of the upregulation of Toll-like receptor 2 (TLR2) in myocardial infarction. BMC Cardiovasc Disord 2022; 22:314. [PMID: 35840880 PMCID: PMC9287878 DOI: 10.1186/s12872-022-02754-y] [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: 01/18/2022] [Accepted: 07/08/2022] [Indexed: 08/30/2023] Open
Abstract
Objective The prevalence and mortality of cardiovascular diseases remain ranked first worldwide. Myocardial infarction (MI) is the central cause of death from cardiovascular diseases, seriously endangering human health. The clinical implication of toll-like receptor 2 (TLR2) remains contradictory, and its mechanism is still unknown. Hence, the objective of this study was to elucidate the clinical value and molecular mechanism of TLR2 in MI. Methods All high-throughput datasets and eligible literature were screened, and the expression levels of TLR2 were collected from the MI. The integrated expression level of TLR2 was displayed by calculating the standardized mean difference (SMD) and the area under the curve (AUC) of the summary receiver operating characteristic curve (sROC). The related TLR2 genes were sent for pathway analyses by gene ontology (GO), Kyoto encyclopedia of genes and genome (KEGG), and disease ontology (DO). Single-cell RNA-seq was applied to ascertain the molecular mechanism of TLR2 in MI. Results Nine microarrays and four reported data were available to calculate the comprehensive expression level of TLR2 in MI, including 325 cases of MI and 306 cases of controls. The SMD was 2.55 (95% CI = 1.35–3.75), and the AUC was 0.76 (95% CI = 0.72–0.79), indicating the upregulation of TLR2 in MI. The related TLR2 genes were primarily enriched in the pathways of atherosclerosis, arteriosclerotic cardiovascular disease, and arteriosclerosis, suggesting the clinical role of TLR2 in the progression of MI. Afterward, TLR2 was upregulated in myeloid cells in MI. Conclusions TLR2 may have a crucial role in progressing from coronary atherosclerosis to MI. The upregulation of TLR2 may have a favorable screening value for MI. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02754-y.
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Affiliation(s)
- Ming-Jie Li
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Shi-Bai Yan
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Hao Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Zhi-Guang Huang
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Dong-Ming Li
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yu-Lu Tang
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yan-Fang Pan
- Department of Pathology, Hospital of Guangxi Liugang Medical Co., LTD./Guangxi Liuzhou Dingshun Forensic Expert Institute, No. 9, Queershan Rd, Liuzhou, 545002, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Zhen Yang
- Department of Gerontology, NO. 923 Hospital of Chinese People's Liberation Army, No. 1 Tangcheng Rd, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Hong-Bo Pan
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Gang Chen
- Department of Pathology/Forensic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
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28
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Yin Q, Zang G, Li N, Sun C, Du R. Agonist-induced Piezo1 activation promote mitochondrial-dependent apoptosis in vascular smooth muscle cells. BMC Cardiovasc Disord 2022; 22:287. [PMID: 35751027 PMCID: PMC9233385 DOI: 10.1186/s12872-022-02726-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Mechanical damage plays an essential role in the progression of atherosclerosis. Piezo1 is a new mechanically sensitive ion channel. The present study investigated the vascular smooth muscle cells (VSMCs) apoptosis induced by Piezo1 activation and explored its underlying mechanism. METHODS We evaluated cell viability and apoptosis rate with cell counting kit-8 (CCK-8) and Annexin V-FITC/PI flow cytometry assay, respectively. And then Western blot was performed to measure the relative protein. Reactive oxygen species (ROS) and intracellular Ca2+ were assessed via fluorescence microscope, and the mitochondrial transmembrane potential was monitored by JC-10 staining. RESULTS Our in vitro study revealed that mice in the ApoE-/- group compared with control mice showed higher Piezo1 expression(P < 0.05). Besides, Yoda1, a Piezo1 agonist, triggered Ca2+ overload, mitochondrial damage, accumulation of ROS, and VSMCs apoptosis in a dose-depend manner. Furthermore, BAPT-AM (an intracellular Ca2+ chelator) and NAC (an antioxidant) suppressed the mitochondrial damage and attenuated the VSMCs apoptosis. CONCLUSION Our study suggested that Piezo1 induced VSMCs apoptosis because of Ca2+ overload, excessive ROS generation, and mitochondrial dysfunction, which indicated that Piezo1 has potential value in treating vascular diseases.
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Affiliation(s)
- Qing Yin
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China.,School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China
| | - Guangyao Zang
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China
| | - Nannan Li
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China
| | - Chenchen Sun
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China
| | - Rongzeng Du
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China.
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29
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Yamaura H, Otsuka K, Ishikawa H, Shirasawa K, Fukuda D, Kasayuki N. Determinants of Non-calcified Low-Attenuation Coronary Plaque Burden in Patients Without Known Coronary Artery Disease: A Coronary CT Angiography Study. Front Cardiovasc Med 2022; 9:824470. [PMID: 35463764 PMCID: PMC9021435 DOI: 10.3389/fcvm.2022.824470] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
Background Although epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), it is unclear whether EAT volume (EAV) can be used to diagnose high-risk coronary plaque burden associated with coronary events. This study aimed to investigate (1) the prognostic impact of low-attenuation non-calcified coronary plaque (LAP) burden on patient level analysis, and (2) the association of EAV with LAP volume in patients without known CAD undergoing coronary computed tomography angiography (CCTA). Materials and Methods This retrospective study consisted of 376 patients (male, 57%; mean age, 65.2 ± 13 years) without known CAD undergoing CCTA. Percent LAP volume (%LAP, <30 HU) was calculated as the LAP volume divided by the vessel volume. EAT was defined as adipose tissue with a CT attenuation value ranging from −250 to −30 HU within the pericardial sac. The primary endpoint was a composite event of death, non-fatal myocardial infarction, and unstable angina and worsening symptoms requiring unplanned coronary revascularization >3 months after CCTA. The determinants of %LAP (Q4) were analyzed using a multivariable logistic regression model. Results During the follow-up period (mean, 2.2 ± 0.9 years), the primary endpoint was observed in 17 patients (4.5%). The independent predictors of the primary endpoint were %LAP (Q4) (hazard ratio [HR], 3.05; 95% confidence interval [CI], 1.09–8.54; p = 0.033] in the Cox proportional hazard model adjusted by CAD-RADS category. Cox proportional hazard ratio analysis demonstrated that %LAP (Q4) was a predictor of the primary endpoint, independnet of CAD severity, Suita score, EAV, or CACS. The independent determinants of %LAP (Q4) were CACS ≥218.3 (p < 0.0001) and EAV ≥125.3 ml (p < 0.0001). The addition of EAV to CACS significantly improved the area under the curve (AUC) to identify %LAP (Q4) than CACS alone (AUC, EAV + CACS vs. CACS alone: 0.728 vs. 0.637; p = 0.013). Conclusions CCTA-based assessment of EAV, CACS, and LAP could help improve personalized cardiac risk management by administering patient-suited therapy.
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Affiliation(s)
- Hiroki Yamaura
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
| | - Kenichiro Otsuka
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan.,Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirotoshi Ishikawa
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan.,Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kuniyuki Shirasawa
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriaki Kasayuki
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
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30
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Kingwell BA, Nicholls SJ, Velkoska E, Didichenko SA, Duffy D, Korjian S, Gibson CM. Antiatherosclerotic Effects of CSL112 Mediated by Enhanced Cholesterol Efflux Capacity. J Am Heart Assoc 2022; 11:e024754. [PMID: 35411789 PMCID: PMC9238469 DOI: 10.1161/jaha.121.024754] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Approximately 12% of patients with acute myocardial infarction (AMI) experience a recurrent major adverse cardiovascular event within 1 year of their primary event, with most occurring within the first 90 days. Thus, there is a need for new therapeutic approaches that address this 90-day post-AMI high-risk period. The formation and eventual rupture of atherosclerotic plaque that leads to AMI is elicited by the accumulation of cholesterol within the arterial intima. Cholesterol efflux, a mechanism by which cholesterol is removed from plaque, is predominantly mediated by apolipoprotein A-I, which is rapidly lipidated to form high-density lipoprotein in the circulation and has atheroprotective properties. In this review, we outline how cholesterol efflux dysfunction leads to atherosclerosis and vulnerable plaque formation, including inflammatory cell recruitment, foam cell formation, the development of a lipid/necrotic core, and degradation of the fibrous cap. CSL112, a human plasma-derived apolipoprotein A-I, is in phase 3 of clinical development and aims to reduce the risk of recurrent cardiovascular events in patients with AMI in the first 90 days after the index event by increasing cholesterol efflux. We summarize evidence from preclinical and clinical studies suggesting that restoration of cholesterol efflux by CSL112 can stabilize plaque by several anti-inflammatory/immune-regulatory processes. These effects occur rapidly and could stabilize vulnerable plaques in patients who have recently experienced an AMI, thereby reducing the risk of recurrent major adverse cardiovascular events in the high-risk early post-AMI period.
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Affiliation(s)
| | | | | | | | | | - Serge Korjian
- PERFUSE Study Group, Cardiovascular Division Departments of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division Departments of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
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31
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Moerman AM, Korteland S, Dilba K, van Gaalen K, Poot DHJ, van Der Lugt A, Verhagen HJM, Wentzel JJ, van Der Steen AFW, Gijsen FJH, Van der Heiden K. The Correlation Between Wall Shear Stress and Plaque Composition in Advanced Human Carotid Atherosclerosis. Front Bioeng Biotechnol 2022; 9:828577. [PMID: 35155418 PMCID: PMC8831262 DOI: 10.3389/fbioe.2021.828577] [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: 12/03/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
The role of wall shear stress (WSS) in atherosclerotic plaque development is evident, but the relation between WSS and plaque composition in advanced atherosclerosis, potentially resulting in plaque destabilization, is a topic of discussion. Using our previously developed image registration pipeline, we investigated the relation between two WSS metrics, time-averaged WSS (TAWSS) and the oscillatory shear index (OSI), and the local histologically determined plaque composition in a set of advanced human carotid plaques. Our dataset of 11 carotid endarterectomy samples yielded 87 histological cross-sections, which yielded 511 radial bins for analysis. Both TAWSS and OSI values were subdivided into patient-specific low, mid, and high tertiles. This cross-sectional study shows that necrotic core (NC) size and macrophage area are significantly larger in areas exposed to high TAWSS or low OSI. Local TAWSS and OSI tertile values were generally inversely related, as described in the literature, but other combinations were also found. Investigating the relation between plaque vulnerability features and different combinations of TAWSS and OSI tertile values revealed a significantly larger cap thickness in areas exposed to both low TAWSS and low OSI. In conclusion, our study confirmed previous findings, correlating high TAWSS to larger macrophage areas and necrotic core sizes. In addition, our study demonstrated new relations, correlating low OSI to larger macrophage areas, and a combination of low TAWSS and low OSI to larger cap thickness.
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Affiliation(s)
- A. M. Moerman
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - S. Korteland
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - K. Dilba
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - K. van Gaalen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - D. H. J. Poot
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - A. van Der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - J. J. Wentzel
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | | | - F. J. H. Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
- Department of Biomedical Engineering, Delft University of Technology, Delft, Netherlands
| | - K. Van der Heiden
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
- *Correspondence: K. Van der Heiden,
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32
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1482-1491. [DOI: 10.1093/ehjci/jeac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Indexed: 11/13/2022] Open
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33
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Lee JE, Park HM, Lim Y, Jeong WGI, Kim YH. Pathophysiology and Role of Coronary CT Angiography in Stable Angina. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:42-53. [PMID: 36237352 PMCID: PMC9238201 DOI: 10.3348/jksr.2021.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/11/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
관상동맥질환의 임상적인 개념은 지난 10년 동안 패러다임의 변화를 보여왔다. 관상동맥질환은 대부분 진행성 질환이며, 관상동맥질환 환자는 질병 진행의 어느 시점에서도 급성 관상동맥 증후군에 직면할 수 있다. 이러한 임상적 맥락에서 2019년 유럽심장학회 가이드라인에서는 조기 진단과 꾸준한 관리가 필요한 관상동맥질환의 임상적인 중요성을 반영하여 “만성 관상동맥증후군”이라는 용어의 사용을 발표하였다. 최근 관상동맥 전산화단층촬영 혈관조영술을 이용한 관상동맥질환의 평가는 많은 발전을 이루었고, 안정형 협심증 또는 만성 관상동맥증후군 환자에서 관상동맥 전산화단층촬영 혈관조영술의 임상적 유용성은 초기 무증상 관상동맥질환의 발견에서부터 죽상경화판의 특성 분석 및 관상동맥질환의 치료 전략 결정에 도움을 주는 역할까지 관상동맥질환의 다양한 단계에 걸쳐 입증되고 있다. 이 종설에서는 안정형 협심증 환자의 이해를 돕는 병태생리를 설명하고 이에 대한 관상동맥 전산화단층촬영의 임상적 적용과 역할에 대해 알아보고자 한다.
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Affiliation(s)
- Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hye Mi Park
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yongwhan Lim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Won GI Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
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Li Kam Wa ME, De Silva K, Collet C, Perera D. FLOWER-MI and the root of the problem with non-culprit revascularisation. Open Heart 2021; 8:openhrt-2021-001763. [PMID: 34819348 PMCID: PMC8614131 DOI: 10.1136/openhrt-2021-001763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
How do we reduce cardiac death and myocardial infarction by percutaneous coronary intervention (PCI) in coronary heart disease? Although the interventional community continues to grapple with this question in stable angina, the benefits of PCI for non-culprit lesions found at ST-elevation myocardial infarction are established. Is it then wishful thinking that an index developed in stable coronary disease, for identifying lesions capable of causing ischaemia will show an incremental benefit over angiographically guided non-culprit PCI? This is the question posed by the recently published FLOW Evaluation to Guide Revascularization in Multi-vessel ST-elevation Myocardial Infarction (FLOWER-MI) trial. We examine the trial design and results; ask if there is any relationship between the baseline physiological significance of a non-culprit lesion and vulnerability to future myocardial infarction; and consider if more sophisticated methods can help guide or defer non-culprit revascularisation.
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Affiliation(s)
- Matthew E Li Kam Wa
- Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust, London, UK .,British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Kalpa De Silva
- Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust, London, UK.,British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
| | - Carlos Collet
- Cardiovascular Center, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | - Divaka Perera
- Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust, London, UK.,British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK
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Lu G, Ye W, Ou J, Li X, Tan Z, Li T, Liu H. Coronary Computed Tomography Angiography Assessment of High-Risk Plaques in Predicting Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:743538. [PMID: 34660742 PMCID: PMC8517134 DOI: 10.3389/fcvm.2021.743538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is a comprehensive, non-invasive and cost-effective imaging assessment approach, which can provide the ability to identify the characteristics and morphology of high-risk atherosclerotic plaques associated with acute coronary syndrome (ACS). The development of CCTA and latest advances in emerging technologies, such as computational fluid dynamics (CFD), have made it possible not only to identify the morphological characteristics of high-risk plaques non-invasively, but also to assess the hemodynamic parameters, the environment surrounding coronaries and so on, which may help to predict the risk of ACS. In this review, we present how CCTA was used to characterize the composition and morphology of high-risk plaques prone to ACS and the current role of CCTA, including emerging CCTA technologies, advanced analysis, and characterization techniques in prognosticating the occurrence of ACS.
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Affiliation(s)
- Guanyu Lu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiehao Ou
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyun Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zekun Tan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tingyu Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
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Shaw LJ, Blankstein R, Chandrashekhar Y. Imaging Plaque: What Is the Value Over Stenosis Alone? JACC Cardiovasc Imaging 2021; 14:2055-2057. [PMID: 34620468 DOI: 10.1016/j.jcmg.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Low attenuation plaque volume on coronary computed tomography angiography is associated with plaque progression. Coron Artery Dis 2021; 33:176-181. [PMID: 34618752 DOI: 10.1097/mca.0000000000001103] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-related clinical factors, laboratory factors, and some imaging factors may lead to statistical bias when investigating coronary plaque progression. In this study, we avoided patient characteristics by comparing morphological characteristics of plaque progression and nonprogression within the same patient with multiple plaques. METHODS From August 2011 to December 2018, 177 consecutive patients with 424 plaques who were followed with coronary computed tomography angiography (CTA) were reviewed retrospectively. Follow-up images of the plaques were used to determine whether the plaque volume or stenosis grade increased. The plaques were divided into progressive and nonprogressive groups. Logistic regression analysis was used to identify the factors associated with plaque progression. Through clinical follow-up, we analyzed whether the factors associated with plaque progression were related to major adverse cardiac events (MACEs). RESULTS There were 223 plaques that progressed during a mean follow-up period of 27.6 ± 15.9 months. The univariate logistic regression model revealed that only low attenuation plaque (LAP) volume (P = 0.02) was associated with plaque progression. After a mean post-CTA follow-up period of 36.7 ± 18.4 months, 37 patients experienced MACEs, and LAP volume was significantly related to future MACEs. CONCLUSION Only a high baseline LAP volume was associated with plaque progression, and patients with progressive plaques and a high LAP volume were more likely to have future MACEs. More attention should be given to plaques with LAP volumes larger than 2.4 mm3.
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Dual-energy CT plaque characteristics of post mortem thin-cap fibroatheroma in comparison to infarct-related culprit lesions. Heart Vessels 2021; 37:400-410. [PMID: 34608510 DOI: 10.1007/s00380-021-01942-8] [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: 11/06/2020] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Improvement of non-invasive identification of high-risk plaque may increase the preventive options of acute coronary syndrome. To describe the characteristics of thin-cap fibroatheroma (TCFA) in a post mortem model in comparison to characteristics of culprit lesions in patients with non-ST-elevation-myocardial-infarction (NSTEMI) using the dual energy computed tomography (DECT). Three post mortem hearts were prepared with iodine-contrast, inserted in a Kyoto phantom and scanned by DECT. Six TCFA were identified using histopathological analysis (cap thickness < 65 μm and necrotic core > 10% of the plaque area). In the NSTEMI group, 29 patients were scheduled to DECT prior to coronary angiography and invasive treatment. Culprit lesions were identified blinded for the patient history by two independent invasive cardiologists using the coronary angiography. The DECT analysis of TCFA and culprit lesions was performed retrospectively with determination of effective atomic number (Effective-Z), Hounsfield Unit (HU), plaque type (non-calcified, predominantly non-calcified, predominantly calcified or calcified), spotty calcification,, plaque length, plaque volume and plaque burden and the remodeling index. The Effective-Z, HU and plaqueburden were significantly different between TCFA and culprit lesions (P < 0.05).The TCFA plaques were more calcified in comparison to culprit lesions (P < 0.05). No significant difference in the other plaque characteristics was observed. The use of DECT demonstrated different Effective-Z values and different characteristics of post mortem TCFA in comparison to in vivo culprit lesions. This finding may highlight, that not all TCFA should be considered as vulnerable.
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Yao J, Yang Z, Huang L, Yang C, Wang J, Cao Y, Hao L, Zhang L, Zhang J, Li P, Wang Z, Sun Y, Ran H. Low-Intensity Focused Ultrasound-Responsive Ferrite-Encapsulated Nanoparticles for Atherosclerotic Plaque Neovascularization Theranostics. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100850. [PMID: 34382370 PMCID: PMC8498883 DOI: 10.1002/advs.202100850] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/22/2021] [Indexed: 05/24/2023]
Abstract
Pathological angiogenesis is a crucial factor that causes atherosclerotic plaque rupture. Sinoporphyrin sodium-mediated sonodynamic therapy (DVDMS-SDT) induces regression of plaque neovascularization in humans without causing obvious side effects. However, a clinical noninvasive theranostic strategy for atherosclerotic plaque neovascularization is urgently needed. A nanoplatform designed for multimodality imaging-guided SDT in plaque angiogenesis theranostics, termed PFP-HMME@PLGA/MnFe2 O4 -ramucirumab nanoparticles (PHPMR NPs), is fabricated. It encapsulates manganese ferrite (MnFe2 O4 ), hematoporphyrin monomethyl ether (HMME), and perfluoropentane (PFP) stabilized by polylactic acid-glycolic acid (PLGA) shells and is conjugated to an anti-VEGFR-2 antibody. With excellent magnetic resonance imaging (MRI)/photoacoustic/ultrasound imaging ability, the distribution of PHPMR NPs in plaque can be observed in real time. Additionally, they actively accumulate in the mitochondria of rabbit aortic endothelial cells (RAECs), and the PHPMR NP-mediated SDT promotes mitochondrial-caspase apoptosis via the production of reactive oxygen species and inhibits the proliferation, migration, and tubulogenesis of RAECs. On day 3, PHPMR NP-mediated SDT induces apoptosis in neovessel endothelial cells and improves hypoxia in the rabbit advanced plaque. On day 28, PHPMR NP-mediated SDT reduces the density of neovessels, subsequently inhibiting intraplaque hemorrhage and inflammation and eventually stabilizing the plaque. Collectively, PHPMR NP-mediated SDT presents a safe and effective theranostic strategy for inhibiting plaque angiogenesis.
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Affiliation(s)
- Jianting Yao
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Zhuowen Yang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin, 150001, P. R. China
| | - Liandi Huang
- State Key Laboratory of Ultrasound in Medicine and Engineering, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Chao Yang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, P. R. China
| | - Jianxin Wang
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, P. R. China
| | - Yang Cao
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Lan Hao
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Liang Zhang
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Jingqi Zhang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin, 150001, P. R. China
| | - Pan Li
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Zhigang Wang
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Yang Sun
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Haitao Ran
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
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Colchicine reduces atherosclerotic plaque vulnerability in rabbits. ATHEROSCLEROSIS PLUS 2021; 45:1-9. [PMID: 36643998 PMCID: PMC9833268 DOI: 10.1016/j.athplu.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 01/18/2023]
Abstract
Background and aims The anti-inflammatory agent colchicine is gaining interest as a treatment for coronary artery disease. However, the effects of colchicine in atherosclerotic animal models are mostly unknown. This study aimed to evaluate colchicine in a rabbit model of atherosclerosis. Methods Twenty-two rabbits were fed a 0.5% cholesterol-enriched diet for 10 weeks and then randomized to receive either oral saline (n=11) or colchicine (350 μg/kg/day; n=11) for 6 weeks, with 0.2% cholesterol-diet during the treatment period. We performed intravascular ultrasound imaging (at start and end of treatment) and histology analyses of the descending thoracic aorta. Leucocyte activation was assessed in vitro on blood samples obtained during treatment. Results Colchicine prevented positive aortic vascular remodelling (p=0.029 vs placebo). This effect was even more marked at high plasma cholesterol level (third quartile of plasma cholesterol, p=0.020). At high cholesterol level, both atherosclerotic plaque and media areas on histomorphology were reduced by colchicine compared to placebo (p=0.031 and p=0.039, respectively). Plaque fibrosis and macrophage area were reduced by colchicine (Masson's trichrome stain: p=0.038; RAM-11: p=0.026). The plaque vulnerability index, assessed by histology, was reduced by colchicine (p=0.040). Elastin/type I collagen ratio in media was significantly higher with colchicine compared to placebo (p=0.013). At a high level of plasma cholesterol, in vitro LPS challenge revealed a decrease in monocyte activation following treatment with colchicine (p<0.001) and no change in the placebo group (p=0.353). Conclusions Colchicine decreases plaque vulnerability with reductions in plaque inflammation, medial fibrosis, outward vascular remodelling and ex vivo monocyte activation.
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Nutrition Status and Renal Function as Predictors in Acute Myocardial Infarction with and without Cancer: A Single Center Retrospective Study. Nutrients 2021; 13:nu13082663. [PMID: 34444823 PMCID: PMC8399317 DOI: 10.3390/nu13082663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Clinical characteristics of nutrition status in acute myocardial infarction (AMI) patients with cancer remains unknown. Therefore, this study aimed to clarify the differences of clinical parameters, including nutrition status, between AMI patients with and without history of cancer. Methods and Results: This retrospective cohort study, using the database of AMI between 2014 and 2019 in Kurume University Hospital, enrolled 411 patients; AMI patients without cancer (n = 358, 87.1%) and with cancer (n = 53, 12.9%). AMI patients with cancer were significantly older with lower body weight, worse renal function, and worse nutrition status. Next, we divided the patients into 4 groups by cancer, age, and plaque area, detected by coronary image devices. The prediction model indicated that nutrition, lipid, and renal functions were significant predictors of AMI with cancer. The ordinal logistic regression model revealed that worse nutrition status, renal dysfunction, lower uric acid, and elevated blood pressure were significant predictors. Finally, we were able to calculate the probability of the presence of cancer, by combining each factor and scoring. Conclusions: Worse nutrition status and renal dysfunction were associated with AMI with cancer, in which nutrition status was a major different characteristic from those without cancer.
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Yang Z, Yao J, Wang J, Zhang C, Cao Y, Hao L, Yang C, Wu C, Zhang J, Wang Z, Ran H, Tian Y. Ferrite-encapsulated nanoparticles with stable photothermal performance for multimodal imaging-guided atherosclerotic plaque neovascularization therapy. Biomater Sci 2021; 9:5652-5664. [PMID: 34259244 DOI: 10.1039/d1bm00343g] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pathological angiogenesis is a critical contributor to atherosclerotic plaque rupture. However, there are few effective theranostic strategies to stabilize plaques by suppressing neovascularization. In this study, we fabricated a polymeric nanosystem using 3 nm manganese ferrite (MnFe2O4) and perfluorohexane (PFH) stabilized by polylactic acid-glycolic acid (PLGA) shells and conjugated to the surface of an anti-vascular endothelial growth factor receptor 2 (VEGFR2) antibody [ramucirumab (Ram)]. The PFH@PLGA/MnFe2O4-Ram nanoparticles (NPs) were used as atherosclerotic plaque angiogenesis theranostics for multimodal imaging-guided photothermal therapy (PTT). Three-nanometer MnFe2O4 is an excellent magnetic resonance imaging T1 and photoacoustic imaging contrast agent. Upon exposure to near-infrared (NIR) light, MnFe2O4 in the NPs could transform NIR light into thermal energy for the photothermal elimination of plaque angiogenesis. Additionally, optical droplet vaporization of PFH in the NPs triggered by the thermal effect to form gas bubbles enhanced ultrasound imaging. Our in vitro experiments revealed that PFH@PLGA/MnFe2O4-Ram NPs actively accumulated in rabbit aortic endothelial cells, and NP-mediated PTT promoted endothelial cell apoptosis while inhibiting their proliferation, migration, and tubulogenesis. Notably, the PFH@PLGA/MnFe2O4-Ram NPs possessed excellent photostability and biocompatibility. In the rabbit advanced atherosclerotic plaque model, PFH@PLGA/MnFe2O4-Ram NP-guided PTT significantly induced apoptosis of neovascular endothelial cells and improved the hypoxia status in the plaque 3 days after treatment. On day 28, PTT significantly reduced the density of neovessels and subsequently stabilized rabbit plaques by inhibiting plaque hemorrhage and macrophage infiltration. Collectively, these results suggest that PFH@PLGA/MnFe2O4-Ram NP-guided PTT is a safe and effective theranostic strategy for inhibiting atherosclerotic plaque angiogenesis.
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Affiliation(s)
- Zhuowen Yang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P. R. China. and Department of Gerontology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, P. R. China
| | - Jianting Yao
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Jianxin Wang
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China
| | - Cong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China
| | - Yang Cao
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Lan Hao
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Chao Yang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, P. R. China
| | - Changjun Wu
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China
| | - Jingqi Zhang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P. R. China.
| | - Zhigang Wang
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Haitao Ran
- Department of Ultrasound, Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Ye Tian
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P. R. China. and Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin 150086, P. R. China
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Gu H, Lu B, Gao Y, Hou Z, Yang S, Yuan X, Zhao S, Wang X. Prognostic Value of Atherosclerosis Progression for Prediction of Cardiovascular Events in Patients with Nonobstructive Coronary Artery Disease. Acad Radiol 2021; 28:980-987. [PMID: 33268210 DOI: 10.1016/j.acra.2020.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Coronary CT angiography (CCTA) is a noninvasive reliable cardiovascular imaging technology to assess coronary atherosclerosis progression. However, there is limited data available to investigate the relationship between the atherosclerosis progression and cardiovascular events in patients with nonobstructive coronary artery disease (CAD). MATERIALS AND METHODS A total of 757 patients (53.4 ± 9.5 years, 61.2% male) with nonobstructive CAD (1%-49% diameter stenosis) who underwent baseline and follow-up CCTA were retrospectively included in this study. Coronary atherosclerosis and its changing were analyzed by these following semi-quantitative scores: (1) obstructive plaque scores (three-vessel plaque score and severe proximal plaque score); (2) scores exhibiting plaque distribution and extent (segment stenosis score and segment involvement score); (3) coronary artery calcium score. The end points of this study were the major adverse cardiac events (MACE), which included cardiac death, coronary revascularization, nonfatal myocardial infarction and hospitalization due to unstable angina. RESULTS The average time between scans was 2.0 years. After their second scan, 82 (10.8%) patients experienced MACE during 4.9 ± 1.0 years follow-up. Combined baseline and follow-up CCTA together, we found that the progression of coronary atherosclerosis was significantly higher in patients with MACE than those without (all p < 0.05). Diabetes mellitus (hazard ratio [HR] = 3.17, p < 0.001), dyslipidemia (HR = 1.69, p = 0.046), and family history of CAD (HR = 1.79, p = 0.005) were independently associated with MACE. Three vessel plaque progression (HR = 2.37, p = 0.026) and severe proximal plaque progression (HR = 3.65, p = 0.003) were strong predictors of MACE. CONCLUSION Coronary atherosclerosis progression had a predictive value of MACE in patients with nonobstructive CAD.
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Affiliation(s)
- Hui Gu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong 250021, People's Republic of China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Gao
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong 250021, People's Republic of China
| | - Xianshun Yuan
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong 250021, People's Republic of China
| | - Shuo Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong 250021, People's Republic of China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong 250021, People's Republic of China.
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Patients with Non-Obstructive Coronary Artery Disease Require Strict Control of All Cardiovascular Risk Factors: Results from the Polish Local Population Medical Records. J Clin Med 2021; 10:jcm10122704. [PMID: 34207396 PMCID: PMC8233810 DOI: 10.3390/jcm10122704] [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: 05/04/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of the project was to compare patients treated with percutaneous transluminal coronary angioplasty (PTCA), who also had undergone PTCA in the past, with a group of people who had had no angiographic stenosis in the lumen of the coronary arteries in the past, and who also required PTCA during index hospitalization. The secondary aim was to compare the obtained data with the characteristics of a group of people who had undergone angiography twice and for whom no significant stenosis had been found in their coronary arteries. The study used registry data concerning 3085 people who had undergone at least two invasive procedures. Acute coronary syndrome (ACS) was significantly more often observed (Non-ST-segment elevation myocardial infarction (NSTEMI) OR 2.76 [1.91–3.99] and ST-segment elevation myocardial infarction (STEMI) OR 2.35 [1.85–2.99]) in patients with no significant coronary stenosis in the past (who required coronary angioplasty at the time of the study), compared to patients who had already had PTCA. They also demonstrated more frequent occurrence of ‘multivessel disease’. This was probably most likely caused by inadequate control of cardiovascular risk factors, as determined by higher total cholesterol levels ([mg/dL] 193.7 ± 44.4 vs. 178.2 ± 43.7) and LDL (123.4 ± 36.2 vs. 117.7 ± 36.2). On the other hand, patients in whom no significant stenosis was found in two consecutive angiographies were more likely to be burdened with chronic obstructive pulmonary disease, atrial fibrillation and chronic kidney disease.
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Wang X, Fu Y, Xie Z, Cao M, Qu W, Xi X, Zhong S, Piao M, Peng X, Jia Y, Meng L, Tian J. Establishment of a Novel Mouse Model for Atherosclerotic Vulnerable Plaque. Front Cardiovasc Med 2021; 8:642751. [PMID: 33796572 PMCID: PMC8007762 DOI: 10.3389/fcvm.2021.642751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background and Aims: Acute coronary syndrome (ACS) is a group of clinical syndromes characterized by rupture or erosion of atherosclerotic unstable plaques. Effective intervention for vulnerable plaques (VP) is of great significance to reduce adverse cardiovascular events. Methods: Fbn1C1039G+/− mice were crossbred with LDLR−/− mice to obtain a novel model for atherosclerotic VP. After the mice were fed with a high-fat diet (HFD) for 12 or 24 weeks, pathological staining and immunohistochemistry analyses were employed to evaluate atherosclerotic lesions. Results: Compared to control mice, Fbn1C1039G+/−LDLR−/− mice developed more severe atherosclerotic lesions, and the positive area of oil red O staining in the aortic sinus was significantly increased after 12 weeks (21.7 ± 2.0 vs. 6.3 ± 2.1) and 24 weeks (32.6 ± 2.5 vs. 18.7 ± 2.6) on a HFD. Additional vulnerable plaque characteristics, including significantly larger necrotic cores (280 ± 19 vs. 105 ± 7), thinner fiber caps (14.0 ± 2.8 vs. 32.6 ± 2.7), apparent elastin fiber fragmentation and vessel dilation (3,010 ± 67 vs. 1,465 ± 49), a 2-fold increase in macrophage number (8.5 ± 1.0 vs. 5.0 ± 0.6), obviously decreased smooth muscle cell number (0.6 ± 0.1 vs. 2.1 ± 0.2) and an ~25% decrease in total collagen content (33.6 ± 0.3 vs. 44.9 ± 9.1) were observed in Fbn1C1039G+/−LDLR−/− mice compared with control mice after 24 weeks. Furthermore, spontaneous plaque rupture, neovascularization, and intraplaque hemorrhage were detected in the model mouse plaque regions but not in those of the control mice. Conclusions: Plaques in Fbn1C1039G+/−LDLR−/− mice fed a HFD show many features of human advanced atherosclerotic unstable plaques. These results suggest that the Fbn1C1039G+/−LDLR−/− mouse is a novel model for investigating the pathological and physiological mechanisms of advanced atherosclerotic unstable plaques.
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Affiliation(s)
- Xueyu Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yahong Fu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zulong Xie
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Muhua Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Wenbo Qu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xiangwen Xi
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shan Zhong
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Minghui Piao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xiang Peng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ying Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lingbo Meng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Won KB, Heo R, Park HB, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, de Araújo Gonçalves P, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors. Atherosclerosis 2021; 324:46-51. [PMID: 33813155 DOI: 10.1016/j.atherosclerosis.2021.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The atherogenic index of plasma (AIP) has been suggested as a marker of plasma atherogenicity. This study aimed to assess the association between AIP and the rapid progression of coronary atherosclerosis using serial coronary computed tomography angiography (CCTA). METHODS A total of 1488 adults (60.9 ± 9.2 years, 58.9% male) who underwent serial CCTA with a median inter-scan period of 3.4 years were included. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Rapid plaque progression (RPP) was defined as the change of percentage atheroma volume (PAV) ≥1.0%/year. All participants were divided into three groups based on AIP tertiles. RESULTS Baseline total PAV (median [interquartile range (IQR)]) (%) (group I [lowest]: 1.91 [0.00, 6.21] vs. group II: 2.82 [0.27, 8.83] vs. group III [highest]: 2.70 [0.41, 7.50]), the annual change of total PAV (median [IQR]) (%/year) (group I: 0.27 [0.00, 0.81] vs. group II: 0.37 [0.04, 1.11] vs. group III: 0.45 [0.06, 1.25]), and the incidence of RPP (group I: 19.7% vs. group II: 27.3% vs. group III: 31.4%) were significantly different among AIP tertiles (all p < 0.05). In multiple logistic regression analysis, the risk of RPP was increased in group III (odds ratio: 1.52, 95% confidence interval: 1.02-2.26; p = 0.042) compared to group I after adjusting for clinical factors and baseline total PAV. CONCLUSIONS Based on serial CCTA findings, AIP is an independent predictive marker for RPP beyond traditional risk factors.
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Affiliation(s)
- Ki-Bum Won
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Ran Heo
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyung-Bok Park
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Ji Min Sung
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal; Nova Medical School, Lisbon, Portugal
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sang-Eun Lee
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sanghoon Shin
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, And Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Hyuk-Jae Chang
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
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Kumar V, Weerakoon S, Dey AK, Earls JP, Katz RJ, Reiner JS, Shaw LJ, Blankstein R, Mehta NN, Choi AD. The evolving role of coronary CT angiography in Acute Coronary Syndromes. J Cardiovasc Comput Tomogr 2021; 15:384-393. [PMID: 33858808 DOI: 10.1016/j.jcct.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/01/2021] [Accepted: 02/14/2021] [Indexed: 12/11/2022]
Abstract
In the United States, non-obstructive coronary disease has been on the rise, and each year, nearly one million adults suffer myocardial infarction, 70% of which are non-ST-segment elevation myocardial infarction (NSTEMI). In addition, approximately 15% of patients suffering NSTEMI will have subsequent readmission for a recurrent acute coronary syndrome (ACS). While invasive angiography remains the standard of care in the diagnostic and therapeutic approach to these patients, these methods have limitations that include procedural complications, uncertain specificity in diagnosis of the culprit lesion in patients with multi-vessel coronary artery disease (CAD), and challenges in following coronary disease over time. The role of coronary computed tomography angiography (CCTA) for evaluating patients with both stable and acute chest pain has seen a paramount upshift in the last decade. This paper reviews the established role of CCTA for the rapid exclusion of obstructive plaque in troponin negative acute chest pain, while exploring opportunities to address challenges in the current approach to evaluating NSTEMI.
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Affiliation(s)
- Vishak Kumar
- Division of Cardiology, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Shaneke Weerakoon
- Division of Cardiology, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - James P Earls
- Division of Cardiology, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Richard J Katz
- Division of Cardiology, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jonathan S Reiner
- Division of Cardiology, Interventional Cardiology Laboratory, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nehal N Mehta
- Division of Cardiology, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Fu Y, Sun C, Li Q, Qian F, Li C, Xi X, Shang D, Wang C, Peng X, Piao M, Qu W, Tian J, Yu B, Gu X, Tian J. Differential RNA expression profiles and competing endogenous RNA-associated regulatory networks during the progression of atherosclerosis. Epigenomics 2021; 13:99-112. [PMID: 33406894 DOI: 10.2217/epi-2020-0252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: To identify differential mRNA and ncRNA expression profiles and competing endogenous RNA-associated regulatory networks during the progression of atherosclerosis (AS). Materials & methods: We systematically analyzed whole-transcriptome sequencing of samples from different stages of AS to evaluate their long noncoding RNA (lncRNA), circular RNA (circRNA), miRNA and mRNA profiles. Results: We constructed three AS-related competing endogenous RNA regulatory networks of differentially expressed circRNAs, lncRNAs, miRNAs and mRNAs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed that the circRNAs in the network were enriched in lipid metabolic processes and participated in the PPAR signaling pathway. Furthermore, lncRNAs were related to receptor activity, myofibrils and cardiovascular system development. Conclusion: The current findings further clarified the regulatory mechanisms at different stages of AS and may provide new ideas and targets for AS.
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Affiliation(s)
- Yahong Fu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China.,Guangxi Key Laboratory of Diabetic Systems Medicine, Guilin, 541004, Guangxi, China
| | - Changbin Sun
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
| | - Qi Li
- Department of Pathology, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Fengcui Qian
- School of Medical Informatics, Daqing Campus, Harbin Medical University, Daqing, 163319, Heilongjiang, China
| | - Chunquan Li
- School of Medical Informatics, Daqing Campus, Harbin Medical University, Daqing, 163319, Heilongjiang, China
| | - Xiangwen Xi
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
| | - Desi Shang
- College of Bioinformatics Science & Technology, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Chuhan Wang
- Department of Pathology, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Xiang Peng
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
| | - Minghui Piao
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
| | - Wenbo Qu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
| | - Jinwei Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China.,Guangxi Key Laboratory of Diabetic Systems Medicine, Guilin, 541004, Guangxi, China
| | - Bo Yu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
| | - Xia Gu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China.,Heilongjiang Provincial Hospital, Harbin, 150030, Heilongjiang, China
| | - Jiangtian Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150086, Heilongjiang, China
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Osborn EA, Albaghdadi M, Libby P, Jaffer FA. Molecular Imaging of Atherosclerosis. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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50
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Asleh R, Manemann SM, Weston SA, Bielinski SJ, Chamberlain AM, Jiang R, Gerber Y, Roger VL. Sex Differences in Outcomes After Myocardial Infarction in the Community. Am J Med 2021; 134:114-121. [PMID: 32622868 PMCID: PMC7752831 DOI: 10.1016/j.amjmed.2020.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Prior studies observed that women experienced worse outcomes than men after myocardial infarction but did not convincingly establish an independent effect of female sex on outcomes, thus failing to impact clinical practice. Current data remain sparse and information on long-term nonfatal outcomes is lacking. To address these gaps in knowledge, we examined outcomes after incident myocardial infarction for women compared with men. METHODS We studied a population-based myocardial infarction incidence cohort in Olmsted County, Minnesota, between 2000 and 2012. Patients were followed for recurrent myocardial infarction, heart failure, and death. A propensity score was constructed to balance the clinical characteristics between men and women; Cox models were weighted using inverse probabilities of the propensity scores. RESULTS Among 1959 patients with incident myocardial infarction (39% women; mean age 73.8 and 64.2 for women and men, respectively), 347 recurrent myocardial infarctions, 464 heart failure episodes, 836 deaths, and 367 cardiovascular deaths occurred over a mean follow-up of 6.5 years. Women experienced a higher occurrence of each adverse event (all P <0.01). After propensity score weighting, women had a 28% increased risk of recurrent myocardial infarction (hazard ratio: 1.28, 95% confidence interval: 1.03-1.59), and there was no difference in risk for any other outcomes (all P >0.05). CONCLUSION After myocardial infarction, women experience a large excess risk of recurrent myocardial infarction but not of heart failure or death independently of clinical characteristics. Future studies are needed to understand the mechanisms driving this association.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases; Department of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | | | | | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Véronique L Roger
- Department of Cardiovascular Diseases; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
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