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Wentzel JJ, Bos D, White SJ, van der Heiden K, Kavousi M, Evans PC. Sex-related differences in coronary and carotid vessel geometry, plaque composition and shear stress obtained from imaging. Atherosclerosis 2024; 395:117616. [PMID: 38944895 DOI: 10.1016/j.atherosclerosis.2024.117616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Atherosclerosis manifests itself differently in men and women with respect to plaque initiation, progression and plaque composition. The observed delay in plaque progression in women is thought to be related to the hormonal status of women. Also features associated with the vulnerability of plaques to rupture seem to be less frequently present in women compared to men. Current invasive and non-invasive imaging modalities allow for visualization of plaque size, composition and high risk vulnerable plaque features. Moreover, image based modeling gives access to local shear stress and shear stress-related plaque growth. In this review, current knowledge on sex-related differences in plaque size, composition, high risk plaque features and shear stress related plaque growth in carotid and coronary arteries obtained from imaging are summarized.
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Affiliation(s)
- J J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, the Netherlands.
| | - D Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - S J White
- Biosciences Institute, Newcastle University, UK
| | - K van der Heiden
- Department of Cardiology, Biomedical Engineering, Erasmus MC, the Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - P C Evans
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London, Faculty of Medicine and Dentistry, Queen Mary University of London, UK
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2
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Canton G, Baylam Geleri D, Hippe DS, Sun J, Guo Y, Balu N, Chu B, Pimentel K, Akçiçek H, Yaman Akçiçek E, Tirschwell D, Tang G, Kohler T, Shibata D, Ferguson MS, Yuan C, Hatsukami TS. Pathophysiology of carotid atherosclerosis: Calcification, intraplaque haemorrhage and pulse pressure as key players. Eur J Radiol 2024; 178:111647. [PMID: 39068857 DOI: 10.1016/j.ejrad.2024.111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/09/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Intraplaque haemorrhage (IPH) is a well-known risk factor for faster plaque progression (volume increase); however, its etiology is unclear. We aimed at determining what other local plaque- and systemic factors contribute to plaque progression and to the development and progression of IPH. METHODS We examined 98 asymptomatic participants with carotid plaque using serial multi-contrast magnetic resonance imaging. We measured the percent of wall volume (%WV=100 x [wall volume] / [total vessel volume]) and measured IPH and calcification volumes. We used generalized estimating equations-based regression to analyze predictors of %WV change and new IPH while accounting for covariates (sex, age and statin use), and multiple non-independent observations per participant. RESULTS Total follow-up was 1.8 ± 0.8 years on average. The presence of IPH (β: 0.6 %/y, p = 0.033) and calcification (β: 1.2 %/y, p = 0.028) were each associated with faster plaque progression. New IPH, detected on a subsequent scan in 4 % of arteries that did not initially have IPH, was associated with larger calcification (odds ratio [OR]: 2.6 per 1-SD increase, p = 0.038) and higher pulse pressure (OR: 2.3 per 1-SD increase, p = 0.016). Larger calcification was associated with greater increases in pulse pressure (β: 1.4 mm Hg/y per 1-SD increase, p = 0.040). CONCLUSIONS IPH and calcification are each independently associated with faster plaque progression. The association of carotid calcification to increased pulse pressure and new IPH development suggests a possible mechanism by which calcification drives IPH development and plaque progression.
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Affiliation(s)
- Gador Canton
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Duygu Baylam Geleri
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Daniel S Hippe
- Clinical Biostatistics, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Jie Sun
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Yin Guo
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Niranjan Balu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Baocheng Chu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Kristi Pimentel
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Halit Akçiçek
- Radiology Department, University of Utah, Salt Lake City, UT, United States
| | - Ebru Yaman Akçiçek
- Radiology Department, University of Utah, Salt Lake City, UT, United States
| | - David Tirschwell
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Gale Tang
- Division of Vascular Surgery, Department of Surgery University of Washington, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Ted Kohler
- Division of Vascular Surgery, Department of Surgery University of Washington, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Dean Shibata
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Marina S Ferguson
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Chun Yuan
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States; Radiology Department, University of Utah, Salt Lake City, UT, United States
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, United States.
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Peret A, Romero-Sanchez G, Dabiri M, McNally JS, Johnson KM, Mossa-Basha M, Eisenmenger LB. MR Angiography of Extracranial Carotid Disease. Magn Reson Imaging Clin N Am 2023; 31:395-411. [PMID: 37414468 DOI: 10.1016/j.mric.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance angiography sequences, such as time-of-flight and contrast-enhanced angiography, provide clear depiction of vessel lumen, traditionally used to evaluate carotid pathologic conditions such as stenosis, dissection, and occlusion; however, atherosclerotic plaques with a similar degree of stenosis may vary tremendously from a histopathological standpoint. MR vessel wall imaging is a promising noninvasive method to evaluate the content of the vessel wall at high spatial resolution. This is particularly interesting in the case of atherosclerosis as vessel wall imaging can identify higher risk, vulnerable plaques as well as has potential applications in the evaluation of other carotid pathologic conditions.
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Affiliation(s)
- Anthony Peret
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Ciudad de México, Mexico City, Mexico
| | - Mona Dabiri
- Radiology Department, Children's Medical Center, Tehran University of Medical Science, No 63, Gharib Avenue, Keshavarz Blv, Tehran 1419733151, Iran
| | - Joseph Scott McNally
- Department of Radiology, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA.
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Rushton A, Carlesso LC, Flynn T, Hing WA, Rubinstein SM, Vogel S, Kerry R. International Framework for Examination of the Cervical Region for Potential of Vascular Pathologies of the Neck Prior to Musculoskeletal Intervention: International IFOMPT Cervical Framework. J Orthop Sports Phys Ther 2023; 53:7-22. [PMID: 36099171 DOI: 10.2519/jospt.2022.11147] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS: This position statement, stemming from the International IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) Cervical Framework, was developed based upon the best contemporary evidence and expert opinion to assist clinicians during their clinical reasoning process when considering presentations involving the head and neck. Developed through rigorous consensus methods, the International IFOMPT Cervical Framework guides assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned interventions. Within the cervical spine, events and presentations of vascular pathologies of the neck are rare but are an important consideration as part of patient examination. Vascular pathologies may be recognizable if the appropriate questions are asked during the patient history-taking process, if interpretation of elicited data enables recognition of this potential, and if the physical examination can be adapted to explore any potential vasculogenic hypothesis. J Orthop Sports Phys Ther 2023;53(1):7-22. Epub: 14 September 2022. doi:10.2519/jospt.2022.11147.
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Yan X, Tang M, Gao J, Wang L, Li L, Ma N, Shi X, Lei X, Zhang X. Sex Differences in Intracranial Atherosclerotic Plaques Among Patients With Ischemic Stroke. Front Cardiovasc Med 2022; 9:860675. [PMID: 35845071 PMCID: PMC9280275 DOI: 10.3389/fcvm.2022.860675] [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: 01/23/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHigh-risk intracranial arterial plaques are the most common cause of ischemic stroke and their characteristics vary between male and female patients. However, sex differences in intracranial plaques among symptomatic patients have rarely been discussed. This study aimed to evaluate sex differences in intracranial atherosclerotic plaques among Chinese patients with cerebral ischemia.MethodsOne hundred and ten patients who experienced ischemic events underwent 3T cardiovascular magnetic resonance vessel wall scanning for the evaluation of intracranial atherosclerotic disease. Each plaque was classified according to its likelihood of causing a stroke (as culprit, uncertain, or non-culprit). The outer wall area (OWA) and lumen area of the lesion and reference sites were measured, and the wall and plaque areas, remodeling ratio, and plaque burden (characterized by a normalized wall index) were further calculated. The composition (T1 hyperintensity, enhancement) and morphology (surface irregularity) of each plaque were analyzed. Sex differences in intracranial plaque characteristics were compared between male and female patient groups.ResultsOverall, 311 plaques were detected in 110 patients with ischemic stroke (81 and 29 male and female patients, respectively). The OWA (P < 0.001) and wall area (P < 0.001) of intracranial arterial lesions were significantly larger in male patients. Regarding culprit plaques, the plaque burden in male patients was similar to that in female patients (P = 0.178, odds ratio [OR]: 0.168, 95% confidence interval [CI]: −0.020 to 0.107). However, the prevalence of plaque T1 hyperintensity was significantly higher than that in female patients (P = 0.005, OR: 15.362, 95% CI: 2.280–103.49). In the overall ischemic stroke sample, intracranial T1 hyperintensity was associated with male sex (OR: 13.480, 95% CI: 2.444–74.354, P = 0.003), systolic blood pressure (OR: 1.019, 95% CI: 1.002–1.036, P = 0.031), and current smoker (OR: 3.245, 95% CI: 1.097–9.598, P = 0.033).ConclusionFor patients with ischemic stroke, the intracranial plaque burden in male patients was similar to that in female patients; however, the plaque characteristics in male patients are associated with higher risk, especially in culprit plaques.
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Affiliation(s)
- Xuejiao Yan
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Lihui Wang
- Department of Radiology, Xi'an International Medical Center Hospital, Xi'an, China
| | - Ling Li
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Niane Ma
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaorui Shi
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Xiaoling Zhang
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Crombag G, Aizaz M, Schreuder F, Benali F, van Dam-Nolen D, Liem M, Lucci C, van der Steen A, Daemen M, Mess W, van der Lugt A, Nederkoorn P, Hendrikse J, Hofman P, van Oostenbrugge R, Wildberger J, Kooi M. Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study. AJNR Am J Neuroradiol 2022; 43:265-271. [PMID: 35121587 PMCID: PMC8985675 DOI: 10.3174/ajnr.a7384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS Eighty-eight symptomatic patients with stroke (<70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P < .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P < .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.
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Affiliation(s)
- G.A.J.C. Crombag
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M. Aizaz
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - F.H.B.M. Schreuder
- Department of Neurology & Donders Institute for Brain Cognition & Behaviour (F.H.B.M.S.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - F. Benali
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | | | - M.I. Liem
- Departments of Neurology (M.I.L., P.J.N.)
| | - C. Lucci
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A.F. van der Steen
- Biomedical Engineering (A.F.v.d.S.), Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M.J.A.P. Daemen
- Pathology (M.J.A.P.D.), Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | | | - A. van der Lugt
- Departments of Radiology and Nuclear Medicine (D.H.K.v.D.-N., A.v.d.L.)
| | | | - J. Hendrikse
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - P.A.M. Hofman
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | - R.J. van Oostenbrugge
- Neurology (R.J.v.O.), Maastricht University Medical Center, Maastricht, the Netherlands,CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - J.E. Wildberger
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M.E. Kooi
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
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Han Y, Zhang R, Yang D, Li D, Han H, Qiao H, Chen S, Wang Y, Yu M, Hong Y, Wang Z, Zhao X, Liu G. Risk Factors for Asymptomatic and Symptomatic Intracranial Atherosclerosis Determined by Magnetic Resonance Vessel Wall Imaging in Chinese Population: A Case–Control Study. Ther Clin Risk Manag 2022; 18:61-70. [PMID: 35058694 PMCID: PMC8764293 DOI: 10.2147/tcrm.s335401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose The association between risk factors and intracranial atherosclerosis disease (ICAD) determined by magnetic resonance (MR) vessel wall imaging in Chinese population has not been investigated. The aim of this study was to investigate the associations of conventional vascular risk factors with asymptomatic and symptomatic ICAD using MR vessel wall imaging in Chinese population. Methods The study population was recruited from two cohort studies of ICASMAP and CAMERA comprised 104 symptomatic ICAD subjects (57.1 ± 11.1 years; 35.6% females), 51 asymptomatic ICAD subjects (70.1 ± 8.4 years; 50.0% females) and 418 controls (58.0 ± 13.3 years; 61.0% females) defined as asymptomatic subjects without ICAD on MR vessel wall imaging. We compared the vascular risk factors between the three groups using a multivariate logistic regression analysis. Results Compared with controls, there was a significant positive association between age (OR: 1.07, 95% CI: 1.03–1.10, p < 0.001) and hypertension (OR: 3.03, 95% CI: 1.45–6.36, p = 0.003) and asymptomatic ICAD. There was a positive association of smoking (OR: 3.41, 95% CI: 1.57–7.42, p = 0.001), hypertension (OR: 7.43, 95% CI: 3.81–14.49, p < 0.001) and diabetes (OR: 3.54, 95% CI: 1.93–6.49, p < 0.001) and an inverse association of high-density lipoprotein (HDL) (p < 0.017) with symptomatic ICAD. Compared to asymptomatic ICAD, there was a significant inverse association of age (OR: 0.86, 95% CI: 0.81–0.92, p < 0.001) and HDL (p < 0.001) with symptomatic ICAD. Conclusion Old age and hypertension are associated with asymptomatic ICAD and smoking, hypertension, diabetes and lower HDL are associated with an increased risk of symptomatic ICAD in Chinese population. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03417063.
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Affiliation(s)
- Yongjun Han
- Department of Radiology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, People’s Republic of China
| | - Dandan Yang
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, People’s Republic of China
| | - Dongye Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, People’s Republic of China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, People’s Republic of China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, People’s Republic of China
| | - Yu Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, People’s Republic of China
| | - Miaoxin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, People’s Republic of China
| | - Yin Hong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, People’s Republic of China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, People’s Republic of China
- Correspondence: Xihai Zhao Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Haidian District, Beijing, 100084, People’s Republic of ChinaTel +86-10-62792662Fax +86-10-62796175 Email
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, People’s Republic of China
- Gaifen Liu Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070,People’s Republic of ChinaTel +86-10-59976746 Email
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Song X, Wei Q, Zhao X, Hou D, Zhao H, Wang L, Zhang X, Zheng Z, Wu J. Association between Short-Term Blood Pressure Variability and Intracranial Atherosclerotic Plaque Vulnerability: A High-Resolution Magnetic Resonance Imaging Study. J Atheroscler Thromb 2021; 29:1383-1392. [PMID: 34707024 PMCID: PMC9444806 DOI: 10.5551/jat.63164] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: short-term blood pressure variability (BPV) as a risk factor of atherosclerosis and cardiovascular events has been investigated. However, its association with atherosclerotic plaque vulnerability remains unknown. The objective of this study was to determine the association between short-term BPV and intracranial atherosclerotic plaque vulnerability.
Methods: this is a cross-sectional analysis of 267 ischemic stroke patients with symptomatic intracranial atherosclerosis (mean age, 65±12 years old; 60.3% male), which were prospectively recruited in a comprehensive stroke center. Systolic and diastolic BP SD, CV, and BP variability ratio (BPVR) from 24 hours, daytime, and nighttime were calculated from 24-h ambulatory blood pressure monitoring, intracranial atherosclerotic plaque burden and vulnerability were evaluated by high-resolution magnetic resonance vessel wall imaging. Logistic regression analysis was used to locate the correlation between short-term BPV and plaque vulnerability.
Results: a total of 36.3% subjects presented with intraplaque hemorrhage (IPH) in this study. Multivariate logistic regression suggested that nighttime diastolic BP CV and 24-h BPVR were associated with intracranial IPH independently after adjusted for cardiovascular risk factors, odds ratio (OR) and 95% confidence interval (CI) for per SD BPV changes were 1.418 (1.051, 1.914) and 0.731 (0.548, 0.976), respectively, and this association also independent of atherosclerosis burden and 24-h mean systolic BP level. Further subgroup analysis by age and hypertension history demonstrated that the statistical correlation could only establish in the elder, and subjects with hypertension.
Conclusion: nighttime diastolic BP CV and 24-h BPVR were associated with intracranial IPH independently, especially in the elderly and subjects with hypertension.
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Affiliation(s)
- Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Qiao Wei
- Department of Neurology, The Second Hospital of Hebei Medical University
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | - Duoduo Hou
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Hongliang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Lixue Wang
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Xiaofeng Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
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Cardio-ankle vascular index is associated with coronary plaque composition assessed with iMAP-intravascular ultrasound in patients with coronary artery disease. J Cardiol 2021; 78:502-508. [PMID: 34284942 DOI: 10.1016/j.jjcc.2021.05.015] [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: 02/12/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The cardio-ankle vascular index (CAVI) is an indicator of arterial stiffness and has been reported to be associated with the severity of coronary artery disease and cardiovascular events. However, whether CAVI can predict the composition of coronary plaques remains unclear. METHODS We enrolled 208 patients who underwent percutaneous coronary intervention (PCI) for culprit lesions evaluated with iMAP-intravascular ultrasound (IVUS), a radiofrequency imaging system for characterizing tissues. iMAP-IVUS classified the culprit plaque composition as fibrotic, lipidic, necrotic, or calcified, and the respective absolute volumes [fibrotic volume (FV), lipidic volume (LV), necrotic volume NV, and calcified volume] and their ratios (%) within the total plaque volume were calculated. A plaque with a median %NV of ≥ 33.2% was defined as a larger NV (LNV) plaque. We measured CAVI and divided the patients into two groups according to CAVI ≥8 (high CAVI, n = 164) or <8 (low CAVI, n = 44). RESULTS Culprit plaques had significantly greater absolute NV (p = 0.016), %NV (p = 0.01), and smaller %FV (p = 0.02) in patients with high CAVI than in those with low CAVI. Patients with high CAVI had a higher prevalence of LNV plaques in culprit lesions than those with low CAVI (54% vs. 34%, p = 0.026). CAVI correlated significantly and positively with absolute NV, LV, and negatively with %FV. In logistic regression analysis after adjustment for the classic coronary risk factors and possible variables associated with vulnerable plaques, high CAVI had an independent and significant association with the presence of LNV plaques (OR, 3.37; 95% CI, 1.45-7.79; p = 0.0032). CONCLUSIONS A high CAVI is associated with the composition of coronary culprit plaques, particularly increased amount of necrotic tissue, in patients with coronary artery disease undergoing PCI .
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10
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Zhang L, Zhu L, Lu M, Zhao X, Li F, Cai J, Yuan C. Comparison of Carotid Plaque Characteristics Between Men and Women Using Magnetic Resonance Vessel Wall Imaging: A Chinese Atherosclerosis Risk Evaluation Study. J Magn Reson Imaging 2021; 54:646-654. [PMID: 33638575 DOI: 10.1002/jmri.27576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population. PURPOSE To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging. STUDY TYPE Cross-sectional. SUBJECTS A total of 567 patients (mean age: 61.5 ± 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery. FIELD STRENGTH A 3.0 T. SEQUENCE T1- and T2-weighted turbo spin echo, three-dimensional time-of-flight (TOF) fast field echo and magnetization-prepared rapid acquisition gradient echo sequences. ASSESSMENT Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women. STATISTICAL TESTS Independent-sample t test, Mann-Whitney U test, chi-square test, and multiple linear and logistic regressions. RESULTS In symptomatic arteries, men had significantly greater LA (46.2 ± 15.6 mm2 vs. 40.7 ± 12.9 mm2 , P < 0.05), WA (33.9 ± 11.5 mm2 vs. 26.3 ± 7.5 mm2 , P < 0.05), and TVA (80.1 ± 20.4 mm2 vs. 67.0 ± 18.0 mm2 , P < 0.05); higher MWT (1.2 ± 0.4 mm vs. 1.0 ± 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 ± 16.9 mm2 vs. 42.1 ± 12.6 mm2 , P < 0.05), WA (32.9 ± 11.0 mm2 vs. 25.8 ± 6.1 mm2 , P < 0.05), and TVA (81.2 ± 22.1 mm2 vs. 67.9 ± 16.5 mm2 , P < 0.05); higher MWT (1.2 ± 0.3 mm vs. 1.0 ± 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 ± 17.2% vs. 17.8 ± 14.1%, P < 0.05) compared with women. DATA CONCLUSION Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lichen Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lina Zhu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Zhengzhou, Henan Province, China
| | - Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Xihai Zhao
- Center For Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Feiyu Li
- Operation Department, RIMAG Medical Imaging Corporation, Beijing, China
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, USA
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11
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Kassem M, Florea A, Mottaghy FM, van Oostenbrugge R, Kooi ME. Magnetic resonance imaging of carotid plaques: current status and clinical perspectives. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1266. [PMID: 33178798 PMCID: PMC7607136 DOI: 10.21037/atm-2020-cass-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T1-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.
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Affiliation(s)
- Mohamed Kassem
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Alexandru Florea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, MUMC+, Maastricht, The Netherlands
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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12
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Larson AS, Brinjikji W, Savastano LE, Huston Iii J, Benson JC. Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors. Cerebrovasc Dis 2020; 49:355-360. [PMID: 32674096 DOI: 10.1159/000508733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied. METHODS A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH. RESULTS Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipidemia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0-1.05], p <0.0001), male sex (OR: 2.5, 95% CI: [1.4-4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6-15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3-5.2], p = 0.009). CONCLUSIONS IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.
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Affiliation(s)
- Anthony S Larson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA, .,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA,
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis E Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Huston Iii
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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13
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Song X, Zhao X, Liebeskind DS, Xu W, Zhang J, Wei C, Xu Y, Wang L, Zheng Z, Wu J. Associations between systemic blood pressure parameters and intraplaque hemorrhage in symptomatic intracranial atherosclerosis: a high-resolution MRI-based study. Hypertens Res 2020; 43:688-695. [PMID: 32037397 DOI: 10.1038/s41440-020-0411-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/18/2019] [Accepted: 01/21/2020] [Indexed: 11/09/2022]
Abstract
The associations between blood pressure parameters and intracranial vulnerable plaques have not been fully elucidated. The purpose of this study was to investigate the associations between systemic blood pressure parameters, as well as their variability, and intraplaque hemorrhage (IPH) in stroke patients with intracranial atherosclerosis. We retrospectively analyzed the high-resolution MRI data set of intracranial atherosclerosis from a comprehensive stroke center. The atherosclerotic plaque burden and presence of IPH in each vessel were obtained from vessel wall imaging. Blood pressure parameters in the first week of admission were used. The systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and their variability (standard deviation [SD] and coefficient of variation [CV]) were compared between the IPH (+) and IPH (-) groups. Logistic regression analysis was used to demonstrate the correlations between different blood pressure parameters and IPH. The results indicated that SBP and PP were associated with multiple plaques and severe luminal stenosis after adjusting for confounders, with OR = 1.071, 95% CI: (1.044-1.098) and OR = 1.039, 95% CI: (1.019-1.060) for SBP and OR = 1.058, 95% CI: (1.027-1.089) and OR = 1.044, 95% CI: (1.019-1.070) for PP, respectively. SBP was associated with IPH after adjusting for cardiovascular risk factors, with OR = 1.021, 95% CI: (1.003-1.038), but not after correcting for plaque burden, with OR = 1.014, 95% CI: (0.996-1.032). No associations between blood pressure variability and atherosclerotic plaque burden or IPH were detected in this study. In conclusion, SBP is associated with IPH after adjusting for cardiovascular risk factors but not after further correction for atherosclerotic plaque burden. The association between blood pressure variability and intracranial atherosclerosis requires further study.
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Affiliation(s)
- Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Wendeng Xu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jun Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chenming Wei
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yilan Xu
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lixue Wang
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China. .,Tsinghua University Hospital, Beijing, China.
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14
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Cao Y, Zhao X, Watase H, Hippe DS, Wu Y, Zhang H, Yue L, Canto GM, Song Y, Shi H, Wang G, Li R, Bao H, Yuan C. Comparison of Carotid Atherosclerosis between Patients at High Altitude and Sea Level: A Chinese Atherosclerosis Risk Evaluation Study. J Stroke Cerebrovasc Dis 2020; 29:104448. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 01/29/2023] Open
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15
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Porcu M, Anzidei M, Suri JS, A Wasserman B, Anzalone N, Lucatelli P, Loi F, Montisci R, Sanfilippo R, Rafailidis V, Saba L. Carotid artery imaging: The study of intra-plaque vascularization and hemorrhage in the era of the "vulnerable" plaque. J Neuroradiol 2019; 47:464-472. [PMID: 30954549 DOI: 10.1016/j.neurad.2019.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/04/2019] [Accepted: 03/04/2019] [Indexed: 01/01/2023]
Abstract
Intraplaque hemorrhage (IPH) is one of the main factors involved in atherosclerotic plaque (AP) instability. Its recognition is crucial for the correct staging and management of patients with carotid artery plaques to limit ischemic stroke. Imaging plays a crucial role in identifying IPH, even if the great variability of intraplaque vascularization and the limitations of our current imaging technologies make it difficult. The intent of this review is to give a general overview of the main features of intraplaque vascularization and IPH on Ultrasound (US), Computed Tomography (CT), Magnetic Resonance (MR) and Nuclear Medicine, and a brief description on the future prospectives.
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Affiliation(s)
- Michele Porcu
- Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Cagliari, Italy.
| | - Michele Anzidei
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jasjit S Suri
- Monitoring and Diagnostic Division, AtheroPoint, Roseville, CA, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicoletta Anzalone
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, via Olgettina 60, 20132, Milan, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Loi
- Department of Biomedial Sciences, Unit of Oncology and Molecular Pathology, University of Cagliari, Cagliari, Italy
| | - Roberto Montisci
- Department of Vascular Surgery, AOU of Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, AOU of Cagliari, University of Cagliari, Cagliari, Italy
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
| | - Luca Saba
- Department of Medical Imaging, AOU of Cagliari, University of Cagliari, Cagliari, Italy
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16
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Crombag GAJC, Schreuder FHBM, van Hoof RHM, Truijman MTB, Wijnen NJA, Vöö SA, Nelemans PJ, Heeneman S, Nederkoorn PJ, Daemen JWH, Daemen MJAP, Mess WH, Wildberger JE, van Oostenbrugge RJ, Kooi ME. Microvasculature and intraplaque hemorrhage in atherosclerotic carotid lesions: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson 2019; 21:15. [PMID: 30832656 PMCID: PMC6398220 DOI: 10.1186/s12968-019-0524-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/04/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The presence of intraplaque haemorrhage (IPH) has been related to plaque rupture, is associated with plaque progression, and predicts cerebrovascular events. However, the mechanisms leading to IPH are not fully understood. The dominant view is that IPH is caused by leakage of erythrocytes from immature microvessels. The aim of the present study was to investigate whether there is an association between atherosclerotic plaque microvasculature and presence of IPH in a relatively large prospective cohort study of patients with symptomatic carotid plaque. METHODS One hundred and thirty-two symptomatic patients with ≥2 mm carotid plaque underwent cardiovascular magnetic resonance (CMR) of the symptomatic carotid plaque for detection of IPH and dynamic contrast-enhanced (DCE)-CMR for assessment of plaque microvasculature. Ktrans, an indicator of microvascular flow, density and leakiness, was estimated using pharmacokinetic modelling in the vessel wall and adventitia. Statistical analysis was performed using an independent samples T-test and binary logistic regression, correcting for clinical risk factors. RESULTS A decreased vessel wall Ktrans was found for IPH positive patients (0.051 ± 0.011 min- 1 versus 0.058 ± 0.017 min- 1, p = 0.001). No significant difference in adventitial Ktrans was found in patients with and without IPH (0.057 ± 0.012 min- 1 and 0.057 ± 0.018 min- 1, respectively). Histological analysis in a subgroup of patients that underwent carotid endarterectomy demonstrated no significant difference in relative microvessel density between plaques without IPH (n = 8) and plaques with IPH (n = 15) (0.000333 ± 0.0000707 vs. and 0.000289 ± 0.0000439, p = 0.585). CONCLUSIONS A reduced vessel wall Ktrans is found in the presence of IPH. Thus, we did not find a positive association between plaque microvasculature and IPH several weeks after a cerebrovascular event. Not only leaky plaque microvessels, but additional factors may contribute to IPH development. TRIAL REGISTRATION NCT01208025 . Registration date September 23, 2010. Retrospectively registered (first inclusion September 21, 2010). NCT01709045 , date of registration October 17, 2012. Retrospectively registered (first inclusion August 23, 2011).
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Affiliation(s)
- Geneviève A. J. C. Crombag
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Floris H. B. M. Schreuder
- Department of Neurology & Donders Institute for Brain Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Raf H. M. van Hoof
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Martine T. B. Truijman
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicky J. A. Wijnen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Stefan A. Vöö
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Patty J. Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Sylvia Heeneman
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul J. Nederkoorn
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jan-Willem H. Daemen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mat J. A. P. Daemen
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Werner H. Mess
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J. E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Robert J. van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M. Eline Kooi
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Zhou C, Yuan C, Li R, Wang W, Li C, Zhao X. Association Between Incomplete Circle of Willis and Carotid Vulnerable Atherosclerotic Plaques. Arterioscler Thromb Vasc Biol 2018; 38:2744-2749. [PMID: 30354232 DOI: 10.1161/atvbaha.118.311797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Carotid high-risk plaque, characterized by intraplaque hemorrhage, fibrous cap rupture, and large lipid-rich necrotic core, is associated with cerebrovascular events. This study sought to investigate the relationship between high-risk carotid plaque and an incomplete circle of Willis (COW).
Approach and Results—
Patients were recruited from a multicenter study, Chinese Atherosclerosis Risk Evaluation (CARE-II) and underwent 3-dimensional time-of-flight magnetic resonance angiography for intracranial arteries and 2-dimensional multicontrast magnetic resonance vessel wall imaging for carotid arteries on a 3.0T magnetic resonance scanner. The integrity of the COW in anterior and posterior portions was evaluated. Characteristics of carotid plaques were assessed. Correlation between incomplete COW and carotid plaque features was determined. Of 482 eligible patients, patients with carotid intraplaque hemorrhage showed significantly higher prevalence of an incomplete anterior COW (52.7% versus 38.5%;
P
=0.022) compared with those without. An incomplete anterior COW was associated with intraplaque hemorrhage before (odds ratio, 1.781; 95% CI, 1.083–2.931;
P
=0.023) and after adjusted for clinical risk factors (odds ratio, 1.945; 95% CI, 1.139–3.321;
P
=0.015). The unilateral carotid artery stenosis showed no correlation with incomplete anterior COW and posterior COW (all
P
>0.025). No significant associations were found between other plaque features and any type of incomplete COW (all
P
>0.025).
Conclusions—
An incomplete COW is independently associated with intraplaque hemorrhage of carotid atherosclerotic plaques.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02017756.
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Affiliation(s)
- Changwu Zhou
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
- Department of Radiology, University of Washington, Seattle (C.Y.)
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
| | - Wei Wang
- From the Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, China (C.Z., W.W.)
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China (C.L.)
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China (C.Y., R.L., X.Z.)
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Change in Carotid Plaque Components. JACC Cardiovasc Imaging 2018; 11:184-192. [DOI: 10.1016/j.jcmg.2016.12.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022]
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Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39:E9-E31. [PMID: 29326139 DOI: 10.3174/ajnr.a5488] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
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Affiliation(s)
- L Saba
- From the Department of Medical Imaging (L.S.), University of Cagliari, Cagliari, Italy
| | - C Yuan
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - T Saam
- Department of Radiology (T.S.), Ludwig-Maximilian University Hospital, Munich, Germany
| | - A R Moody
- Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Li
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - C C Matouk
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - H R Jäger
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | | | - M E Kooi
- Department of Radiology (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Z Fan
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - D Saloner
- Department of Radiology and Biomedical Imaging (D.S.), University of California, San Francisco, California
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - D J Mikulis
- Division of Neuroradiology (D.J.M.), Department of Medical Imaging, University Health Network
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
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20
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Filipek A, Czerwińska ME, Kiss AK, Polański JA, Naruszewicz M. Oleacein may inhibit destabilization of carotid plaques from hypertensive patients. Impact on high mobility group protein-1. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2017; 32:68-73. [PMID: 28732809 DOI: 10.1016/j.phymed.2017.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/20/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In patients with hypertension the haemorrhage into carotid atherosclerotic plaque increases risk of plaque destabilization and rupture. Our previous study showed that oleacein, a secoiridoid present in extra virgin olive oil, enhanced uptake of haemoglobin-haptoglobin complex and change macrophage phenotype from pro-inflammatory M1 to anti-inflammatory M2. PURPOSE The aim this study was to investigate a potential role of oleacein in attenuation of carotid plaque destabilisation ex vivo. METHODS Samples of atherosclerotic plaque were harvested from 20 patients with hypertension /11 women and 9 men/, who underwent carotid endarterectomy after transient ischemic attacks. Matching pieces of each plaque were incubated with increased concentration of pure oleacein /range 0-20 µM/ for 24 h. HMGB1, MMP-9, MMP-9/NGAL, TF and IL-10, as well as HO-1 secretion from plaque was measured by enzyme-linked immunosorbent assay /ELISA/. Statistical significance was set at P < 0.05 and P < 0.001. RESULTS Oleacein at the concentrations of 10 and 20 µM significantly (P < 0.001) decreased secretion of HMGB1 (up 90%), MMP-9 (up to 80%), MMP-9/NGAL complex (up to 80%) and TF (more than 90%) from the treated plaque, as compared to control. At the same time IL-10 and HO-1 release increased by more than 80% (P < 0.001). CONCLUSION Our results indicate that oleacein possess ability to attenuate the destabilization of carotid plaque and could be potentially useful in the reduction of ischemic stroke risk.
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Affiliation(s)
- Agnieszka Filipek
- Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Monika E Czerwińska
- Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Anna K Kiss
- Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Jerzy A Polański
- Chair and Department of General, Vascular and Oncologic Surgery, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Marek Naruszewicz
- Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland.
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21
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Lin R, Chen S, Liu G, Xue Y, Zhao X. Association Between Carotid Atherosclerotic Plaque Calcification and Intraplaque Hemorrhage. Arterioscler Thromb Vasc Biol 2017; 37:1228-1233. [PMID: 28450297 DOI: 10.1161/atvbaha.116.308360] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
Objective—
Carotid intraplaque hemorrhage (IPH) is associated with cardiovascular events. Calcification, which frequently accompanies IPH, may play a role in IPH occurrence. In this study, we aimed to investigate the associations between calcification characteristics and IPH in carotid plaques.
Approach and results—
One hundred seventeen patients with cerebrovascular symptoms and carotid plaques detected by ultrasound were recruited and underwent multicontrast magnetic resonance imaging. Advanced carotid plaques with composition measured by magnetic resonance imaging were included in the analysis. Carotid calcifications were divided into the following categories: surface, mixed, and deep calcification. They were also classified into single and multiple calcifications according to quantity. Logistic regression models utilizing generalized estimating equations were performed to evaluate the relationship between calcification and IPH. Of 117 subjects, 85 with 142 plaques were included in the final analysis, whereas 32 were excluded because of lack of plaque compositions. Of the 142 plaques, 40 (28.2%) had IPH. Plaques with IPH showed greater prevalence of calcification than those without (87.5% versus 55.9%;
P
=0.005). After adjusting for age, low-density lipoprotein, maximum wall thickness, and maximum soft plaque thickness, multiple calcifications (odd ratio, 10.1; 95% confidence interval, 3.3–30.4), surface calcification (odd ratio, 29.4; 95% confidence interval, 4.1–210.8), and mixed calcifications (odd ratio, 27.9; 95% confidence interval, 7.3–107.1) were found to be strongly associated with the presence of IPH (all
P
<0.05).
Conclusions—
Surface calcification and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of IPH, suggesting that both quantity and location of calcification may play important roles in the occurrence of IPH. These findings may provide novel insights for understanding mechanisms of IPH.
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Affiliation(s)
- Ruolan Lin
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.)
| | - Shuo Chen
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.)
| | - Gaifen Liu
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.)
| | - Yunjing Xue
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.).
| | - Xihai Zhao
- From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China (R.L., Y.X.); Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (S.C., X.Z.); and Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (G.L.).
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22
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Hahn LA, Mackinnon A, Foley DL, Morgan VA, Waterreus A, Watts GF, Castle DJ, Liu D, Galletly CA. The role of arterial elasticity and cardiovascular peripheral resistance as clinically relevant indices of health status in people with psychosis. Schizophr Res 2017; 184:88-95. [PMID: 27939827 DOI: 10.1016/j.schres.2016.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/09/2016] [Accepted: 11/29/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Hypertension is one of the most important risk factors for cardiovascular disease (CVD). Systolic and diastolic blood pressure (BP) are higher in people with psychosis compared to the general population, but there is little research into measures of the elasticity of the arterial wall (pulse pressure; PP) and peripheral resistance (mean arterial pressure; MAP). PP and MAP can provide an additional perspective on the functioning of the circulatory system. This study investigated PP and MAP in people with psychosis, using factors known to be related to PP and MAP in the general population. METHOD Participants included 1421 people aged 18-64years, from the second Australian national survey of psychosis, untreated with antihypertensive medication. We tested the interaction and main effects between age and gender on PP, MAP, systolic BP and diastolic BP. Odds ratios were calculated in people exceeding the at-risk thresholds for PP and MAP. Multiple linear regression was used to test whether factors associated with at-risk PP and MAP in the general population were similarly associated in the psychosis population. RESULTS The interaction effect between age and gender on PP, MAP, systolic BP and diastolic BP was not statistically significant. Variables that retained significance in the regression model in explaining higher PP and MAP were: male gender, higher age, and having a family history of hypertension. CONCLUSION Clinicians monitoring and treating CV risk in this population need to ensure that they have recorded whether there is a family history of hypertension, and should be especially, more vigilant in men and in older patients.
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Affiliation(s)
- Lisa A Hahn
- Level 4, Eleanor Harrald Building, Royal Adelaide Hospital, University of Adelaide, Discipline of Psychiatry, Adelaide, SA 5000, Australia.
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Sydney, NSW, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Debra L Foley
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
| | - Gerald F Watts
- Cardiometabolic Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia.
| | - David J Castle
- St Vincent's Hospital, Melbourne and Department of Psychiatry, The University of Melbourne, VIC, Australia.
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Northern Adelaide Local Area Health Network, Adelaide, SA, Australia.
| | - Cherrie A Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide Ramsay Health Care, Mental Health Services, Northern Adelaide Local Health Network, Adelaide, SA, Australia.
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23
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Tanaka K, Kitagawa M, Onishi A, Yamanari T, Ogawa-Akiyama A, Mise K, Inoue T, Morinaga H, Uchida HA, Sugiyama H, Wada J. Arterial Stiffness is an Independent Risk Factor for Anemia After Percutaneous Native Kidney Biopsy. Kidney Blood Press Res 2017; 42:284-293. [PMID: 28531895 DOI: 10.1159/000477453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/13/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Bleeding is the most common complication after renal biopsy. Although numerous predictors of bleeding have been reported, it remains unclear whether arterial stiffness affects bleeding complications. METHOD We performed an observational study of the renal biopsies performed in our division over an approximately 6-year period (May 2010 to May 2016). The clinical and laboratory factors were analyzed to reveal the risk factors associated with bleeding, with a focus on anemia (defined as a ≥10% decrease in hemoglobin [Hb] after biopsy). The brachial-ankle pulse wave velocity (baPWV) was measured to evaluate arterial stiffness. RESULTS This study included 462 patients (male, n=244; female, n=218). Anemia (defined above) was observed in 54 patients (11.7%). The risk of anemia was higher in women, older patients, and patients with lower serum albumin, lower eGFR and lower diastolic blood pressure after biopsy. We then performed a further analysis of 187 patients whose baPWV data were available. Multivariate analysis revealed that a higher baPWV was an independent risk factor for anemia. ROC analysis for predicting anemia found that a baPWV value of 1839 cm/s had the best performance (AUC 0.689). CONCLUSION An increased baPWV may be a more valuable predictor of bleeding than any of the other reported risk factors.
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Affiliation(s)
- Keiko Tanaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Masashi Kitagawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Akifumi Onishi
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama, Japan
| | - Toshio Yamanari
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Ayu Ogawa-Akiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Koki Mise
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Tatsuyuki Inoue
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Hiroshi Morinaga
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan
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24
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Wang X, Sun J, Zhao X, Hippe DS, Hatsukami TS, Liu J, Li R, Canton G, Song Y, Yuan C. Ipsilateral plaques display higher T1 signals than contralateral plaques in recently symptomatic patients with bilateral carotid intraplaque hemorrhage. Atherosclerosis 2017; 257:78-85. [PMID: 28110259 PMCID: PMC5325786 DOI: 10.1016/j.atherosclerosis.2017.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Prospective studies have shown a strong association between carotid intraplaque hemorrhage (IPH), detected by magnetic resonance imaging (MRI), and cerebrovascular ischemic events. However, IPH is also observed in a substantial number of asymptomatic patients. We hypothesized that there are differences in the characteristics of IPH+ plaques associated with recent symptoms, compared to IPH+ plaques not associated with recent symptoms. METHODS Patients with recent (≤2 weeks) anterior circulation ischemic events were scanned using a standardized multisequence protocol. Those showing IPH bilaterally were included and analyzed for differences in T1/T2 signals, plaque morphology, and coexisting plaque characteristics between the ipsilateral symptomatic and contralateral asymptomatic sides. RESULTS Thirty-one subjects (67 ± 9 years, 97% males) with bilateral IPH were studied. Despite comparable luminal stenosis (53 ± 42% vs. 53 ± 39%, p = 0.99), T1 signal of IPH measured as signal-intensity-ratio compared to muscle was stronger (SIRIPH-to-muscle: 5.8 ± 2.4 vs. 4.7 ± 1.8, p = 0.004) and tended to be more extensively distributed (IPH volume: 150 ± 199 vs. 88 ± 106 mm3, p = 0.071) on the symptomatic side. IPH+ plaques on the symptomatic side were longer (24 ± 6 vs. 21 ± 7 mm, p = 0.026) and associated with larger necrotic core volume (406 ± 354 vs. 291 ± 293 mm3, p = 0.039) than those on the asymptomatic side. CONCLUSIONS In recently symptomatic patients with bilateral carotid IPH, the symptomatic side showed stronger T1 signals, larger necrotic cores, and longer plaque length than the asymptomatic side. Serial studies on the temporal relationship between these imaging features and clinical events will eventually establish their diagnostic and prognostic value beyond the mere presence of IPH.
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Affiliation(s)
- Xianling Wang
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Jin Liu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Yan Song
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Radiology, Beijing Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA; Department of Biomedical Engineering, Tsinghua University, Beijing, China; Department of Bioengineering, University of Washington, Seattle, WA, USA.
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25
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崔 园, 陈 潇, 马 露, 卢 明, 姚 国, 杨 家, 赵 锡, 蔡 剑. [Magnetic resonance imaging characteristics of unilateral versus bilateral intraplaque hemorrhage in patients with carotid atherosclerotic plaques]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:517-521. [PMID: 28446406 PMCID: PMC6744101 DOI: 10.3969/j.issn.1673-4254.2017.04.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the difference in the vulnerability of carotid atherosclerotic plaques in patients with unilateral and bilateral intraplaque hemorrhage (IPH). METHODS A retrospective analysis was conducted among 44 patients with unilateral IPH (30 cases) or bilateral IPH (14 cases) in the carotid plaques detected by magnetic resonance imaging (MRI) in our hospital between December, 2009 and December, 2012. The age, maximum wall thickness and incidence of fibrous cap rupture were compared between the two groups. RESULTS Compared with those with unilateral IPH, the patients with bilateral IPHs had a significantly younger age (66.6∓9.4 years vs 73.7∓9.0 years, P=0.027), a significantly greater maximum plaque thickness (6.3∓1.9 mm vs 5.0∓1.3 mm, P=0.035) and a higher incidence of ulcers (50% vs 13.3%, P=0.025). Logistic regression analysis revealed a significant association between bilateral IPHs and the occurrence of ulcer with an odd ratio (OR) of 6.5 (95% confidence interval [CI]: 1.5-28.7, P=0.014). After adjustment for gender in Model 1, bilateral IPHs were still significantly associated with presence of ulcer (OR=5.7, 95%CI: 1.1-29.2, P=0.036). But after adjustment for age (P=0.131) or maximum plaque thickness (P=0.139) in model 2, no significant correlation was found between bilateral IPHs and the presence of ulcer. CONCLUSION Compared with patients with unilateral IPH, those with bilateral IPHs are at a younger age and have a greater plaque burden and a higher incidence of fibrous cap rupture, suggesting a greater vulnerability of the carotid plaques in patients with bilateral IPHs.
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Affiliation(s)
- 园园 崔
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
| | - 潇祎 陈
- 清华大学生物医学影像研究中心,北京 100084Center for Biomedical Imaging Research, Tsinghua University, Beijing 100084, China
- 首都医科大学北京脑重大疾病研究院,北京 100069Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - 露 马
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
| | - 明明 卢
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
| | - 国恩 姚
- 解放军总医院第一附属医院神经内科,北京 100048Department of Neurology, First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China
| | - 家斐 杨
- 解放军总医院第一附属医院放射科,北京 100048Department of Radiology, First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China
| | - 锡海 赵
- 清华大学生物医学影像研究中心,北京 100084Center for Biomedical Imaging Research, Tsinghua University, Beijing 100084, China
| | - 剑鸣 蔡
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
- 解放军总医院第一附属医院放射科,北京 100048Department of Radiology, First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China
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26
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Sun J, Canton G, Balu N, Hippe DS, Xu D, Liu J, Hatsukami TS, Yuan C. Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage: An In Vivo Magnetic Resonance Imaging Study. Arterioscler Thromb Vasc Biol 2016; 36:743-9. [PMID: 26848155 DOI: 10.1161/atvbaha.115.307043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/20/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Effective prevention and management strategies of intraplaque hemorrhage (IPH) remain elusive because of our limited knowledge regarding its contributing factors. This hypothesis-generating study aimed to investigate associations between cardiovascular risk factors and IPH for improved understanding of the pathogenesis of IPH. APPROACH AND RESULTS Asymptomatic subjects with 16% to 79% stenosis on ultrasound underwent carotid magnetic resonance imaging using a large-coverage, 3-dimensional magnetic resonance imaging protocol. Individual plaques (maximum thickness >1.5 mm) in bilateral carotid arteries were identified, and presence of IPH was determined. From 80 subjects, 176 de novo plaques were measured, of which 38 (21.6%) contained IPH. Blood pressure (BP), primarily low diastolic BP, was associated with IPH in multivariate analysis adjusted for age, sex, and plaque size (odds ratio with 95% confidence interval per 10-mm Hg increase: 0.51 [0.30-0.88]), which was little changed after adjusting for antihypertensive use and systemic atherosclerosis. Antiplatelet use was associated with IPH in age and sex-adjusted models (P=0.018), for which a trend remained after considering plaque size and past medical history (odds ratio for aspirin alone versus none: 3.1 [0.66-14.8]; odds ratio for clopidogrel or dual therapy versus none: 5.3 [0.80-35.0]; P=0.083). CONCLUSIONS Low diastolic BP was independently associated with IPH, which was not attributed to treatment difference or BP changes from systemic atherosclerosis. Hemodynamic changes from lowering diastolic BP may be the pathophysiological link. Prospective serial studies are needed to assess whether BP and antiplatelet use are associated with the development of new or repeated IPH.
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Affiliation(s)
- Jie Sun
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Gador Canton
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Niranjan Balu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Dongxiang Xu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Jin Liu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Thomas S Hatsukami
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Chun Yuan
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle.
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Moody AR, Singh N. Incorporating Carotid Plaque Imaging into Routine Clinical Carotid Magnetic Resonance Angiography. Neuroimaging Clin N Am 2015; 26:29-44. [PMID: 26610658 DOI: 10.1016/j.nic.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incorporation of a short, easy-to-acquire and simple to read sequence to visualize the vessel wall and detect intraplaque hemorrhage (IPH) is achievable now. Demonstration of IPH may be helpful in primary or secondary prevention of neuroischemic events, assessment prior to carotid intervention and the general definition of an individual's vascular phenotype. The addition of an IPH-detecting vessel wall sequence only adds 5 to 6 minutes to a standard carotid MRI examination making clinical translation feasible and achievable.
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Affiliation(s)
- Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Navneet Singh
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Singh N, Moody AR, Roifman I, Bluemke DA, Zavodni AEH. Advanced MRI for carotid plaque imaging. Int J Cardiovasc Imaging 2015; 32:83-9. [PMID: 26293362 PMCID: PMC4706840 DOI: 10.1007/s10554-015-0743-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 10/28/2022]
Abstract
Atherosclerosis is the ubiquitous underling pathological process that manifests in heart attack and stroke, cumulating in the death of one in three North American adults. High-resolution magnetic resonance imaging (MRI) is able to delineate atherosclerotic plaque components and total plaque burden within the carotid arteries. Using dedicated hardware, high resolution images can be obtained. Combining pre- and post-contrast T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient echo weighted fat-saturation imaging, plaque components can be defined. Post-processing software allows for semi- and fully automated quantitative analysis. Imaging correlation with surgical specimens suggests that this technique accurately differentiates plaque features. Total plaque burden and specific plaque components such as a thin fibrous cap, large fatty or necrotic core and intraplaque hemorrhage are accepted markers of neuroischemic events. Given the systemic nature of atherosclerosis, emerging science suggests that the presence of carotid plaque is also an indicator of coronary artery plaque burden, although the preliminary data primarily involves patients with stable coronary disease. While the availability and cost-effectiveness of MRI will ultimately be important determinants of whether carotid MRI is adopted clinically in cardiovascular risk assessment, the high accuracy and reliability of this technique suggests that it has potential as an imaging biomarker of future risk.
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Affiliation(s)
- Navneet Singh
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Idan Roifman
- Division of Cardiology, Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David A Bluemke
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Anna E H Zavodni
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada.
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29
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Baroncini LAV, de Castro Sylvestre L, Filho RP. Carotid intima-media thickness and carotid plaque represent different adaptive responses to traditional cardiovascular risk factors. IJC HEART & VASCULATURE 2015; 9:48-51. [PMID: 28785705 PMCID: PMC5497319 DOI: 10.1016/j.ijcha.2015.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 11/26/2022]
Abstract
Aim To assess the effects of each traditional cardiovascular risk factor (hypertension, diabetes mellitus, dyslipidemia, and smoking), including the presence of coronary artery disease (CAD), on carotid intima-media thickness (CIMT) and to assess the degree of carotid plaque occurrence. Methods A total of 553 outpatients (216 men and 337 women; mean age 67.06 ± 12.44 years) who underwent a carotid artery ultrasound were screened for carotid plaque and CIMT measurements. Results The CIMT medians were higher in males (P < .001) and in patients with hypertension (P < .001). A linear increase occurred in mean CIMT of 0.0059 mm for each year of increase in age. The presence of plaque indicated a tendency to correlate with CIMT (P = .067). The presence of hypertension associated with diabetes (P = .0061; estimated difference 0.0494 mm) or dyslipidemia (P = .0016; estimated difference 0.0472 mm) or CAD (P = .0043; estimated difference 0.0527 mm) increased the mean CIMT measurements. The probability of plaque occurrence in carotid arteries is influenced by the age (P < .001) and is higher in patients with dyslipidemia (P = .008) and CAD (P < .001). Conclusions Hypertension is the strongest cardiovascular risk factor that increases CIMT, followed by age and male sex. Age and dyslipidemia increase the probability of carotid plaque. Increased CIMT and plaque could be present in the same patient caused by different risk factors and with independent effects on the artery wall and different clinical prognoses. Hypertension alone or with diabetes, dyslipidemia or CAD increases CIMT, but not the probability of carotid plaque. There is no current evidence to suggest that CIMT may progress to atherosclerotic plaque. Increased CIMT and plaque have different clinical prognoses in the same patient.
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Affiliation(s)
- Liz Andréa Villela Baroncini
- Pontifícia Universidade Católica do Paraná, Medical School, Health Sciences Postgraduate Program, Rua Imaculada Conceição 1155 - Bloco CCBS, CEP: 80215-901 Curitiba, Brazil
| | - Lucimary de Castro Sylvestre
- Pontifícia Universidade Católica do Paraná, Medical School, Health Sciences Postgraduate Program, Rua Imaculada Conceição 1155 - Bloco CCBS, CEP: 80215-901 Curitiba, Brazil
| | - Roberto Pecoits Filho
- Pontifícia Universidade Católica do Paraná, Medical School, Health Sciences Postgraduate Program, Rua Imaculada Conceição 1155 - Bloco CCBS, CEP: 80215-901 Curitiba, Brazil
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30
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Vaughan L, Bushnell C, Bell CL, Espeland MA. Global cognitive function before, surrounding, and after ischemic stroke: the role of risk and protective factors varies with time among ischemic stroke survivors. AGING NEUROPSYCHOLOGY AND COGNITION 2015; 23:117-31. [PMID: 26073439 DOI: 10.1080/13825585.2015.1058323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An estimated 65% of individuals demonstrate multidomain cognitive impairment poststroke, although little is known about the varying role of cognitive risk and protective factors in preischemic, peri-ischemic, and postischemic stroke phases. Longitudinal changes in global cognitive function after ischemic stroke are not well characterized, especially in older adults over age 80. We examined global cognitive function trajectories in these three phases across a mean follow-up of 8.12 (2.30) years in 159 female stroke survivors aged 65-79 at baseline using linear mixed models with change points. In separate models controlling for demographic variables, we tested the interaction of baseline risk and protective factors with stroke phase on global cognitive function. None of the prestroke global cognitive function means or trajectories differed significantly. At the time of ischemic stroke, higher body mass index (BMI), the presence of hypertension (HTN), low optimism, and higher physical function were all associated with significantly greater mean decreases in global cognition (all p's <.0.0001), but were not significantly different from the contrasting level (all p's >0.05). Higher BMI, the presence of HTN, low optimism, and higher physical function were in turn protective of global cognitive decline postischemic stroke (all contrasting p values <.01). Baseline factors may play either a risk or a protective role in global cognitive function depending on the phase of ischemic stroke.
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Affiliation(s)
- Leslie Vaughan
- a Department of Social Sciences and Health Policy , Wake Forest School of Medicine , Winston Salem , NC , 27157 , USA
| | - Cheryl Bushnell
- b Department of Neurology , Wake Forest School of Medicine , Winston-Salem , NC , 27157 , USA
| | - Christina L Bell
- c Department of Geriatric Medicine , University of Hawaii , Honolulu , HI 96817 , USA
| | - Mark A Espeland
- d Department of Biostatistical Sciences , Wake Forest School of Medicine , Winston-Salem , NC , 27157 , USA
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31
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Semi-automatic MRI segmentation and volume quantification of intra-plaque hemorrhage. Int J Comput Assist Radiol Surg 2014; 10:67-74. [DOI: 10.1007/s11548-014-1010-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
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32
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Selwaness M, van den Bouwhuijsen Q, Mattace-Raso FU, Verwoert GC, Hofman A, Franco OH, Witteman JC, van der Lugt A, Vernooij MW, Wentzel JJ. Arterial Stiffness Is Associated With Carotid Intraplaque Hemorrhage in the General Population. Arterioscler Thromb Vasc Biol 2014; 34:927-32. [DOI: 10.1161/atvbaha.113.302603] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
The relation between arterial stiffness and atherosclerosis, and specifically the influence of arterial stiffness on plaque composition, is largely unknown. In a population-based study, we investigated the association between arterial stiffness and the presence and composition of carotid atherosclerotic plaques.
Approach and Results—
Arterial stiffness was measured in 6527 participants (67.0±8.6 years) using aortic pulse wave velocity (PWV). Presence of carotid atherosclerotic plaques was assessed with ultrasound. Subsequently, 1059 subjects with carotid plaques (>2.5 mm) underwent MRI to assess plaque composition (presence of intraplaque hemorrhage, lipid, and calcification). Generalized estimation equation analyses adjusted for age, sex, mean arterial pressure, heart rate, carotid wall thickening, pulse pressure, and traditional cardiovascular risk factors were used to study the association between PWV and the presence and composition of carotid atherosclerotic plaques. In multivariable analysis, higher PWV was independently related to higher prevalence of carotid atherosclerotic plaque on ultrasound (odds ratio for highest quartile of PWV compared with lowest quartile, 1.24 [95% confidence interval, 1.02–1.51]). Furthermore, higher PWV was associated with intraplaque hemorrhage (age- and sex-adjusted odds ratio per SD increase in PWV, 1.20 [1.04–1.38] and calcification, 1.18 [1.03–1.35]), but not with lipid. After adjustment for cardiovascular risk factors, PWV remained significantly associated with intraplaque hemorrhage (1.20 [1.01–1.43]). Additional adjustment for pulse pressure did not materially affect the effect estimate (1.19 [1.00–1.42]).
Conclusions—
Higher PWV is associated with presence and composition of carotid atherosclerotic plaques, in particular with intraplaque hemorrhage. These findings provide further clues for understanding the development of vulnerable atherosclerotic plaque.
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Affiliation(s)
- Mariana Selwaness
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Quirijn van den Bouwhuijsen
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Francesco U.S. Mattace-Raso
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Germaine C. Verwoert
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Oscar H. Franco
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Jacqueline C.M. Witteman
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Aad van der Lugt
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Meike W. Vernooij
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
| | - Jolanda J. Wentzel
- From the Departments of Epidemiology (M.S., G.C.V., A.H., O.H.F., J.C.M.W., M.W.V.), Radiology (Q.v.d.B., A.v.d.L., M.W.V.), Internal Medicine (F.U.S.M.-R.), and Cardiology, Biomedical Engineering (J.J.W.), Erasmus MC, Rotterdam, The Netherlands
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