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Gharios C, van Leent MMT, Chang HL, Abohashem S, O’Connor D, Osborne MT, Tang CY, Kaufman AE, Robson PM, Ramachandran S, Calcagno C, Mani V, Trivieri MG, Seligowski AV, Dekel S, Mulder WJM, Murrough JW, Shin LM, Tawakol A, Fayad ZA. Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure. Eur Heart J 2024; 45:1753-1764. [PMID: 38753456 PMCID: PMC11107120 DOI: 10.1093/eurheartj/ehae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND AIMS Chronic stress associates with cardiovascular disease, but mechanisms remain incompletely defined. Advanced imaging was used to identify stress-related neural imaging phenotypes associated with atherosclerosis. METHODS Twenty-seven individuals with post-traumatic stress disorder (PTSD), 45 trauma-exposed controls without PTSD, and 22 healthy controls underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). Atherosclerotic inflammation and burden were assessed using 18F-FDG PET (as maximal target-to-background ratio, TBR max) and MRI, respectively. Inflammation was assessed using high-sensitivity C-reactive protein (hsCRP) and leucopoietic imaging (18F-FDG PET uptake in spleen and bone marrow). Stress-associated neural network activity (SNA) was assessed on 18F-FDG PET as amygdala relative to ventromedial prefrontal cortex (vmPFC) activity. MRI diffusion tensor imaging assessed the axonal integrity (AI) of the uncinate fasciculus (major white matter tract connecting vmPFC and amygdala). RESULTS Median age was 37 years old and 54% of participants were female. There were no significant differences in atherosclerotic inflammation between participants with PTSD and controls; adjusted mean difference in TBR max (95% confidence interval) of the aorta 0.020 (-0.098, 0.138), and of the carotids 0.014 (-0.091, 0.119). Participants with PTSD had higher hsCRP, spleen activity, and aorta atherosclerotic burden (normalized wall index). Participants with PTSD also had higher SNA and lower AI. Across the cohort, carotid atherosclerotic burden (standard deviation of wall thickness) associated positively with SNA and negatively with AI independent of Framingham risk score. CONCLUSIONS In this study of limited size, participants with PTSD did not have higher atherosclerotic inflammation than controls. Notably, impaired cortico-limbic interactions (higher amygdala relative to vmPFC activity or disruption of their intercommunication) associated with carotid atherosclerotic burden. Larger studies are needed to refine these findings.
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Affiliation(s)
- Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
| | - Mandy M T van Leent
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helena L Chang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 10029-6574, USA
| | - David O’Connor
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 10029-6574, USA
| | - Cheuk Y Tang
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Audrey E Kaufman
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Sarayu Ramachandran
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Claudia Calcagno
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Venkatesh Mani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Maria Giovanna Trivieri
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonia V Seligowski
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
| | - Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Willem J M Mulder
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Laboratory of Chemical Biology, Department of Biochemical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - James W Murrough
- Depression and Anxiety Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
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2
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Gheysen L, Maes L, Caenen A, Segers P, Peirlinck M, Famaey N. Uncertainty quantification of the wall thickness and stiffness in an idealized dissected aorta. J Mech Behav Biomed Mater 2024; 151:106370. [PMID: 38224645 DOI: 10.1016/j.jmbbm.2024.106370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024]
Abstract
Personalized treatment informed by computational models has the potential to markedly improve the outcome for patients with a type B aortic dissection. However, existing computational models of dissected walls significantly simplify the characteristic false lumen, tears and/or material behavior. Moreover, the patient-specific wall thickness and stiffness cannot be accurately captured non-invasively in clinical practice, which inevitably leads to assumptions in these wall models. It is important to evaluate the impact of the corresponding uncertainty on the predicted wall deformations and stress, which are both key outcome indicators for treatment optimization. Therefore, a physiology-inspired finite element framework was proposed to model the wall deformation and stress of a type B aortic dissection at diastolic and systolic pressure. Based on this framework, 300 finite element analyses, sampled with a Latin hypercube, were performed to assess the global uncertainty, introduced by 4 uncertain wall thickness and stiffness input parameters, on 4 displacement and stress output parameters. The specific impact of each input parameter was estimated using Gaussian process regression, as surrogate model of the finite element framework, and a δ moment-independent analysis. The global uncertainty analysis indicated minor differences between the uncertainty at diastolic and systolic pressure. For all output parameters, the 4th quartile contained the major fraction of the uncertainty. The parameter-specific uncertainty analysis elucidated that the material stiffness and relative thickness of the dissected membrane were the respective main determinants of the wall deformation and stress. The uncertainty analysis provides insight into the effect of uncertain wall thickness and stiffness parameters on the predicted deformation and stress. Moreover, it emphasizes the need for probabilistic rather than deterministic predictions for clinical decision making in aortic dissections.
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Affiliation(s)
- Lise Gheysen
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Belgium.
| | - Lauranne Maes
- Biomechanics Section, Mechanical Engineering, KU Leuven, Belgium
| | - Annette Caenen
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Belgium; Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Belgium
| | - Mathias Peirlinck
- Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, the Netherlands
| | - Nele Famaey
- Biomechanics Section, Mechanical Engineering, KU Leuven, Belgium
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3
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Munoz C, Fotaki A, Hua A, Hajhosseiny R, Kunze KP, Ismail TF, Neji R, Pushparajah K, Botnar RM, Prieto C. Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease. J Magn Reson Imaging 2023; 58:1110-1122. [PMID: 36757267 PMCID: PMC10946808 DOI: 10.1002/jmri.28613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. PURPOSE To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). STUDY TYPE Prospective. POPULATION A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). FIELD STRENGTH/SEQUENCE 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. ASSESSMENT iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. STATISTICAL TESTS Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland-Altman analysis. A P value < 0.05 was considered statistically significant. RESULTS Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. DATA CONCLUSION iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Camila Munoz
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Anastasia Fotaki
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Alina Hua
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Karl P. Kunze
- MR Research CollaborationsSiemens Healthcare LimitedFrimleyUK
| | - Tevfik F. Ismail
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedFrimleyUK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - René M. Botnar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Escuela de Ingeniería, Pontificia Universidad Católica de ChileSantiagoChile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare Engineering iHEALTHSantiagoChile
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Escuela de Ingeniería, Pontificia Universidad Católica de ChileSantiagoChile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare Engineering iHEALTHSantiagoChile
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4
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Qazi S, Gona PN, Oyama-Manabe N, Salton CJ, O'Donnell CJ, Manning WJ, Chuang ML. Prevalence and distribution of aortic plaque by sex and age group among community-dwelling adults. Clin Imaging 2023; 94:79-84. [PMID: 36495849 DOI: 10.1016/j.clinimag.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/04/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
RATIONALE AND OBJECTIVES Atherosclerosis of the aorta is associated with increased risk of cardiovascular mortality and vascular events. We aim to describe the prevalence and distribution of non-calcified atherosclerotic plaque in the descending aorta as quantified by noncontrast cardiovascular magnetic resonance (CMR) in a community-dwelling cohort of adults. MATERIALS AND METHODS We used CMR to quantify noncalcified aortic plaque in 1726 participants (aged 65 ± 9 years, 46.7% men) from the Cohort Study Offspring cohort. ECG-gated, fat-suppressed, T2-weighted, black blood turbo spin echo sequence was used to acquire 36 transverse slices covering the descending aorta from just below the arch to the aortoiliac bifurcation. Plaque was defined as discrete luminal protrusions ≥1 mm; these were manually traced, then summed to determine total descending aortic plaque (DAP) and segmental thoracic and abdominal aortic plaque (TAP, AAP). Participants were stratified by sex and age group (<55, 55-64, 65-74, ≥75y). A healthy referent group (without clinical cardiovascular disease, smoking, diabetes, impaired renal function; (N = 768, 43.8% men) was used to determine upper 90th percentile cutpoints for DAP and AAP which were then applied to the overall study cohort. RESULTS Prevalence of DAP was similar between men (47.3%) and women (48.9%), p = 0.50, as was AAP prevalence (men: 44.5%, women: 46.7%, p = 0.16); TAP was less prevalent in both sexes (men: 8.9%, women: 7.1%, p = 0.15). Both prevalence and burden of DAP, AAP and TAP increased with advancing age. CONCLUSION Noncalcified plaque prevalence, visualized on CMR, in community-dwelling adults is similar between the sexes, and both prevalence and burden of aortic plaque increase with greater age.
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Affiliation(s)
- Saadia Qazi
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Philimon N Gona
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, United States of America
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Carol J Salton
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Christopher J O'Donnell
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Warren J Manning
- Harvard Medical School, Boston, MA, United States of America; Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Radiology Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Michael L Chuang
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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5
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Ververs FA, Eikendal ALM, Kofink D, Nuboer R, Westenberg JJM, Hovenkamp GT, Kemps JJ, Coenen ICJ, Daems JJN, Claus LR, Ju Y, Wulffraat NM, van der Ent CK, Monaco C, Boes M, Leiner T, Grotenhuis HB, Schipper HS. Preclinical Aortic Atherosclerosis in Adolescents With Chronic Disease. J Am Heart Assoc 2022; 11:e024675. [PMID: 35861840 PMCID: PMC9707823 DOI: 10.1161/jaha.122.024675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Adolescents with chronic disease are often exposed to inflammatory, metabolic, and hemodynamic risk factors for early atherosclerosis. Since postmortem studies have shown that atherogenesis starts in the aorta, the CDACD (Cardiovascular Disease in Adolescents with Chronic Disease) study investigated preclinical aortic atherosclerosis in these adolescents.
Methods and Results
The cross‐sectional CDACD study enrolled 114 adolescents 12 to 18 years old with chronic disorders including juvenile idiopathic arthritis, cystic fibrosis, obesity, corrected coarctation of the aorta, and healthy controls with a corrected atrial septal defect. Cardiovascular magnetic resonance was used to assess aortic pulse wave velocity and aortic wall thickness, as established aortic measures of preclinical atherosclerosis. Cardiovascular magnetic resonance showed a higher aortic pulse wave velocity, which reflects aortic stiffness, and higher aortic wall thickness in all adolescent chronic disease groups, compared with controls (
P
<0.05). Age (β=0.253), heart rate (β=0.236), systolic blood pressure (β=−0.264), and diastolic blood pressure (β=0.365) were identified as significant predictors for aortic pulse wave velocity, using multivariable linear regression analysis. Aortic wall thickness was predicted by body mass index (β=0.248) and fasting glucose (β=0.242), next to aortic lumen area (β=0.340). Carotid intima‐media thickness was assessed using ultrasonography, and was only higher in adolescents with coarctation of the aorta, compared with controls (
P
<0.001).
Conclusions
Adolescents with chronic disease showed enhanced aortic stiffness and wall thickness compared with controls. The enhanced aortic pulse wave velocity and aortic wall thickness in adolescents with chronic disease could indicate accelerated atherogenesis. Our findings underscore the importance of the aorta for assessment of early atherosclerosis, and the need for tailored cardiovascular follow‐up of children with chronic disease.
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Affiliation(s)
- Francesca A. Ververs
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Anouk L. M. Eikendal
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Daniel Kofink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Roos Nuboer
- Department of Pediatrics Meander Medical Center Amersfoort Amersfoort the Netherlands
| | | | - Gijs T. Hovenkamp
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Jitske J.A. Kemps
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Iris C. J. Coenen
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Joëlle J. N. Daems
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Laura R. Claus
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Yillie Ju
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Nico M. Wulffraat
- Department of Pediatric Immunology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
- Rare Immunodeficiency, Autoinflammatory and Autoimmune European Reference Network Utrecht the Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Claudia Monaco
- Kennedy Institute of RheumatologyUniversity of Oxford Oxford UK
| | - Marianne Boes
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
- Department of Pediatric Immunology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Tim Leiner
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
- Department of Radiology Mayo Clinic Rochester MN
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Henk S. Schipper
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
- Kennedy Institute of RheumatologyUniversity of Oxford Oxford UK
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6
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Holmes DR, Alkhouli MA, Klaas JP, Brinjikji W, Savastano LE, Lanzino G, Benson JC. Change of Heart: The Underexplored Role of Plaque Hemorrhage in the Evaluation of Stroke of Undetermined Etiology. J Am Heart Assoc 2022; 11:e025323. [PMID: 35475334 PMCID: PMC9238607 DOI: 10.1161/jaha.122.025323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the evaluation of embolic strokes of undetermined source, great emphasis is often placed on cardiovascular disease, namely on atrial fibrillation. Other pathophysiologic mechanisms, however, may also be involved. Carotid artery intraplaque hemorrhage (IPH)—the presence of blood components within an atheromatous plaque—has become increasingly recognized as a possible etiologic mechanism in some cryptogenic strokes. IPH is a marker of plaque instability and is associated with ipsilateral neurologic ischemic events, even in nonstenotic carotid plaques. As recognition of carotid IPH as an etiology of embolic strokes has grown, so too has the complexity with which such patients are evaluated and treated, particularly because overlaps exist in the risk factors for atrial fibrillation and IPH. In this article, we review what is currently known about carotid IPH and how this clinical entity should be approached in the context of the evaluation of embolic strokes of undetermined source.
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Affiliation(s)
- David R Holmes
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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7
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van der Toorn JE, Bos D, Ikram MK, Verwoert GC, van der Lugt A, Ikram MA, Vernooij MW, Kavousi M. Carotid Plaque Composition and Prediction of Incident Atherosclerotic Cardiovascular Disease. Circ Cardiovasc Imaging 2022; 15:e013602. [PMID: 35196868 DOI: 10.1161/circimaging.121.013602] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether information on carotid plaque composition contributes to prediction of incident atherosclerotic cardiovascular disease (ASCVD) remains to be investigated. We determined the sex-specific added value of carotid plaque components for predicting incident ASCVD events, beyond traditional cardiovascular risk factors. METHODS Between 2007 and 2012, participants from the population-based Rotterdam Study with asymptomatic carotid wall thickening >2.5 mm on ultrasonography were invited for carotid magnetic resonance imaging. Among 1349 participants (mean age: 72 years [SD±9.3], 49.5% women) without cardiovascular disease, we assessed plaque thickness, luminal stenosis (>30%), presence of intraplaque hemorrhage, lipid-rich necrotic core, and calcification. Follow-up for ASCVD was complete until January 1, 2015. Using Cox proportional hazards models, we fitted sex-specific prediction models including traditional cardiovascular risk factors (base model). We extended the base model by single and simultaneous additions of plaque characteristics and calculated improvement of model performance by the C statistics. RESULTS During a median follow-up of 4.8 years, 60 men and 48 women developed ASCVD. In women, presence of intraplaque hemorrhage was associated with incident ASCVD (adjusted hazard ratio, 3.37 [95% CI, 1.81-6.25]). The C statistic (95% CI) improved from 0.73 (0.66-0.79) to 0.76 (0.70-0.83) after single addition of intraplaque hemorrhage to the base model. Simultaneous addition of plaque components, plaque thickness, and stenosis did not change the results. In men, only carotid stenosis was statistically significantly associated with incident ASCVD (adjusted hazard ratio, 1.75 [95% CI, 1.00-3.08]); yet, the association diminished after the addition of other plaque characteristics, and no improvements were observed in C statistics. CONCLUSIONS Presence of intraplaque hemorrhage contributes to the prediction of incident ASCVD in women, beyond traditional cardiovascular risk factors, other plaque components, plaque size, and stenosis.
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Affiliation(s)
- Janine E van der Toorn
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine (J.E.v.d.T., D.B., A.v.d.L., M.W.V.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine (J.E.v.d.T., D.B., A.v.d.L., M.W.V.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,Department of Neurology (M.K.I.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Germaine C Verwoert
- Department of Cardiology (G.C.V.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine (J.E.v.d.T., D.B., A.v.d.L., M.W.V.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine (J.E.v.d.T., D.B., A.v.d.L., M.W.V.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology (J.E.v.d.T., D.B., M.K.I., M.A.I., M.W.V., M.K.), Erasmus MC, University Medical Centre Rotterdam, The Netherlands
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8
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Kocyigit D, Scanameo A, Xu B. Multimodality imaging for the prevention of cardiovascular events: Coronary artery calcium and beyond. Cardiovasc Diagn Ther 2021; 11:840-858. [PMID: 34295709 DOI: 10.21037/cdt-19-654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has been the leading cause of death worldwide for more than a decade. Prevention is of utmost importance to reduce related mortality. The innovations in cardiovascular imaging technology, in addition to our improved understanding of coronary atherosclerosis pathogenesis, have resulted in cardiovascular imaging becoming one of the most influential tools for diagnosis and risk stratification in ASCVD. Although numerous publications have emerged on this topic, data that guide routine cardiology clinical practice currently focus on the utility of a limited number of such modalities, namely arterial ultrasonography and computed tomography. Herein, current evidence with respect to the role of multimodality cardiovascular imaging on ASCVD prevention will be reviewed.
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Affiliation(s)
- Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Xin R, Yang D, Xu H, Han H, Li J, Miao Y, Du Z, Ding Q, Deng S, Ning Z, Shen R, Li R, Li C, Yuan C, Zhao X. Comparing Symptomatic and Asymptomatic Carotid Artery Atherosclerosis in Patients With Bilateral Carotid Vulnerable Plaques Using Magnetic Resonance Imaging. Angiology 2021; 73:104-111. [PMID: 34018407 DOI: 10.1177/00033197211012531] [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] [Indexed: 11/15/2022]
Abstract
We compared plaque characteristics between symptomatic and asymptomatic sides in patients with bilateral carotid vulnerable plaques using magnetic resonance imaging (MRI). Participants (n = 67; mean age: 65.8 ± 7.7 years, 61 males) with bilateral carotid vulnerable plaques were included. Vulnerable plaques were characterized by intraplaque hemorrhage (IPH), large lipid-rich necrotic core (LRNC), or fibrous cap rupture (FCR) on MRI. Symptomatic vulnerable plaques showed greater plaque burden, LRNC volume (median: 221.4 vs 134.8 mm3, P = .003), IPH volume (median: 32.2 vs 22.5 mm3, P = .030), maximum percentage (Max%) LRNC (median: 51.3% vs 41.8%, P = .002), Max%IPH (median: 13.4% vs 9.5%, P = .022), cumulative slices of LRNC (median: 10 vs 8, P = .005), and more juxtaluminal IPH and/or thrombus (29.9% vs 6.0%, P = .001) and FCR (37.3% vs 16.4%, P = .007) than asymptomatic ones. After adjusting for plaque burden, differences in juxtaluminal IPH and/or thrombus (odds ratio [OR]: 5.49, 95% CI: 1.61-18.75, P = .007) and FCR (OR: 2.90, 95% CI: 1.16-7.24, P = .022) between bilateral sides remained statistically significant. For patients with bilateral carotid vulnerable plaques, symptomatic plaques had greater burden, more juxtaluminal IPH and/or thrombus, and FCR compared with asymptomatic ones. The differences in juxtaluminal IPH and/or thrombus and FCR between bilateral sides were independent of plaque burden.
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Affiliation(s)
- Ruijing Xin
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Dandan Yang
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute of Brain Disorders, Beijing, China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Huimin Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Jin Li
- Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yingyu Miao
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Qian Ding
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Shasha Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Chun Yuan
- Department of Radiology, 7284University of Washington, Seattle, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, 118223Tsinghua University School of Medicine, Beijing, China
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10
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Kundel V, Reid M, Fayad Z, Ayappa I, Mani V, Rueschman M, Redline S, Shea S, Shah N. Sleep duration and vascular inflammation using hybrid positron emission tomography/magnetic resonance imaging: results from the Multi-Ethnic Study of Atherosclerosis (MESA). J Clin Sleep Med 2021; 17:2009-2018. [PMID: 33969819 DOI: 10.5664/jcsm.9382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Short sleep duration (SD) is associated with cardiovascular disease (CVD). We investigated the relationship between objective SD and subclinical atherosclerosis employing hybrid PET/MRI with 18F-FDG tracer in the MESA cohort. METHODS We utilized data from MESA-SLEEP and MESA-PET ancillary studies. SD and sleep fragmentation index (SFI) were assessed using 7-day actigraphy. The primary and secondary outcomes were carotid inflammation, defined using target-to-background ratios (TBR), and measures of carotid wall remodeling (carotid wall thickness [CWT]), summarized by SD category. Multivariate linear regression was performed to assess the association between SD and SFI with the primary/secondary outcomes, adjusting for several covariates including apnea-hypopnea index (AHI), and CVD risk. RESULTS Our analytical sample (n=58) was 62% female (mean age 68±8.4 years). Average SD was 5.1±0.9 hours in the short SD group (≤6 hours/night, 31%), and 7.1±0.8 hours in the normal SD group (69%). Prevalence of pathologic vascular inflammation (TBRmax>1.6) was higher in the short SD group (89% vs. 53%, p=0.009). Those with short SD had a higher TBRmax (1.77 vs 1.71), though this was not statistically significant (p=0.39). CWT was positively correlated with SFI even after adjusting for covariates (Beta [SE]=0.073±[0.032], p=0.025). CONCLUSIONS Prevalence of pathologic vascular inflammation was higher among those who slept ≤6 hours, and vascular inflammation was higher among those with a SD of ≤6 hours. Interestingly, SFI was positively correlated with CWT even after adjustment for covariates. Our results are hypothesis-generating but suggest that both habitual SD and SFI should be investigated in future studies as potential risk factors for subclinical atherosclerosis.
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Affiliation(s)
- Vaishnavi Kundel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Zahi Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Indu Ayappa
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Venkatesh Mani
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Steven Shea
- Department of Medicine, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Neomi Shah
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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11
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Yuan C, Miller Z, Zhao XQ. Magnetic Resonance Imaging: Cardiovascular Applications for Clinical Trials. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Willemink MJ, Coolen BF, Dyvorne H, Robson PM, Bander I, Ishino S, Pruzan A, Sridhar A, Zhang B, Balchandani P, Mani V, Strijkers GJ, Nederveen AJ, Leiner T, Fayad ZA, Mulder WJM, Calcagno C. Ultra-high resolution, 3-dimensional magnetic resonance imaging of the atherosclerotic vessel wall at clinical 7T. PLoS One 2020; 15:e0241779. [PMID: 33315867 PMCID: PMC7735577 DOI: 10.1371/journal.pone.0241779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
Accurate quantification and characterization of atherosclerotic plaques with MRI requires high spatial resolution acquisitions with excellent image quality. The intrinsically better signal-to-noise ratio (SNR) at high-field clinical 7T compared to the widely employed lower field strengths of 1.5 and 3T may yield significant improvements to vascular MRI. However, 7T atherosclerosis imaging also presents specific challenges, related to local transmit coils and B1 field inhomogeneities, which may overshadow these theoretical gains. We present the development and evaluation of 3D, black-blood, ultra-high resolution vascular MRI on clinical high-field 7T in comparison lower-field 3T. These protocols were applied for in vivo imaging of atherosclerotic rabbits, which are often used for development, testing, and validation of translatable cardiovascular MR protocols. Eight atherosclerotic New Zealand White rabbits were imaged on clinical 7T and 3T MRI scanners using 3D, isotropic, high (0.63 mm3) and ultra-high (0.43 mm3) spatial resolution, black-blood MR sequences with extensive spatial coverage. Following imaging, rabbits were sacrificed for validation using fluorescence imaging and histology. Image quality parameters such as SNR and contrast-to-noise ratio (CNR), as well as morphological and functional plaque measurements (plaque area and permeability) were evaluated at both field strengths. Using the same or comparable imaging parameters, SNR and CNR were in general higher at 7T compared to 3T, with a median (interquartiles) SNR gain of +40.3 (35.3-80.1)%, and a median CNR gain of +68.1 (38.5-95.2)%. Morphological and functional parameters, such as vessel wall area and permeability, were reliably acquired at 7T and correlated significantly with corresponding, widely validated 3T vessel wall MRI measurements. In conclusion, we successfully developed 3D, black-blood, ultra-high spatial resolution vessel wall MRI protocols on a 7T clinical scanner. 7T imaging was in general superior to 3T with respect to image quality, and comparable in terms of plaque area and permeability measurements.
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Affiliation(s)
- Martin J. Willemink
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Bram F. Coolen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hadrien Dyvorne
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Philip M. Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ilda Bander
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Seigo Ishino
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Alison Pruzan
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Arthi Sridhar
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Bei Zhang
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Venkatesh Mani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Gustav J. Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zahi A. Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Willem J. M. Mulder
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Medical Biochemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudia Calcagno
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
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13
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Brunner G, Virani SS, Sun W, Liu L, Dodge RC, Nambi V, Coresh J, Mosley TH, Sharrett AR, Boerwinkle E, Ballantyne CM, Wasserman BA. Associations Between Carotid Artery Plaque Burden, Plaque Characteristics, and Cardiovascular Events: The ARIC Carotid Magnetic Resonance Imaging Study. JAMA Cardiol 2020; 6:79-86. [PMID: 33206125 DOI: 10.1001/jamacardio.2020.5573] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It remains unknown whether in an asymptomatic community-based cohort magnetic resonance imaging (MRI) measures of plaque characteristics are independently associated with incident cardiovascular disease (CVD) events when adjusted for carotid artery (CA) wall thickness, a measure of plaque burden. Objective To assess associations of CA MRI plaque characteristics with incident CVD events. Design, Setting, and Participants The Atherosclerosis Risk in Communities (ARIC) study is a prospective epidemiologic study of the incidence of CVD in 15 792 adults of which 2066 women and men were enrolled in the ARIC Carotid MRI substudy. ARIC participants were enrolled from 1987 to 1989, and the substudy was conducted between January 2004 and December 2005. Analysis began January 2017 and ended August 2020. Exposures Incident CVD events during a median (interquartile range [IQR]) follow-up time of 10.5 (8.1-10.9) years were assessed. Main Outcomes and Measures Proportional hazards Cox analyses were performed to ascertain associations between MRI variables of CA plaque burden and plaque characteristics. Results Of 15 792 ARIC participants, 2066 were enrolled in the substudy, of whom 1256 (701 women [55.8%]) had complete data and were eligible for incident CVD analyses. Carotid artery plaques in participants with incident CVD events (172 [13.7%]) compared with those without (1084 [86.3%]) had a higher normalized wall index (median [IQR], 0.48 [0.36-0.62] vs 0.43 [0.34-0.55]; P = .001), maximum CA wall thickness (median [IQR], 2.22 [1.37-3.52] mm vs 1.96 [1.29-2.85] mm; P = .01), maximum CA stenosis (median [IQR], 5% [0%-22%] vs 0% [0%-13%]; P < .001), and when present, a larger lipid core volume (median [IQR], 0.05 [0.02-0.11] mL vs 0.03 [0.01-0.07] mL; P = .03), respectively. The presence of a lipid core was independently associated with incident CVD events when adjusted for traditional CVD risk factors and maximum CA wall thickness (hazard ratio, 2.48 [95% CI, 1.36-4.51]; P = .003), whereas the presence of calcification was not. The frequency of intraplaque hemorrhage presence in this population of individuals free of CVD at baseline who were not recruited for carotid stenosis was too small to draw any meaningful conclusions (intraplaque hemorrhage presence: 68 of 1256 participants [5.4%]). Carotid artery lumen area and maximum stenosis, which were overall low, were independently associated with incident CVD events when adjusted for traditional CVD risk factors, as anticipated. Conclusions and Relevance The presence of a CA lipid core on MRI is associated with incident CVD events independent of maximum CA wall thickness in asymptomatic participants.
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Affiliation(s)
- Gerd Brunner
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Wensheng Sun
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rhiannon C Dodge
- The University of Texas Health Science Center School of Public Health, Houston
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas H Mosley
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Boerwinkle
- The University of Texas Health Science Center School of Public Health, Houston
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Ben-Aicha S, Casaní L, Muñoz-García N, Joan-Babot O, Peña E, Aržanauskaitė M, Gutierrez M, Mendieta G, Padró T, Badimon L, Vilahur G. HDL (High-Density Lipoprotein) Remodeling and Magnetic Resonance Imaging-Assessed Atherosclerotic Plaque Burden: Study in a Preclinical Experimental Model. Arterioscler Thromb Vasc Biol 2020; 40:2481-2493. [PMID: 32847390 DOI: 10.1161/atvbaha.120.314956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE HDL (high-density lipoprotein) role in atherosclerosis is controversial. Clinical trials with CETP (cholesterylester transfer protein)-inhibitors have not provided benefit. We have shown that HDL remodeling in hypercholesterolemia reduces HDL cardioprotective potential. We aimed to assess whether hypercholesterolemia affects HDL-induced atherosclerotic plaque regression. Approach and Results: Atherosclerosis was induced in New Zealand White rabbits for 3-months by combining a high-fat-diet and double-balloon aortic denudation. Then, animals underwent magnetic resonance imaging (basal plaque) and randomized to receive 4 IV infusions (1 infusion/wk) of HDL isolated from normocholesterolemic (NC-HDL; 75 mg/kg; n=10), hypercholesterolemic (HC-HDL; 75 mg/Kg; n=10), or vehicle (n=10) rabbits. Then, animals underwent a second magnetic resonance imaging (end plaque). Blood, aorta, and liver samples were obtained for analyses. Follow-up magnetic resonance imaging revealed that NC-HDL administration regressed atherosclerotic lesions by 4.3%, whereas, conversely, the administration of HC-HDLs induced a further 6.5% progression (P<0.05 versus basal). Plaque characterization showed that HC-HDL administered animals had a 2-fold higher lipid and cholesterol content versus those infused NC-HDL and vehicle (P<0.05). No differences were observed among groups in CD31 levels, nor in infiltrated macrophages or smooth muscle cells. Plaques from HC-HDL administered animals exhibited higher Casp3 (caspase 3) content (P<0.05 versus vehicle and NC-HDL) whereas plaques from NC-HDL infused animals showed lower expression of Casp3, Cox1 (cyclooxygenase 1), inducible nitric oxide synthase, and MMP (metalloproteinase) activity (P<0.05 versus HC-HDL and vehicle). HDLs isolated from animals administered HC-HDL displayed lower antioxidant potential and cholesterol efflux capacity as compared with HDLs isolated from NC-HDL-infused animal and vehicle or donor HDL (P<0.05). There were no differences in HDL-ApoA1 content, ABCA1 (ATP-binding cassette transporter A1) vascular expression, and SRB1 (scavenger receptor B1) and ABCA1 liver expression. CONCLUSIONS HDL particles isolated from a hypercholesterolemic milieu lose their ability to regress and stabilize atherosclerotic lesions. Our data suggest that HDL remodeling in patients with co-morbidities may lead to the loss of HDL atheroprotective functions.
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Affiliation(s)
- Soumaya Ben-Aicha
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
- School of Medicine, University of Barcelona (UB), Spain (S.B., G.M.)
| | - Laura Casaní
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
| | - Natàlia Muñoz-García
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
| | - Oriol Joan-Babot
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
| | - Esther Peña
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III (T.P., L.B., G.V., E.P.)
| | - Monika Aržanauskaitė
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
| | - Manuel Gutierrez
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
| | - Guiomar Mendieta
- School of Medicine, University of Barcelona (UB), Spain (S.B., G.M.)
- Cardiology Department, Hospital Clinico Barcelona Spain (G.M.)
| | - Teresa Padró
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III (T.P., L.B., G.V., E.P.)
| | - Lina Badimon
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III (T.P., L.B., G.V., E.P.)
- Cardiovascular Research Chair, Universidad Autónoma Barcelona (UAB), Spain(L.B.)
| | - Gemma Vilahur
- Cardiovascular Program-ICCC, Research Institute-Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain (S.B., L.C., N.M.-G., O.J.-B., E.P., M.A., M.G., T.P., L.B., G.V.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III (T.P., L.B., G.V., E.P.)
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15
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Wüst RCI, Calcagno C, Daal MRR, Nederveen AJ, Coolen BF, Strijkers GJ. Emerging Magnetic Resonance Imaging Techniques for Atherosclerosis Imaging. Arterioscler Thromb Vasc Biol 2020; 39:841-849. [PMID: 30917678 DOI: 10.1161/atvbaha.118.311756] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis is a prevalent disease affecting a large portion of the population at one point in their lives. There is an unmet need for noninvasive diagnostics to identify and characterize at-risk plaque phenotypes noninvasively and in vivo, to improve the stratification of patients with cardiovascular disease, and for treatment evaluation. Magnetic resonance imaging is uniquely positioned to address these diagnostic needs. However, currently available magnetic resonance imaging methods for vessel wall imaging lack sufficient discriminative and predictive power to guide the individual patient needs. To address this challenge, physicists are pushing the boundaries of magnetic resonance atherosclerosis imaging to increase image resolution, provide improved quantitative evaluation of plaque constituents, and obtain readouts of disease activity such as inflammation. Here, we review some of these important developments, with specific focus on emerging applications using high-field magnetic resonance imaging, the use of quantitative relaxation parameter mapping for improved plaque characterization, and novel 19F magnetic resonance imaging technology to image plaque inflammation.
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Affiliation(s)
- Rob C I Wüst
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Claudia Calcagno
- Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., G.J.S.)
| | - Mariah R R Daal
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Aart J Nederveen
- Radiology and Nuclear Medicine (A.J.N.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Bram F Coolen
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Gustav J Strijkers
- From the Biomedical Engineering and Physics (R.C.I.W., M.R.R.D., B.F.C., G.J.S.), Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., G.J.S.)
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Robinson JG, Williams KJ, Gidding S, Borén J, Tabas I, Fisher EA, Packard C, Pencina M, Fayad ZA, Mani V, Rye KA, Nordestgaard BG, Tybjærg-Hansen A, Douglas PS, Nicholls SJ, Pagidipati N, Sniderman A. Eradicating the Burden of Atherosclerotic Cardiovascular Disease by Lowering Apolipoprotein B Lipoproteins Earlier in Life. J Am Heart Assoc 2019; 7:e009778. [PMID: 30371276 PMCID: PMC6474943 DOI: 10.1161/jaha.118.009778] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Samuel Gidding
- 3 Department of Pediatric Cardiology Nemours/Alfred I. duPont Hospital for Children DE
| | - Jan Borén
- 4 Department of Molecular and Clinical Medicine University of Gothenberg Sweden
| | - Ira Tabas
- 5 Department of Medicine Columbia University Medical Center New York NY
| | - Edward A Fisher
- 6 Department of Cell Biology New York University School of Medicine New York NY
| | - Chris Packard
- 7 Department of Biochemistry University of Glasgow Scotland
| | - Michael Pencina
- 8 Department of Biostatistics and Informatics Duke University Durham NC
| | - Zahi A Fayad
- 9 Department of Radiology Mount Sinai School of Medicine New York NY
| | - Venkatesh Mani
- 9 Department of Radiology Mount Sinai School of Medicine New York NY
| | - Kerry Anne Rye
- 10 Department of Pathology University of New South Wales Sydney Australia
| | | | | | | | | | | | - Allan Sniderman
- 14 Department of Medicine University of Montreal Montreal Canada
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17
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Bachi K, Mani V, Kaufman AE, Alie N, Goldstein RZ, Fayad ZA, Alia-Klein N. Imaging plaque inflammation in asymptomatic cocaine addicted individuals with simultaneous positron emission tomography/magnetic resonance imaging. World J Radiol 2019; 11:62-73. [PMID: 31205601 PMCID: PMC6556593 DOI: 10.4329/wjr.v11.i5.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/05/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic cocaine use is associated with stroke, coronary artery disease and myocardial infarction, resulting in severe impairments or sudden mortality. In the absence of clear cardiovascular symptoms, individuals with cocaine use disorder (iCUD) seeking addiction treatment receive mostly psychotherapy and psychiatric pharmacotherapy, with no attention to vascular disease (i.e., atherosclerosis). Little is known about the pre-clinical signs of cardiovascular risk in iCUD and early signs of vascular disease are undetected in this underserved population.
AIM To assess inflammation, plaque burden and plaque composition in iCUD aiming to detect markers of atherosclerosis and vascular disease.
METHODS The bilateral carotid arteries were imaged with positron emission tomography/magnetic resonance imaging (PET/MRI) in iCUD asymptomatic for cardiovascular disease, healthy controls, and individuals with cardiovascular risk. PET with 18F-fluorodeoxyglucose (18F-FDG) evaluated vascular inflammation and 3-D dark-blood MRI assessed plaque burden including wall area and thickness. Drug use and severity of addiction were assessed with standardized instruments.
RESULTS The majority of iCUD and controls had carotid FDG-PET signal greater than 1.6 but lower than 3, indicating the presence of mild to moderate inflammation. However, the MRI measure of wall structure was thicker in iCUD as compared to the controls and cardiovascular risk group, indicating greater carotid plaque burden. iCUD had larger wall area as compared to the healthy controls but not as compared to the cardiovascular risk group, indicating structural wall similarities between the non-control study groups. In iCUD, wall area correlated with greater cocaine withdrawal and craving.
CONCLUSION These preliminary results show markers of carotid artery disease burden in cardiovascular disease-asymptomatic iCUD. Broader trials are warranted to develop protocols for early detection of cardiovascular risk and preventive intervention in iCUD.
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Affiliation(s)
- Keren Bachi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Audrey E Kaufman
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Nadia Alie
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Rita Z Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
| | - Nelly Alia-Klein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
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Virani SS, Ballantyne CM. From Plaque Burden to Plaque Composition: Toward Personalized Risk Assessment. JACC Cardiovasc Imaging 2018; 10:250-252. [PMID: 28279372 DOI: 10.1016/j.jcmg.2016.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center; Houston, Texas; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Eikendal ALM, den Ruijter HM, Haaring C, Saam T, van der Geest RJ, Westenberg JJM, Bots ML, Hoefer IE, Leiner T. Sex, body mass index, and blood pressure are related to aortic characteristics in healthy, young adults using magnetic resonance vessel wall imaging: the AMBITYON study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:173-182. [PMID: 28569376 PMCID: PMC5813077 DOI: 10.1007/s10334-017-0626-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 12/31/2022]
Abstract
Objectives More detailed evaluation of atherosclerosis and its key determinants in young individuals is warranted to improve knowledge on the pathophysiology of its development and progression. This study evaluated associations of magnetic resonance imaging (MRI)-derived aortic wall area, wall thickness, and pulse wave velocity (PWV) with cardiovascular risk factors in asymptomatic, young adults. Materials and methods In 124 adults (age: 25–35 years) from the general population-based Atherosclerosis Monitoring and Biomarker Measurements in the Young study, demography, anthropometry, and blood samples were collected. The studied MRI-parameters were measured using a 3.0T MRI system. Relations between cardiovascular risk factors and aortic characteristics were assessed using multivariable linear regression analyses. Results Mean age was 31.8 years, 47.6% was male. Aortic wall area was positively associated with age [β = 0.01, (95% confidence interval (CI) 2.00 × 10−3, 0.02), p = 0.01] and BMI [β = 0.01, (0.01, 0.02), p = 0.003] and negatively associated with sex (reference: men) [β = −0.06, (−0.11, −0.01), p = 0.02]. Natural logarithm transformed (ln) aortic wall thickness was positively associated with BMI [β = 0.01, (1.00 × 10−3, 0.02), p = 0.02]. Ln aortic PWV was positively associated with 10 mmHg increment of SBP [β = 0.06, (0.03, 0.09), p < 0.001] and DBP [β = 0.06, (0.02, 0.09), p = 0.006]. No relations were observed for smoking and lipids. Conclusions Already in early adulthood, aortic wall geometry and stiffness vary by age, sex, BMI, and blood pressure.
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Affiliation(s)
- Anouk L M Eikendal
- Department of Radiology (E01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Cees Haaring
- Department of Radiology (E01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Rob J van der Geest
- Division of Image Processing, Department of Radiology, 1-C2S Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jos J M Westenberg
- Division of Image Processing, Department of Radiology, 1-C2S Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Imo E Hoefer
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology (E01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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20
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LeBlanc S, Bibeau K, Bertrand OF, Lévesque V, Deschênes St-Pierre B, Pibarot P, Després JP, Larose E. Carotid versus coronary atherosclerosis burdens in acute compared with chronic symptomatic coronary artery disease. Can J Physiol Pharmacol 2017; 95:878-887. [PMID: 28520469 DOI: 10.1139/cjpp-2016-0588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Prediction of coronary events remains elusive. Carotid atherosclerosis may be a surrogate for coronary risk, as carotid and coronary diseases occur simultaneously - albeit at times with a weak association - depending on clinical presentation. We investigated carotid and coronary atherosclerosis in men with new-onset unstable coronary artery disease (CAD) presenting with acute ST-segment elevation myocardial infarction (STEMI) vs. long-standing severe chronic stable angina (CSA). Bilateral carotid artery and 3-vessel coronary artery atherosclerosis burdens were measured within 1 month, respectively, by 3D-volumetric carotid magnetic resonance imaging and coronary angiography-derived modified CASS-50 score. Men with STEMI (n = 50) and long-standing CSA (n = 50), matched for age, were enrolled (58.6 ± 8.8 years). All of them had carotid atherosclerosis. Atherosclerosis burden was greater in the carotid arteries of STEMI vs. CSA (wall volume: 196.2 ± 44.4 vs. 169.2 ± 38.0 mm3/4 mm, p = 0.002), but greater in the coronary arteries of CSA vs. STEMI (modified CASS-50 score: 3 vs. 1, p < 0.0001). Normalized wall index (NWI) of internal carotid was associated with modified CASS-50 score in STEMI (ρ = 0.40, p = 0.022) and in CSA (ρ = -0.39, p = 0.031). Carotid atherosclerosis was observed in all CAD patients, and atherosclerosis burden in carotid and in coronary arteries varied according to clinical presentation.
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Affiliation(s)
- Stéphanie LeBlanc
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Karine Bibeau
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada
| | - Olivier F Bertrand
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Valérie Lévesque
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Béatrice Deschênes St-Pierre
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Philippe Pibarot
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Jean-Pierre Després
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Eric Larose
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec City, QC G1V 4G5, Canada.,b Département de médecine, Faculté de médecine, Université Laval, Québec City, QC G1V 0A6, Canada
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21
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Cao Y, Sun Y, Zhou B, Zhao H, Zhu Y, Xu J, Liu X. Atherosclerotic plaque burden of middle cerebral artery and extracranial carotid artery characterized by MRI in patients with acute ischemic stroke in China: association and clinical relevance. Neurol Res 2017; 39:344-350. [PMID: 28136710 DOI: 10.1080/01616412.2017.1281196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study sought to compare the atherosclerotic plaque burden between middle cerebral artery (MCA) and extracranial carotid artery (ECA) in ischemic stroke patients using high-resolution, black-blood (HR BB) MRI and to investigate the relationship between plaque burden found in both arteries and stroke severity. METHODS All subjects with recent ischemic stroke underwent MCA and ECA HR BB MRI at 3.0 Tesla. For each artery segment, the thickness, area and signal intensities of plaques were recorded. Plaque burden, as measured by normalized wall index (NWI = wall area/total vessel area × 100%) were calculated. All patients received a clinical stroke severity score as measured by the National Institutes of Health Stroke Scale (NIHSS) scores at the time of admission. RESULTS A total of 65 stroke subjects were included in the final analysis. MCA exhibited significantly greater NWI than the ipsilateral ECA (symptomatic MCA vs. ECA: 58.04 ± 8.19 vs. 37.53 ± 10.25, p < 0.001; asymptomatic MCA vs. ECA: 53.80 ± 4.49 vs. 34.85 ± 4.27, p < 0.001, respectively). NWI in symptomatic MCA and ECA were significantly associated with NIHSS scores (r = 0.779 vs. 0.645; p < 0.001 respectively). Moreover, stronger statistical correlations between NIHSS scores and NWI were found in MCA, as compared with ECA during multivariate linear regression analysis. CONCLUSION Greater atherosclerotic plaque burden and a closer association with stroke severity were found for the MCA as compared to the ipsilateral ECA. Identification of MCA plaque lesions by MRI may be helpful for developing more aggressive strategies for stroke prevention.
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Affiliation(s)
- Ye Cao
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yi Sun
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Bin Zhou
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Huilin Zhao
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ying Zhu
- b Department of Neurology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jianrong Xu
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaosheng Liu
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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22
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Doris MK, Dweck MR, Fayad ZA. The future of imaging in cardiovascular disease intervention trials: 2017 and beyond. Curr Opin Lipidol 2016; 27:605-614. [PMID: 27798490 PMCID: PMC5675037 DOI: 10.1097/mol.0000000000000350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW As our understanding of cardiovascular disease has advanced over the past decades, multiple novel treatment strategies have been developed with the hope of reducing the global morbidity and mortality associated with this condition. Large-scale trials to test such novel therapies using clinical end points are expensive, leading to interest in phase II clinical trials with imaging-derived outcome measures. RECENT FINDINGS Noninvasive imaging techniques that assess changes in both atherosclerotic disease burden and plaque composition in response to therapy are well established. With the advent of molecular techniques and hybrid imaging, we now have the ability to assess disease activity alongside these standard anatomic assessments. This multifaceted approach has the potential to provide a more comprehensive assessment of the actions and efficacy of novel therapies in the carotids, aorta and coronary arteries. SUMMARY This review will examine how advanced noninvasive imaging strategies have been used to investigate drug efficacy in intervention trials to date, and crucially how these approaches are set to evolve and play a central role in developing the next generation of atherosclerotic medication.
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Affiliation(s)
- Mhairi K Doris
- aCentre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK bTranslational and Molecular Imaging Institute cZena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Singh J, Brunner G, Morrisett JD, Ballantyne CM, Lumsden AB, Shah DJ, Decuzzi P. Patient-Specific Flow Descriptors and Normalized wall index in Peripheral Artery Disease: a Preliminary Study. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING. IMAGING & VISUALIZATION 2016; 6:119-127. [PMID: 29503774 PMCID: PMC5830147 DOI: 10.1080/21681163.2016.1184589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/26/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS MRI-based hemodynamics have been applied to study the relationship between time-averaged wall shear stresses (TAWSS), oscillatory shear index (OSI) and atherosclerotic lesions in the coronary arteries, carotid artery, and human aorta. However, the role of TAWSS and OSI are poorly understood in lower extremity arteries. The aim of this work was to investigate the feasibility of hemodynamic assessment of the superficial femoral artery (SFA) in patients with peripheral artery disease (PAD) and we hypothesized that there is an association between TAWSS and OSI, respectively, and atherosclerotic burden expressed as the normalized wall index (NWI). METHODS Six cases of 3D vascular geometries of the SFA and related inlet/outlet flow conditions were extracted from patient-specific MRI data including baseline, 12 and 24 months. Blood flow simulations were performed to compute flow descriptors, including TAWSS and OSI, and NWI. RESULTS NWI was correlated positively with TAWSS (correlation coefficient: r = 0.592; p < 0.05). NWI was correlated negatively with OSI (correlation coefficient: r = -0.310, p < 0.01). Spatially averaged TAWSS and average NWI increased significantly between baseline and 24-months, whereas OSI decreased over 2-years. CONCLUSIONS In this pilot study with a limited sample size, TAWSS was positively associated with NWI, a measure of plaque burden, whereas OSI showed an inverse relationship. However, our findings need to be verified in a larger prospective study. MRI-based study of hemodynamics is feasible in the superficial femoral artery.
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Affiliation(s)
- Jaykrishna Singh
- Department of Translational Imaging, The Houston Methodist Research Institute (HMRI), Houston, TX
| | - Gerd Brunner
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
- Methodist DeBakey Heart & Vascular Center, The Houston Methodist Research Institute (HMRI), Houston, TX
| | - Joel D. Morrisett
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
- Methodist DeBakey Heart & Vascular Center, The Houston Methodist Research Institute (HMRI), Houston, TX
| | - Christie M. Ballantyne
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
- Methodist DeBakey Heart & Vascular Center, The Houston Methodist Research Institute (HMRI), Houston, TX
| | - Alan B. Lumsden
- Methodist DeBakey Heart & Vascular Center, The Houston Methodist Research Institute (HMRI), Houston, TX
| | - Dipan J. Shah
- Methodist DeBakey Heart & Vascular Center, The Houston Methodist Research Institute (HMRI), Houston, TX
| | - Paolo Decuzzi
- Department of Translational Imaging, The Houston Methodist Research Institute (HMRI), Houston, TX
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Reference Values for Cardiac and Aortic Magnetic Resonance Imaging in Healthy, Young Caucasian Adults. PLoS One 2016; 11:e0164480. [PMID: 27732640 PMCID: PMC5061387 DOI: 10.1371/journal.pone.0164480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/26/2016] [Indexed: 12/04/2022] Open
Abstract
Background Reference values for morphological and functional parameters of the cardiovascular system in early life are relevant since they may help to identify young adults who fall outside the physiological range of arterial and cardiac ageing. This study provides age and sex specific reference values for aortic wall characteristics, cardiac function parameters and aortic pulse wave velocity (PWV) in a population-based sample of healthy, young adults using magnetic resonance (MR) imaging. Materials and Methods In 131 randomly selected healthy, young adults aged between 25 and 35 years (mean age 31.8 years, 63 men) of the general-population based Atherosclerosis-Monitoring-and-Biomarker-measurements-In-The-YOuNg (AMBITYON) study, descending thoracic aortic dimensions and wall thickness, thoracic aortic PWV and cardiac function parameters were measured using a 3.0T MR-system. Age and sex specific reference values were generated using dedicated software. Differences in reference values between two age groups (25–30 and 30–35 years) and both sexes were tested. Results Aortic diameters and areas were higher in the older age group (all p<0.007). Moreover, aortic dimensions, left ventricular mass, left and right ventricular volumes and cardiac output were lower in women than in men (all p<0.001). For mean and maximum aortic wall thickness, left and right ejection fraction and aortic PWV we did not observe a significant age or sex effect. Conclusion This study provides age and sex specific reference values for cardiovascular MR parameters in healthy, young Caucasian adults. These may aid in MR guided pre-clinical identification of young adults who fall outside the physiological range of arterial and cardiac ageing.
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Raggi P, Baldassarre D, Day S, de Groot E, Fayad Z. Non-invasive imaging of atherosclerosis regression with magnetic resonance to guide drug development. Atherosclerosis 2016; 251:476-482. [DOI: 10.1016/j.atherosclerosis.2016.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
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Ramadan R, Dhawan SS, Binongo JNG, Alkhoder A, Jones DP, Oshinski JN, Quyyumi AA. Effect of Angiotensin II Type I Receptor Blockade with Valsartan on Carotid Artery Atherosclerosis: A Double Blind Randomized Clinical Trial Comparing Valsartan and Placebo (EFFERVESCENT). Am Heart J 2016; 174:68-79. [PMID: 26995372 DOI: 10.1016/j.ahj.2015.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/22/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Progression of atherosclerosis is associated with a greater risk for adverse outcomes. Angiotensin II plays a key role in the pathogenesis and progression of atherosclerosis. We aimed to investigate the effects of angiotensin II type-1 receptor blockade with Valsartan on carotid wall atherosclerosis, with the hypothesis that Valsartan will reduce progression of atherosclerosis. METHODS Subjects (n = 120) with carotid intima-media thickness >0.65 mm by ultrasound were randomized (2:1) in a double-blind manner to receive either Valsartan or placebo for 2 years. Bilateral T2-weighted black-blood carotid magnetic resonance imaging was performed at baseline, 12 and 24 months. Changes in the carotid bulb vessel wall area and wall thickness were primary endpoints. Secondary endpoints included changes in carotid plaque thickness, plasma levels of aminothiols, C-reactive protein, fibrinogen, and endothelium-dependent and -independent vascular function. RESULTS Over 2 years, the carotid bulb vessel wall area decreased with Valsartan (-6.7, 95% CI [-11.6, -1.9] mm(2)) but not with placebo (3.4, 95% CI [-2.8, 9.6] mm(2)), P = .01 between groups. Similarly, mean wall thickness decreased with Valsartan (-0.18, 95% CI [-0.30, -0.06] mm), but not with placebo (0.08, 95% CI [-0.07, 0.23] mm), P = .009 between groups. Furthermore, plaque thickness decreased with Valsartan (-0.35, 95% CI [-0.63, -0.08] mm) but was unchanged with placebo (+0.28, 95% CI [-0.11, 0.69] mm), P = .01 between groups. These findings were unaffected by statin therapy or changes in blood pressure. Notably, there were significant improvements in the aminothiol cysteineglutathione disulfide, and trends to improvements in fibrinogen levels and endothelium-independent vascular function. CONCLUSIONS In subjects with carotid wall thickening, angiotensin II type-1 receptor blockade was associated with regression in carotid atherosclerosis. Whether these effects translate into improved outcomes in subjects with subclinical atherosclerosis warrants investigation.
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Dweck MR, Puntmann VO, Vesey AT, Fayad ZA, Nagel E. MR Imaging of Coronary Arteries and Plaques. JACC Cardiovasc Imaging 2016; 9:306-16. [DOI: 10.1016/j.jcmg.2015.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/25/2015] [Accepted: 12/03/2015] [Indexed: 01/13/2023]
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Urban MW, Qiang B, Song P, Nenadic IZ, Chen S, Greenleaf JF. Investigation of the effects of myocardial anisotropy for shear wave elastography using impulsive force and harmonic vibration. Phys Med Biol 2016; 61:365-82. [PMID: 26674613 PMCID: PMC4816222 DOI: 10.1088/0031-9155/61/1/365] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The myocardium is known to be an anisotropic medium where the muscle fiber orientation changes through the thickness of the wall. Shear wave elastography methods use propagating waves which are measured by ultrasound or magnetic resonance imaging (MRI) techniques to characterize the mechanical properties of various tissues. Ultrasound- or MR-based methods have been used and the excitation frequency ranges for these various methods cover a large range from 24-500 Hz. Some of the ultrasound-based methods have been shown to be able to estimate the fiber direction. We constructed a model with layers of elastic, transversely isotropic materials that were oriented at different angles to simulate the heart wall in systole and diastole. We investigated the effect of frequency on the wave propagation and the estimation of fiber direction and wave speeds in the different layers of the assembled models. We found that waves propagating at low frequencies such as 30 or 50 Hz showed low sensitivity to the fiber direction but also had substantial bias in estimating the wave speeds in the layers. Using waves with higher frequency content (>200 Hz) allowed for more accurate fiber direction and wave speed estimation. These results have particular relevance for MR- and ultrasound-based elastography applications in the heart.
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Affiliation(s)
- Matthew W. Urban
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Bo Qiang
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Pengfei Song
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Ivan Z. Nenadic
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Shigao Chen
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - James F. Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
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Multimodality Noninvasive Imaging of Thoracic Aortic Aneurysms: Time to Standardize? Can J Cardiol 2016; 32:48-59. [DOI: 10.1016/j.cjca.2015.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 01/16/2023] Open
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Wong SK, Mobolaji-Iawal M, Arama L, Cambe J, Biso S, Alie N, Fayad ZA, Mani V. Atherosclerosis imaging using 3D black blood TSE SPACE vs 2D TSE. World J Radiol 2014; 6:192-202. [PMID: 24876923 PMCID: PMC4037545 DOI: 10.4329/wjr.v6.i5.192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/30/2014] [Accepted: 04/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare 3D Black Blood turbo spin echo (TSE) sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) vs 2D TSE in evaluating atherosclerotic plaques in multiple vascular territories.
METHODS: The carotid, aortic, and femoral arterial walls of 16 patients at risk for cardiovascular or atherosclerotic disease were studied using both 3D black blood magnetic resonance imaging SPACE and conventional 2D multi-contrast TSE sequences using a consolidated imaging approach in the same imaging session. Qualitative and quantitative analyses were performed on the images. Agreement of morphometric measurements between the two imaging sequences was assessed using a two-sample t-test, calculation of the intra-class correlation coefficient and by the method of linear regression and Bland-Altman analyses.
RESULTS: No statistically significant qualitative differences were found between the 3D SPACE and 2D TSE techniques for images of the carotids and aorta. For images of the femoral arteries, however, there were statistically significant differences in all four qualitative scores between the two techniques. Using the current approach, 3D SPACE is suboptimal for femoral imaging. However, this may be due to coils not being optimized for femoral imaging. Quantitatively, in our study, higher mean total vessel area measurements for the 3D SPACE technique across all three vascular beds were observed. No significant differences in lumen area for both the right and left carotids were observed between the two techniques. Overall, a significant-correlation existed between measures obtained between the two approaches.
CONCLUSION: Qualitative and quantitative measurements between 3D SPACE and 2D TSE techniques are comparable. 3D-SPACE may be a feasible approach in the evaluation of cardiovascular patients.
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Watanabe Y, Nagayama M, Sakata A, Okumura A, Amoh Y, Ishimori T, Nakashita S, Dodo Y. Evaluation of Fibrous Cap Rupture of Atherosclerotic Carotid Plaque with Thin-Slice Source Images of Time-of-Flight MR Angiography. Ann Vasc Dis 2014; 7:127-33. [PMID: 24995056 DOI: 10.3400/avd.oa.13-00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/08/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the ability of source image of time-of-flight magnetic resonance angiography (TOF-MRA) in the detection of fibrous cap rupture of atherosclerotic carotid plaques. MATERIALS AND METHODS From the database of radiological information in our hospital, 35 patients who underwent carotid MR imaging and subsequent carotid endoarterectomy within 2 weeks were included in this retrospective study. MR imaging included thin-slice time-of-flight MR angiography, black-blood T1- and T2-weighted imaging. Sensitivity, specificity and accuracy were calculated for the detection of fibrous cap rupture with source image of TOF-MRA. The Cohen k coefficient was also calculated to quantify the degree of concordance of source image of TOF-MRA with histopathological data. RESULTS Sensitivity, specificity and accuracy in the detection of fibrous cap rupture were 90% (95%CI: 81-98), 69% (95%CI: 56-82) and 79% (95%CI: 71-87) with a k value of 0.59. The false positives (n = 15) were caused by partial-volume averaging between fibrous cap and lumen at the shoulder of carotid plaque. The false negatives (n = 5) were underestimated as partial thinning of fibrous cap. CONCLUSION Source image of TOF-MRA can be useful in the detection of fibrous cap rupture with high sensitivity, but further technical improvement should be necessary to overcome shortcomings causing image degradation.
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Affiliation(s)
- Yuji Watanabe
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masako Nagayama
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akihiko Sakata
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Okumura
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshiki Amoh
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takayoshi Ishimori
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoru Nakashita
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshihiro Dodo
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Mensel B, Quadrat A, Schneider T, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Lorbeer R. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol 2014; 24:2038-44. [PMID: 24816934 DOI: 10.1007/s00330-014-3188-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/13/2014] [Accepted: 04/14/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To provide age- and sex-specific reference values for MRI-derived wall thickness of the ascending and descending aorta in the general population. MATERIALS AND METHODS Data of 753 subjects (311 females) aged 21-81 years were analysed. MRI was used to determine the aortic wall thickness (AWT). Equations for reference value calculation according to age were established for females and males. RESULTS Median wall thickness of the ascending aorta was 1.46 mm (5th-95th range: 1.15-1.88 mm) for females and 1.56 mm (1.22-1.99 mm) for males. Median wall thickness of the descending aorta was 1.26 mm (0.97-1.58 mm) in females and 1.36 mm (1.04-1.75 mm) in males. While median and 5th and 95th percentiles for the ascending and descending aorta increased with age in both sexes, the association between age and median AWT was stronger in males than in females for both the ascending and descending aorta. CONCLUSIONS Reference values for the ascending and descending AWT are provided. In a healthy sample from the general population, the wall of the ascending aorta is thicker than the wall of the descending aorta, and both walls are thicker in males than females. The increase in wall thickness with age is greater in males. KEY POINTS Ascending aortic wall thickness is greater than descending aortic wall thickness. Ascending and descending aortic wall thickness is greater in males. Thoracic aortic wall thickness increases with age in both sexes. The age-related increase in aortic wall thickness is stronger in males.
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Affiliation(s)
- Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany,
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Kozor R, Grieve SM, Buchholz S, Kaye S, Darke S, Bhindi R, Figtree GA. Regular cocaine use is associated with increased systolic blood pressure, aortic stiffness and left ventricular mass in young otherwise healthy individuals. PLoS One 2014; 9:e89710. [PMID: 24717541 PMCID: PMC3981670 DOI: 10.1371/journal.pone.0089710] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/22/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The cardiovascular impact of cocaine use in otherwise healthy individuals who consider themselves 'social' users is not well established. METHODS/RESULTS Twenty regular cocaine users and 20 control subjects were recruited by word-of-mouth. Cardiovascular magnetic resonance was performed to assess cardiac and vascular structure and function. Cocaine users had higher systolic blood pressure compared to non-users (134±11 vs 126±11 mmHg, p = 0.036), a finding independent of age, body surface area, smoking and alcohol consumption. Cocaine use was associated with increased arterial stiffness - reflected by reduced aortic compliance (1.3±0.2 vs 1.7±0.5 cm2×10-2.mmHg-1, p = 0.004), decreased distensibility (3.8±0.9 vs 5.1±1.4 mmHg-1.10-3, p = 0.001), increased stiffness index (2.6±0.6 vs 2.1±0.6, p = 0.005), and higher pulse wave velocity (5.1±0.6 vs 4.4±0.6 m.s-1, p = 0.001). This change in aortic stiffness was independent of vessel wall thickness. Left ventricular mass was 18% higher in cocaine users (124±25 vs 105±16 g, p = 0.01), a finding that was independent of body surface area, and left atrial diameter was larger in the user group than controls (3.8±0.6 vs 3.5±0.3 cm, p = 0.04). The increased left ventricular mass, systolic blood pressure and vascular stiffness measures were all associated with duration and/or frequency of cocaine use. No late gadolinium enhancement or segmental wall motion abnormalities were seen in any of the subjects. CONCLUSIONS Compared with the non-user control cohort, cocaine users had increased aortic stiffness and systolic blood pressure, associated with greater left ventricular mass. These measures are all well known risk factors for premature cardiovascular events, highlighting the dangers of cocaine use, even in a 'social' setting, and have important public health implications.
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Affiliation(s)
- Rebecca Kozor
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Stuart M. Grieve
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stefan Buchholz
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ravinay Bhindi
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Gemma A. Figtree
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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Mani V, Woodward M, Samber D, Bucerius J, Tawakol A, Kallend D, Rudd JHF, Abt M, Fayad ZA. Predictors of change in carotid atherosclerotic plaque inflammation and burden as measured by 18-FDG-PET and MRI, respectively, in the dal-PLAQUE study. Int J Cardiovasc Imaging 2014; 30:571-82. [PMID: 24458953 DOI: 10.1007/s10554-014-0370-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/15/2014] [Indexed: 12/17/2022]
Abstract
Baseline predictors of response to treatment of patients with coronary heart disease (CHD) with respect to vascular inflammation and atherosclerotic plaque burden are poorly understood. From post hoc analysis of the dal-PLAQUE study (NCT00655473), 18F-fluorodeoxyglucose-positron emission tomography (18-FDG-PET) imaging and carotid black blood magnetic resonance imaging (MRI) were used to track changes in these vascular parameters. Baseline demographics, imaging, and biomarkers were collected/measured in 130 patients with CHD or CHD risk-equivalents, and imaging follow-up at 6 months (PET) and 24 months (MRI) was performed. Using stepwise linear regression, predictors of change in carotid plaque inflammation by PET [target-to-background ratio (TBR), n = 92] and plaque burden by MRI [wall area (WA) and total vessel area (TVA), n = 89] were determined. Variables with p < 0.05 in multivariable models were considered independently significant. Interleukin-6, systolic blood pressure and standard deviation of wall thickness (WT) at baseline were independently positively associated with 18-FDG uptake (mean of maximum [MeanMax] TBR change over 6 months). Mean of mean TBR, phospholipase A2, apolipoprotein A-I, and high-sensitivity C-reactive protein at baseline were independently negatively associated with MeanMax TBR change over 6 months. Mean WT and plasminogen activator inhibitor-1 (PAI-1) activity at baseline, and age, were independently associated with change in WA over 24 months. For TVA changes; mean WA and PAI-1 activity at baseline, age, and female gender were independent predictors. These findings may help determine patients most suitable for clinical trials employing plaque inflammation or burden changes as endpoints.
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Affiliation(s)
- Venkatesh Mani
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,
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Calcagno C, Ramachandran S, Izquierdo-Garcia D, Mani V, Millon A, Rosenbaum D, Tawakol A, Woodward M, Bucerius J, Moshier E, Godbold J, Kallend D, Farkouh ME, Fuster V, Rudd JHF, Fayad ZA. The complementary roles of dynamic contrast-enhanced MRI and 18F-fluorodeoxyglucose PET/CT for imaging of carotid atherosclerosis. Eur J Nucl Med Mol Imaging 2013; 40:1884-93. [PMID: 23942908 DOI: 10.1007/s00259-013-2518-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/11/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Inflammation and neovascularization in vulnerable atherosclerotic plaques are key features for severe clinical events. Dynamic contrast-enhanced (DCE) MRI and FDG PET are two noninvasive imaging techniques capable of quantifying plaque neovascularization and inflammatory infiltrate, respectively. However, their mutual role in defining plaque vulnerability and their possible overlap has not been thoroughly investigated. We studied the relationship between DCE-MRI and (18)F-FDG PET data from the carotid arteries of 40 subjects with coronary heart disease (CHD) or CHD risk equivalent, as a substudy of the dal-PLAQUE trial (NCT00655473). METHODS The dal-PLAQUE trial was a multicenter study that evaluated dalcetrapib, a cholesteryl ester transfer protein modulator. Subjects underwent anatomical MRI, DCE-MRI and (18)F-FDG PET. Only baseline imaging and biomarker data (before randomization) from dal-PLAQUE were used as part of this substudy. Our primary goal was to evaluate the relationship between DCE-MRI and (18)F-FDG PET data. As secondary endpoints, we evaluated the relationship between (a) PET data and whole-vessel anatomical MRI data, and (b) DCE-MRI and matching anatomical MRI data. All correlations were estimated using a mixed linear model. RESULTS We found a significant inverse relationship between several perfusion indices by DCE-MRI and (18)F-FDG uptake by PET. Regarding our secondary endpoints, there was a significant relationship between plaque burden measured by anatomical MRI with several perfusion indices by DCE-MRI and (18)F-FDG uptake by PET. No relationship was found between plaque composition by anatomical MRI and DCE-MRI or (18)F-FDG PET metrics. CONCLUSION In this study we observed a significant, weak inverse relationship between inflammation measured as (18)F-FDG uptake by PET and plaque perfusion by DCE-MRI. Our findings suggest that there may be a complex relationship between plaque inflammation and microvascularization during the different stages of plaque development. (18)F-FDG PET and DCE-MRI may have complementary roles in future clinical practice in identifying subjects at high risk of cardiovascular events.
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Affiliation(s)
- Claudia Calcagno
- Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
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Mensel B, Kühn JP, Schneider T, Quadrat A, Hegenscheid K. Mean thoracic aortic wall thickness determination by cine MRI with steady-state free precession: validation with dark blood imaging. Acad Radiol 2013; 20:1004-8. [PMID: 23830606 DOI: 10.1016/j.acra.2013.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/14/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the validity and reliability of measuring mean aortic wall thickness (MAWT) of the ascending and descending aorta using cine steady-state free precession (SSFP) imaging compared to dark blood (DB) imaging. MATERIALS AND METHODS DB and SSFP images of the thoracic aorta acquired at 1.5 T in 50 volunteers (26 women, 24 men; mean age: 50.2 ± 13.1 years) were used. MAWT was calculated on DB and SSFP images for the ascending and descending aorta at the level of the right pulmonary artery by two independent observers. Validity was assessed using Bland-Altman analysis, Passing-Bablok regression, and Spearman correlation. Reliability was assessed using Bland-Altman analysis and intraclass coefficients (ICCs). RESULTS The mean MAWT of the ascending aorta on DB and SSFP images was 1.89 ± 0.21 mm and 1.87 ± 0.20 mm. The measurements for the descending aorta were 1.60 ± 0.22 and 1.63 ± 0.20 mm, respectively. Comparison of DB and SSFP measurements revealed a mean bias of 1.3% (95% limits of agreement (LOA): -7.9, 10.5%) for the ascending and of -2.1% (LOA: -10.5, 6.3%) for the descending aorta. The corresponding regression equation was y = 0.042 + 0.960 × (r = 0.91; P < .0001) and y = 0.118 + 0.939 × (r = 0.95; P < .0001), respectively. Intra- and interobserver variability showed a mean bias of less than 2.0% and LOA of less than ±15.0%. ICCs were greater than or equal to 0.85. CONCLUSIONS MAWT determination in the ascending and descending aorta using cine SSFP sequences is highly valid and reliable compared to DB imaging.
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Relationship between particulate matter exposure and atherogenic profile in "Ground Zero" workers as shown by dynamic contrast enhanced MR imaging. Int J Cardiovasc Imaging 2012. [PMID: 23179748 DOI: 10.1007/s10554-012-0154-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this pilot study, we hypothesize that dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has the potential to evaluate differences in atherosclerosis profiles in patients subjected to high (initial dust cloud) and low (after 13 September 2001) particulate matter (PM) exposure. Exposure to PM may be associated with adverse health effects leading to increased morbidity. Law enforcement workers were exposed to high levels of particulate pollution after working at "Ground Zero" and may exhibit accelerated atherosclerosis. 31 subjects (28 male) with high (n = 19) or low (n = 12) exposure to PM underwent DCE-MRI. Demographics (age, gender, family history, hypertension, diabetes, BMI, and smoking status), biomarkers (lipid profiles, hs-CRP, BP) and ankle-brachial index (ABI) measures (left and right) were obtained from all subjects. Differences between the high and low exposures were compared using independent samples t test. Using linear forward stepwise regression with information criteria model, independent predictors of increased area under curve (AUC) from DCE-MRI were determined using all variables as input. Confidence interval of 95 % was used and variables with p > 0.1 were eliminated. p < 0.05 was considered significant. Subjects with high exposure (HE) had significantly higher DCE-MRI AUC uptake (increased neovascularization) compared to subjects with lower exposure (LE). (AUC: 2.65 ± 0.63 HE vs. 1.88 ± 0.69 LE, p = 0.016). Except for right leg ABI, none of the other parameters were significantly different between the two groups. Regression model indicated that only HE to PM, CRP > 3.0 and total cholesterol were independently associated with increased neovascularization (in decreasing order of importance, all p < 0.026). HE to PM may increase plaque neovascularization, and thereby potentially indicate worsening atherogenic profile of "Ground Zero" workers.
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Kerwin WS. Carotid artery disease and stroke: assessing risk with vessel wall MRI. ISRN CARDIOLOGY 2012; 2012:180710. [PMID: 23209940 PMCID: PMC3504380 DOI: 10.5402/2012/180710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022]
Abstract
Although MRI is widely used to diagnose stenotic carotid arteries, it also detects characteristics of the atherosclerotic plaque itself, including its size, composition, and activity. These features are emerging as additional risk factors for stroke that can be feasibly acquired clinically. This paper summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA ; VPDiagnostics Incorporation, Seattle, WA 98101, USA
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Maceira AM, Mohiaddin RH. Cardiovascular magnetic resonance in systemic hypertension. J Cardiovasc Magn Reson 2012; 14:28. [PMID: 22559053 PMCID: PMC3372443 DOI: 10.1186/1532-429x-14-28] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 05/06/2012] [Indexed: 12/28/2022] Open
Abstract
Systemic hypertension is a highly prevalent potentially modifiable cardiovascular risk factor. Imaging plays an important role in the diagnosis of underlying causes for hypertension, in assessing cardiovascular complications of hypertension, and in understanding the pathophysiology of the disease process. Cardiovascular magnetic resonance (CMR) provides accurate and reproducible measures of ventricular volumes, mass, function and haemodynamics as well as uniquely allowing tissue characterization of diffuse and focal fibrosis. In addition, CMR is well suited for exclusion of common secondary causes for hypertension. We review the current and emerging clinical and research applications of CMR in hypertension.
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Affiliation(s)
- Alicia M Maceira
- Cardiac Imaging Unit, ERESA Clinic, C/ Marqués de San Juan, 6, 46015, Valencia, Spain
| | - Raad H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Sakellarios AI, Stefanou K, Siogkas P, Tsakanikas VD, Bourantas CV, Athanasiou L, Exarchos TP, Fotiou E, Naka KK, Papafaklis MI, Patterson AJ, Young VEL, Gillard JH, Michalis LK, Fotiadis DI. Novel methodology for 3D reconstruction of carotid arteries and plaque characterization based upon magnetic resonance imaging carotid angiography data. Magn Reson Imaging 2012; 30:1068-82. [PMID: 22617149 DOI: 10.1016/j.mri.2012.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 12/20/2011] [Accepted: 03/08/2012] [Indexed: 01/24/2023]
Abstract
In this study, we present a novel methodology that allows reliable segmentation of the magnetic resonance images (MRIs) for accurate fully automated three-dimensional (3D) reconstruction of the carotid arteries and semiautomated characterization of plaque type. Our approach uses active contours to detect the luminal borders in the time-of-flight images and the outer vessel wall borders in the T(1)-weighted images. The methodology incorporates the connecting components theory for the automated identification of the bifurcation region and a knowledge-based algorithm for the accurate characterization of the plaque components. The proposed segmentation method was validated in randomly selected MRI frames analyzed offline by two expert observers. The interobserver variability of the method for the lumen and outer vessel wall was -1.60%±6.70% and 0.56%±6.28%, respectively, while the Williams Index for all metrics was close to unity. The methodology implemented to identify the composition of the plaque was also validated in 591 images acquired from 24 patients. The obtained Cohen's k was 0.68 (0.60-0.76) for lipid plaques, while the time needed to process an MRI sequence for 3D reconstruction was only 30 s. The obtained results indicate that the proposed methodology allows reliable and automated detection of the luminal and vessel wall borders and fast and accurate characterization of plaque type in carotid MRI sequences. These features render the currently presented methodology a useful tool in the clinical and research arena.
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Affiliation(s)
- Antonis I Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
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Caballero P, Alonso R, Rosado P, Mata N, Fernández-Friera L, Jiménez-Borreguero LJ, Badimon L, Mata P. Detection of subclinical atherosclerosis in familial hypercholesterolemia using non-invasive imaging modalities. Atherosclerosis 2012; 222:468-72. [PMID: 22460051 DOI: 10.1016/j.atherosclerosis.2012.02.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 02/02/2012] [Accepted: 02/27/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the extent of subclinical atherosclerosis in asymptomatic familial hypercholesterolemia (FH) patients using non-invasive images techniques. PATIENTS, METHODS AND RESULTS The atherosclerotic burden of 36 molecularly defined FH patients (18 males, 45.7±10.9 years) without evidence of cardiovascular disease receiving lipid-lowering treatment and 19 (47.8±11.3 years) controls was investigated. Descending thoracic aorta magnetic resonance imaging (MRI) was performed in a 1.5 T equipment with T1 and T2 sequences to characterize atherosclerotic plaques and to measure aortic wall volumen. Carotid intima-media thickness (cIMT) and presence of plaques were measured using B-mode carotid ultrasound. Mean aortic wall volumen, cIMT and atherosclerotic plaques in aorta were significantly higher in FH cases (P<0.001). A significant correlation between aortic wall volume and cIMT was observed (P<0.01). Aortic MRI detected plaques in 94% and carotid ultrasound in 14% of cases. Lipid-rich plaques were observed only in FH cases (33%) and were associated with family history of premature coronary artery disease (P<0.05). CONCLUSIONS Asymptomatic middle-aged FH patients have significantly higher atherosclerotic burden than controls. cIMT has shown a significant correlation with aortic wall volume and MRI allowed the detection of lipid-rich plaques in FH subjects that were associated with family history of premature coronary artery disease.
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Virani SS, Catellier DJ, Pompeii LA, Nambi V, Hoogeveen RC, Wasserman BA, Coresh J, Mosley TH, Otvos JD, Sharrett AR, Boerwinkle E, Ballantyne CM. Relation of cholesterol and lipoprotein parameters with carotid artery plaque characteristics: the Atherosclerosis Risk in Communities (ARIC) carotid MRI study. Atherosclerosis 2011; 219:596-602. [PMID: 21868017 PMCID: PMC3226845 DOI: 10.1016/j.atherosclerosis.2011.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/28/2011] [Accepted: 08/01/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a paucity of data regarding relations of apolipoproteins (apolipoprotein B [ApoB] and apolipoprotein A-1 [Apo A-1]), lipoprotein particle measures (low-density lipoprotein particle concentration [LDLp] and high-density lipoprotein particle concentration [HDLp]), and lipoprotein cholesterol measures (low-density lipoprotein cholesterol [LDL-C], non-high-density lipoprotein cholesterol [non-HDL-C], and high-density lipoprotein cholesterol [HDL-C]) with atherosclerotic plaque burden, plaque eccentricity, and lipid-rich core presence as a marker of high-risk plaques. METHODS Carotid artery magnetic resonance imaging was performed in 1670 Atherosclerosis Risk in Communities study participants. Vessel wall and lipid cores were measured; normalized wall index (NWI), standard deviation (SD) of wall thickness (measure of plaque eccentricity) were calculated; and lipid cores were detected in vessels with ≥ 1.5mm thickness. Fasting concentrations of cholesterol, ApoB and Apo A-1, and LDLp and HDLp were measured. RESULTS Measures of plaque burden (carotid wall volume, wall thickness, and NWI) were positively associated with atherogenic cholesterol and lipoproteins (p < 0.05 for total cholesterol, LDL-C, non-HDL-C, ApoB, and LDLp), but not with HDL-C, Apo A-1, or HDLp. SD of wall thickness was associated with total cholesterol (p 0.01) and non-HDL-C (p 0.02). Although measures of atherogenic or anti-atherogenic cholesterol or lipoprotein were not individually associated with detection of a lipid-rich core, their ratios (total cholesterol/HDL-C, non-HDL-C/HDL-C, and LDLp/HDLp) were associated with lipid-rich core presence (p ≤ 0.05). CONCLUSION Extent of carotid atherosclerosis is associated with atherogenic cholesterol and lipoproteins. Atherogenic/anti-atherogenic cholesterol or particle ratios were associated with presence of a detectable lipid-rich core.
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Affiliation(s)
- Salim S. Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | | | - Lisa A. Pompeii
- The University of Texas Health Science Center at Houston, Houston, TX
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Ron C. Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Bruce A. Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Josef Coresh
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | | | - A. Richey Sharrett
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, Houston, TX
| | - Christie M. Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
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Fayad ZA, Mani V, Woodward M, Kallend D, Abt M, Burgess T, Fuster V, Ballantyne CM, Stein EA, Tardif JC, Rudd JHF, Farkouh ME, Tawakol A. Safety and efficacy of dalcetrapib on atherosclerotic disease using novel non-invasive multimodality imaging (dal-PLAQUE): a randomised clinical trial. Lancet 2011; 378:1547-59. [PMID: 21908036 PMCID: PMC4151875 DOI: 10.1016/s0140-6736(11)61383-4] [Citation(s) in RCA: 401] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dalcetrapib modulates cholesteryl ester transfer protein (CETP) activity to raise high-density lipoprotein cholesterol (HDL-C). After the failure of torcetrapib it was unknown if HDL produced by interaction with CETP had pro-atherogenic or pro-inflammatory properties. dal-PLAQUE is the first multicentre study using novel non-invasive multimodality imaging to assess structural and inflammatory indices of atherosclerosis as primary endpoints. METHODS In this phase 2b, double-blind, multicentre trial, patients (aged 18-75 years) with, or with high risk of, coronary heart disease were randomly assigned (1:1) to dalcetrapib 600 mg/day or placebo for 24 months. Randomisation was done with a computer-generated randomisation code and was stratified by centre. Patients and investigators were masked to treatment. Coprimary endpoints were MRI-assessed indices (total vessel area, wall area, wall thickness, and normalised wall index [average carotid]) after 24 months and (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT assessment of arterial inflammation within an index vessel (right carotid, left carotid, or ascending thoracic aorta) after 6 months, with no-harm boundaries established before unblinding of the trial. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00655473. FINDINGS 189 patients were screened and 130 randomly assigned to placebo (66 patients) or dalcetrapib (64 patients). For the coprimary MRI and PET/CT endpoints, CIs were below the no-harm boundary or the adverse change was numerically lower in the dalcetrapib group than in the placebo group. MRI-derived change in total vessel area was reduced in patients given dalcetrapib compared with those given placebo after 24 months; absolute change from baseline relative to placebo was -4·01 mm(2) (90% CI -7·23 to -0·80; nominal p=0·04). The PET/CT measure of index vessel most-diseased-segment target-to-background ratio (TBR) was not different between groups, but carotid artery analysis showed a 7% reduction in most-diseased-segment TBR in the dalcetrapib group compared with the placebo group (-7·3 [90% CI -13·5 to -0·8]; nominal p=0·07). Dalcetrapib did not increase office blood pressure and the frequency of adverse events was similar between groups. INTERPRETATION Dalcetrapib showed no evidence of a pathological effect related to the arterial wall over 24 months. Moreover, this trial suggests possible beneficial vascular effects of dalcetrapib, including the reduction in total vessel enlargement over 24 months, but long-term safety and clinical outcomes efficacy of dalcetrapib need to be analysed. FUNDING F Hoffmann-La Roche Ltd.
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Affiliation(s)
- Zahi A Fayad
- Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Kylintireas I, Shirodaria C, Lee JMS, Cunningon C, Lindsay A, Francis J, Robson MD, Neubauer S, Channon KM, Choudhury RP. Multimodal cardiovascular magnetic resonance quantifies regional variation in vascular structure and function in patients with coronary artery disease: relationships with coronary disease severity. J Cardiovasc Magn Reson 2011; 13:61. [PMID: 22017860 PMCID: PMC3256113 DOI: 10.1186/1532-429x-13-61] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 10/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) of the vessel wall is highly reproducible and can evaluate both changes in plaque burden and composition. It can also measure aortic compliance and endothelial function in a single integrated examination. Previous studies have focused on patients with pre-identified carotid atheroma. We define these vascular parameters in patients presenting with coronary artery disease and test their relations to its extent and severity. METHODS AND RESULTS 100 patients with CAD [single-vessel (16%); two-vessel (39%); and three-vessel (42%) non-obstructed coronary arteries (3%)] were studied. CAD severity and extent was expressed as modified Gensini score (mean modified score 12.38 ± 5.3). A majority of carotid plaque was located in the carotid bulb (CB). Atherosclerosis in this most diseased segment correlated modestly with the severity and extent of CAD, as expressed by the modified Gensini score (R = 0.251, P < 0.05). Using the AHA plaque classification, atheroma class also associated with CAD severity (rho = 0.26, P < 0.05). The distal descending aorta contained the greatest plaque, which correlated with the degree of CAD (R = 0.222; P < 0.05), but with no correlation with the proximal descending aorta, which was relatively spared (R = 0.106; P = n. s.). Aortic distensibility varied along its length with the ascending aorta the least distensible segment. Brachial artery FMD was inversely correlated with modified Gensini score (R = -0.278; P < 0.05). In multivariate analysis, distal descending aorta atheroma burden, distensibility of the ascending aorta, carotid atheroma class and FMD were independent predictors of modified Gensini score. CONCLUSIONS Multimodal vascular CMR shows regional abnormalities of vascular structure and function that correlate modestly with the degree and extent of CAD.
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Affiliation(s)
- Ilias Kylintireas
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Cheerag Shirodaria
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Justin MS Lee
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Colin Cunningon
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Alistair Lindsay
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Jane Francis
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Matthew D Robson
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Keith M Channon
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Robin P Choudhury
- Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Prasad SK. Review of journal of cardiovascular magnetic resonance 2010. J Cardiovasc Magn Reson 2011; 13:48. [PMID: 21914185 PMCID: PMC3182946 DOI: 10.1186/1532-429x-13-48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/13/2011] [Indexed: 12/15/2022] Open
Abstract
There were 75 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2010, which is a 34% increase in the number of articles since 2009. The quality of the submissions continues to increase, and the editors were delighted with the recent announcement of the JCMR Impact Factor of 4.33 which showed a 90% increase since last year. Our acceptance rate is approximately 30%, but has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. Last year for the first time, the Editors summarized the papers for the readership into broad areas of interest or theme, which we felt would be useful to practitioners of cardiovascular magnetic resonance (CMR) so that you could review areas of interest from the previous year in a single article in relation to each other and other recent JCMR articles 1. This experiment proved very popular with a very high rate of downloading, and therefore we intend to continue this review annually. The papers are presented in themes and comparison is drawn with previously published JCMR papers to identify the continuity of thought and publication in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - David N Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Philip J Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Raad H Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Sanjay K Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
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Fayad ZA, Mani V, Woodward M, Kallend D, Bansilal S, Pozza J, Burgess T, Fuster V, Rudd JHF, Tawakol A, Farkouh ME. Rationale and design of dal-PLAQUE: a study assessing efficacy and safety of dalcetrapib on progression or regression of atherosclerosis using magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Am Heart J 2011; 162:214-221.e2. [PMID: 21835280 DOI: 10.1016/j.ahj.2011.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 05/03/2011] [Indexed: 12/18/2022]
Abstract
dal-PLAQUE is a placebo-controlled multicenter study designed to assess the effect of dalcetrapib on imaging measures of plaque inflammation and plaque burden. dal-PLAQUE is a multimodality imaging study in the context of the large dal-HEART Program. Decreased high-density lipoprotein cholesterol is linked to increased risk of coronary heart disease (CHD). Dalcetrapib, a compound that increases high-density lipoprotein cholesterol by modulating cholesteryl ester transfer protein, is being studied to assess if it can reduce the progression of atherosclerotic disease and thereby decrease cardiovascular morbidity and mortality. Patients with CHD or CHD-risk equivalents were randomized to receive 600 mg dalcetrapib or placebo daily for 24 months, in addition to conventional lipid-lowering medication and other medications for cardiovascular risk factors. The primary outcomes are the effect of dalcetrapib on 18F-fluorodeoxyglucose positron emission tomography target-to-background ratio after 6 months and magnetic resonance imaging (MRI) plaque burden (wall area, wall thickness, total vessel area, and wall area/total vessel area ratio) after 12 months. Secondary objectives include positron emission tomography target-to-background ratio at 3 months and MRI plaque burden at 6 and 24 months; plaque composition at 6, 12, and 24 months; and aortic compliance at 6 months. A tertiary objective is to examine the dynamic contrast-enhanced MRI parameters of plaque neovascularization. In total, 189 subjects entered screening, and 130 were randomized. dal-PLAQUE will provide important information on the effects of dalcetrapib on markers of inflammation and atherosclerotic plaque burden and, thereby, on the safety of cholesteryl ester transfer protein modulation with dalcetrapib. Results are expected in 2011.
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Affiliation(s)
- Zahi A Fayad
- Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Degnan AJ. Risk prediction with carotid MRI. Neurosurgery 2011; 69:E1033. [PMID: 21694655 DOI: 10.1227/neu.0b013e31822999a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Neubauer S, Prasad SK. Review of Journal of Cardiovascular Magnetic Resonance 2009. J Cardiovasc Magn Reson 2010; 12:15. [PMID: 20302618 PMCID: PMC2847562 DOI: 10.1186/1532-429x-12-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
There were 56 articles published in the Journal of Cardiovascular Magnetic Resonance in 2009. The editors were impressed with the high quality of the submissions, of which our acceptance rate was about 40%. In accordance with open-access publishing, the articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. We have therefore chosen to briefly summarise the papers in this article for quick reference for our readers in broad areas of interest, which we feel will be useful to practitioners of cardiovascular magnetic resonance (CMR). In some cases where it is considered useful, the articles are also put into the wider context with a short narrative and recent CMR references. It has been a privilege to serve as the Editor of the JCMR this past year. I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- DJ Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - DN Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - PJ Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - WJ Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215 USA. Harvard Medical School, 25 Shattuck Street Boston, MA 02115 USA
| | - RH Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - S Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - SK Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
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Hayashi K, Mani V, Nemade A, Aguiar S, Postley JE, Fuster V, Fayad ZA. Variations in atherosclerosis and remodeling patterns in aorta and carotids. J Cardiovasc Magn Reson 2010; 12:10. [PMID: 20205722 PMCID: PMC2848016 DOI: 10.1186/1532-429x-12-10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 03/05/2010] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Atherosclerosis is a progressive disease that causes vascular remodeling that can be positive or negative. The evolution of arterial wall thickening and changes in lumen size under current "standard of care" in different arterial beds is unclear. The purpose of this study was to examine arterial remodeling and progression/regression of atherosclerosis in aorta and carotid arteries of individuals at risk for atherosclerosis normalized over a 1-year period. METHODS In this study, 28 patients underwent at least 2 black-blood in vivo cardiovascular magnetic resonance (CMR) scans of aorta and carotids over a one-year period (Mean 17.8 +/- 7.5 months). Clinical risk profiles for atherosclerosis and medications were documented and patients were followed by their referring physicians under current "standard of care" guidelines. Carotid and aortic wall lumen areas were matched across the time-points from cross-sectional images. RESULTS The wall area increased by 8.67%, 10.64%, and 13.24% per year (carotid artery, thoracic aorta and abdominal aorta respectively, p < 0.001). The lumen area of the abdominal aorta increased by 4.97% per year (p = 0.002), but the carotid artery and thoracic aorta lumen areas did not change significantly. The use of statin therapy did not change the rate of increase of wall area of carotid artery, thoracic and abdominal aorta, but decreased the rate of change of lumen area of carotid artery (-3.08 +/- 11.34 vs. 0.19 +/- 12.91 p < 0.05). CONCLUSIONS Results of this study of multiple vascular beds indicated that different vascular locations exhibited varying progression of atherosclerosis and remodeling as monitored by CMR.
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Affiliation(s)
- Katsumi Hayashi
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - Venkatesh Mani
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - Ajay Nemade
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - Silvia Aguiar
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - John E Postley
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Valentin Fuster
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Zahi A Fayad
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Watanabe Y, Nagayama M. MR plaque imaging of the carotid artery. Neuroradiology 2010; 52:253-74. [PMID: 20155353 DOI: 10.1007/s00234-010-0663-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 01/13/2010] [Indexed: 02/08/2023]
Abstract
Atherosclerotic carotid plaque represents a major cause of cerebral ischemia. The detection of vulnerable plaque is important for preventing future cardiovascular events. The key factors in advanced plaque that are most likely to lead to patient complications are the condition of the fibrous cap, the size of the necrotic core and hemorrhage, and the extent of inflammatory activity within the plaque. Magnetic resonance (MR) imaging has excellent soft tissue contrast and can allow for a more accurate and objective estimation of carotid wall morphology and plaque composition. Recent advances in MR imaging techniques have permitted serial monitoring of atherosclerotic disease evolution and the identification of intraplaque risk factors for accelerated progression. The purpose of this review article is to review the current state of techniques of carotid wall MR imaging and the characterization of plaque components and surface morphology with MR imaging, and to describe the clinical practice of carotid wall MR imaging for the determination of treatment plan.
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Affiliation(s)
- Yuji Watanabe
- Department of Radiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
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