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Wong M, Dai Y, Ge J. Pan-vascular disease: what we have done in the past and what we can do in the future? CARDIOLOGY PLUS 2024; 9:1-5. [PMID: 38584611 PMCID: PMC10994062 DOI: 10.1097/cp9.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Mingjen Wong
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Yuxiang Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
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Pasterkamp G, den Ruijter HM, Giannarelli C. False Utopia of One Unifying Description of the Vulnerable Atherosclerotic Plaque: A Call for Recalibration That Appreciates the Diversity of Mechanisms Leading to Atherosclerotic Disease. Arterioscler Thromb Vasc Biol 2022; 42:e86-e95. [PMID: 35139657 DOI: 10.1161/atvbaha.121.316693] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is a complex disease characterized by the formation of arterial plaques with a broad diversity of morphological phenotypic presentations. Researchers often apply one description of the vulnerable plaque as a gold standard in preclinical and clinical research that could be applied as a surrogate measure of a successful therapeutic intervention, despite the variability in lesion characteristics that may underly a thrombotic occlusion. The complex mechanistic interplay underlying progression of atherosclerotic disease is a consequence of the broad range of determinants such as sex, risk factors, hemodynamics, medications, and the genetic landscape. Currently, we are facing an overwhelming amount of data based on genetic, transcriptomic, proteomic, and metabolomic studies that all point to heterogeneous molecular profiles of atherosclerotic lesions that lead to a myocardial infarction or stroke. The observed molecular diversity implies that one unifying model cannot fully recapitulate the natural history of atherosclerosis. Despite emerging data obtained from -omics studies, a description of a natural history of atherosclerotic disease in which cell-specific expression of proteins or genes are included is still lacking. This also applies to the insights provided by genome-wide association studies. This review will critically discuss the dogma that the progression of atherosclerotic disease can be captured in one unifying natural history model of atherosclerosis.
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Affiliation(s)
- Gerard Pasterkamp
- Circulatory Health Laboratories (G.P., H.M.d.R.), University Medical Center Utrecht, the Netherlands.,Central Diagnostics Laboratories (G.P.), University Medical Center Utrecht, the Netherlands
| | - Hester M den Ruijter
- Circulatory Health Laboratories (G.P., H.M.d.R.), University Medical Center Utrecht, the Netherlands.,Laboratory of Experimental Cardiology (H.M.d.R.), University Medical Center Utrecht, the Netherlands
| | - Chiara Giannarelli
- NYU Cardiovascular Research Center (C.G.), New York University Grossman School of Medicine.,Department of Pathology (C.G.), New York University Grossman School of Medicine
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Recent Trends in Artificial Intelligence-Assisted Coronary Atherosclerotic Plaque Characterization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910003. [PMID: 34639303 PMCID: PMC8508413 DOI: 10.3390/ijerph181910003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 01/21/2023]
Abstract
Coronary artery disease is a major cause of morbidity and mortality worldwide. Its underlying histopathology is the atherosclerotic plaque, which comprises lipid, fibrous and—when chronic—calcium components. Intravascular ultrasound (IVUS) and intravascular optical coherence tomography (IVOCT) performed during invasive coronary angiography are reference standards for characterizing the atherosclerotic plaque. Fine image spatial resolution attainable with contemporary coronary computed tomographic angiography (CCTA) has enabled noninvasive plaque assessment, including identifying features associated with vulnerable plaques known to presage acute coronary events. Manual interpretation of IVUS, IVOCT and CCTA images demands scarce physician expertise and high time cost. This has motivated recent research into and development of artificial intelligence (AI)-assisted methods for image processing, feature extraction, plaque identification and characterization. We performed parallel searches of the medical and technical literature from 1995 to 2021 focusing respectively on human plaque characterization using various imaging modalities and the use of AI-assisted computer aided diagnosis (CAD) to detect and classify atherosclerotic plaques, including their composition and the presence of high-risk features denoting vulnerable plaques. A total of 122 publications were selected for evaluation and the analysis was summarized in terms of data sources, methods—machine versus deep learning—and performance metrics. Trends in AI-assisted plaque characterization are detailed and prospective research challenges discussed. Future directions for the development of accurate and efficient CAD systems to characterize plaque noninvasively using CCTA are proposed.
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Liu K, Wilkins JT, Colangelo LA, Lloyd-Jones DM. Does Lowering Low-Density Lipoprotein Cholesterol With Statin Restore Low Risk in Middle-Aged Adults? Analysis of the Observational MESA Study. J Am Heart Assoc 2021; 10:e019695. [PMID: 33998284 PMCID: PMC8483525 DOI: 10.1161/jaha.120.019695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background It is unclear if statin therapy in midlife can restore low cardiovascular risk in hypercholesterolemic individuals. Methods and Results At baseline, we grouped 5687 MESA (Multi‐Ethnic Study of Atherosclerosis) participants aged ≥50 years without clinical cardiovascular disease (CVD) by Adult Treatment Panel III statin treatment recommendation and statin treatment status. We used Cox regression to compare the risks for coronary heart disease and CVD between the untreated group with low‐density lipoprotein cholesterol (LDL‐C) <100 mg/dL (reference) and other groups, adjusting for CVD risk factors. We also grouped participants by LDL‐C level (< or ≥100 mg/dL), coronary artery calcium score (0 or >0 Agatston units), and statin status (untreated or treated) with the untreated LDL‐C <100 mg/dL and coronary artery calcium=0 Agatston units as the reference. There were 567 coronary heart disease and 848 CVD events over 15 years of follow‐up. The hazard ratios (HRs) for coronary heart disease and CVD in the group with statin‐treated LDL‐C <100 mg/dL were 1.16 (95% CI, 0.85–1.58) and 1.02 (95% CI, 0.78–1.32), respectively. However, participants with coronary artery calcium >0 Agatston units, treated to LDL‐C <100 mg/dL had HRs of 2.6 (95% CI, 1.7–4.2) for coronary heart disease and 1.8 (95% CI, 1.2–2.6) for CVD. Conclusions Individuals treated with statins to LDL‐C <100 mg/dL had similar levels of risk for atherosclerotic CVD as individuals with untreated LDL‐C <100 mg/dL. However, individuals with coronary artery calcium >0 Agatston units have substantially higher risks despite lipid‐lowering therapy, suggesting that statin treatment in midlife may not restore a low‐risk state in primary prevention patients with established coronary atherosclerosis.
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Affiliation(s)
- Kiang Liu
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL
| | - John T Wilkins
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL.,The Department of Medicine Division of Cardiology Northwestern University, Feinberg School of Medicine Chicago IL
| | - Laura A Colangelo
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL.,The Department of Medicine Division of Cardiology Northwestern University, Feinberg School of Medicine Chicago IL
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Montarello NJ, Nelson AJ, Verjans J, Nicholls SJ, Psaltis PJ. The role of intracoronary imaging in translational research. Cardiovasc Diagn Ther 2020; 10:1480-1507. [PMID: 33224769 DOI: 10.21037/cdt-20-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This has helped further our appreciation of the natural history of coronary artery disease (CAD) and the risk for major adverse cardiovascular events (MACE), evaluate the responsiveness to conventional and experimental therapeutic interventions, and assist in guiding percutaneous coronary intervention (PCI). Here we review the use of different imaging modalities for these purposes and the lessons they have provided thus far.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J Nelson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Duke Clinical Research Institute, Durham, NC, USA
| | - Johan Verjans
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Mazhar J, Figtree G, Vernon ST, Galougahi KK, Carlo J, Nissen SE, Nicholls SJ. Progression of coronary atherosclerosis in patients without standard modifiable risk factors. Am J Prev Cardiol 2020; 4:100116. [PMID: 34327476 PMCID: PMC8315424 DOI: 10.1016/j.ajpc.2020.100116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background and aims The outcome of patients with clinical coronary artery disease despite traditional risk factors is poorly understood. Methods Clinical characteristics and plaque burden on serial intravascular ultrasonography were compared in patients without (n = 165) and with (n = 492) standard modifiable risk factors after matching on age, sex and use of statins from a database of 5823 patients participating in clinical trials of anti-atherosclerotic therapies. Results Patients without standard modifiable risk factors had lower baseline systolic blood pressure (118 ± 12 vs. 129 ± 17 mmHg, p < 0.001), low-density lipoprotein cholesterol (87 ± 21 vs. 104 ± 34 mg/dl, p < 0.001), triglycerides [106 vs. 136 mg/dl, p < 0.001)] and C-reactive protein [1.5 vs. 2.1 mg/l, p = 0.001]. At baseline, patients without modifiable risk factors had a lower percent atheroma volume (35.7 ± 8.6 vs. 38 ± 8.8%, p = 0.004) and total atheroma volume (174.7 ± 80 vs. 190.9 ± 84 mm3, p = 0.03) and less images with calcification (22.2 vs. 26.5%, p = 0.025). The use of aspirin and statin prior to and during the trials was similar. The use of ACE inhibitors and beta blockers was lower in the no risk factor group prior to and during the trials. The change in percent atheroma volume (−0.2 ± 2.8 vs. −0.1 ± 3.6%, p = 0.71), total atheroma volume (−5.5 ± 23.4 vs. −3.8 ± 22.7 mm3, p = 0.42), and the percentage of patients demonstrating any degree of progression (50.9% vs 45.1%, p = 0.20) were similar in those without and with standard modifiable risk factors, respectively. Conclusion Patients who develop clinical coronary atherosclerosis without standard modifiable risk factors have similar rates of plaque progression to those with traditional risk factors. Outcome of patients with CAD despite no traditional risk factors is poorly understood. Serial intravascular ultrasound studies provide an opportunity to examine this. Patients without standard risk factors had lower plaque burden and calcification. Use of aspirin and statin was similar in patients with and without standard risk factors. Plaque progression was similar in those without and with standard risk factors.
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Affiliation(s)
- Jawad Mazhar
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | - Gemma Figtree
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | - Stephen T Vernon
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | | | - Julie Carlo
- C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Australia
| | - Steven E Nissen
- C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Australia
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Fedewa R, Puri R, Fleischman E, Lee J, Prabhu D, Wilson DL, Vince DG, Fleischman A. Artificial Intelligence in Intracoronary Imaging. Curr Cardiol Rep 2020; 22:46. [DOI: 10.1007/s11886-020-01299-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Pavillard E, Sewall L. A post-market, multi-vessel evaluation of the imaging of peripheral arteries for diagnostic purposeS comparing optical Coherence tomogrApy and iNtravascular ultrasound imaging (SCAN). BMC Med Imaging 2020; 20:18. [PMID: 32059702 PMCID: PMC7023791 DOI: 10.1186/s12880-020-0420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Intravascular imaging plays an important part in diagnosis of vascular conditions and providing insight for treatment strategy. Two main imaging modalities are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The objective of this study was to prove non-inferiority of OCT imaging to IVUS images in matched segments of peripheral vessels in patients with suspected peripheral vascular disease. Methods The SCAN study was a prospective, non-inferiority clinical study of matched IVUS and OCT images collected along defined segments of peripheral vessels from twelve subjects (mean age 68 ± 10.3 years; 10 men) displaying symptoms of vascular disease. Luminal diameters were measured by both imaging systems at the distal, middle, and proximal points of the defined segments. Three blinded interventional radiologists evaluated the quality of both imaging modalities in identifying layered structures (3-point grading), plaque (5-point grading), calcification (5-point grading), stent structure (3-point grading), and artifacts (3-point grading) from 240 randomly ordered images. Mean grading scores and luminal diameters were calculated and analyzed with Student’s t-Test and Mann-Whitney-Wilcoxon testing. Intrareader reproducibility was calculated by intraclass correlation (ICC) analysis. Results The mean scoring of plaque, calcification, and vascular stent struts by the three readers was significant better in terms of image quality for OCT than IVUS (p < 0.001, p = 0.001, p = 0.004, respectively). The mean scores of vessel wall component visibility and artifacts generated by the two imaging systems were not significantly different (p = 0.19, p = 0.07, respectively). Mean vessel luminal diameter and area at three specific locations within the vessels were not significantly different between the two imaging modalities. No patient injury, adverse effect or device malfunction were noted during the study. Conclusions Imaging by OCT provides the physician with better visualization of some vessel and plaque chacteristics, but both IVUS and OCT imaging are safe and effective methods of examining peripheral vessels in order to perform diagnostic assessment of peripheral vessels and provide information necessary for the treatment strategy of peripheral artery disease. Trial registration NCT03480685 registered on 29 March 2018.
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Affiliation(s)
- Edward Pavillard
- Pennsylvania Vascular Institute, 420 W. Linfield-Trappe Road Suite 3200, Limerick, PA, 19468, USA.
| | - Luke Sewall
- AMITA Health, 911 N. Elm Street Suite 128, Hinsdale, IL, 60521, USA
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Nelson AJ, Ardissino M, Psaltis PJ. Current approach to the diagnosis of atherosclerotic coronary artery disease: more questions than answers. Ther Adv Chronic Dis 2019; 10:2040622319884819. [PMID: 31700595 PMCID: PMC6826912 DOI: 10.1177/2040622319884819] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/03/2019] [Indexed: 01/10/2023] Open
Abstract
Despite its commonality in routine clinical practice, the approach to a diagnosis of atherosclerotic coronary artery disease remains complex and, in part, contentious. The traditional dogma linking ischaemia to hard clinical outcomes has been questioned and reframed over the years; rather than being a predictor of hard clinical outcomes, the degree of ischaemia may simply be a marker of atherosclerotic disease burden. A renewed interest in the imaging of plaque burden has spawned the contemporary role of CT imaging for not only diagnosis and prognosis, but also for dictating downstream management. As the technology develops and evidence expands, decisions on investigative modalities remain centred around patient factors, local availability, test performance and cost. This review summarizes the available methods for diagnosis in the symptomatic patient and provides an overview of the current evidence behind functional and anatomical approaches.
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Affiliation(s)
- Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, USA
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Maddalena Ardissino
- Duke Clinical Research Institute, Durham, NC, USA
- School of Medicine, Imperial College, London, UK
| | - Peter J. Psaltis
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Danielsen KV, Wiese S, Hove J, Bendtsen F, Møller S. Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival? Dig Dis Sci 2018. [PMID: 29516327 DOI: 10.1007/s10620-018-5006-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT angiography is a robust marker of coronary arteriosclerosis. AIMS To study the burden of coronary arteriosclerosis in cirrhotic patients of various etiologies and association to cardiac dysfunction and survival. METHODS Fifty-seven patients with cirrhosis without cardiovascular disease underwent coronary CT angiography, tissue Doppler echocardiography, electrocardiogram and registration of clinical and biochemical characteristics. RESULTS In patients with cirrhosis the median coronary artery calcium-score was increased in comparison with age and race-adjusted healthy reference values (men: 328 vs. 9 HU and women: 136 vs. 0 HU; p < 0.001). Moreover, the coronary artery calcium-score in alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p < 0.001). Coronary artery calcium-score correlated with age (p = 0.002) but not with established cardiovascular risk factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died but coronary artery calcium-score was not associated with survival. CONCLUSIONS Coronary arteriosclerosis was particular extensive in patients with alcoholic cirrhosis. However, the current results suggest that coronary arteriosclerosis only have limited influence on cardiac function and survival. Surprisingly, no other established risk factors apart from age seemed to interfere with coronary arteriosclerosis in cirrhotic patients.
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Affiliation(s)
- Karen V Danielsen
- Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark. .,Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark.
| | - Signe Wiese
- Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark.,Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Jens Hove
- Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Flemming Bendtsen
- Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Søren Møller
- Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark
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