Intravascular ultrasonography: using imaging end points in coronary atherosclerosis trials

Enhancement of Ultrasonic Transducer Bandwidth by Acoustic Impedance Gradient Matching Layer

High-performance broadband ultrasound transducers provide superior imaging quality in biomedical ultrasound imaging. However, a matching design that perfectly transmits the acoustic energy between the active piezoelectric element and the target medium over the operating spectrum is still lacking. In this work, an anisotropic gradient acoustic impedance composite material as the matching layer of an ultrasonic transducer was designed and fabricated; it is a non-uniform material with the continuous decline of acoustic impedance along the direction of ultrasonic propagation in a sub-wavelength range. This material provides a broadband window for ultrasonic propagation in a wide frequency range and achieves almost perfect sound energy transfer efficiency from the piezoelectric material to the target medium. Nano tungsten particles and epoxy resin were selected as filling and basic materials, respectively. Along the direction of ultrasonic propagation, the proportion of tungsten powder was carefully controlled to decrease gradually, following the natural exponential form in a very narrow thickness range. Using this new material as a matching layer with high-performance single crystals, the -6 dB bandwidth of the PMN-PT ultrasonic transducer could reach over 170%, and the insertion loss was only -20.3 dB. The transducer achieved a temporal signal close to a single wavelength, thus there is the potential to dramatically improve the resolution and imaging quality of the biomedical ultrasound imaging system.

Broadband gradient impedance matching using an acoustic metamaterial for ultrasonic transducers

High-quality broadband ultrasound transducers yield superior imaging performance in biomedical ultrasonography. However, proper design to perfectly bridge the energy between the active piezoelectric material and the target medium over the operating spectrum is still lacking. Here, we demonstrate a new anisotropic cone-structured acoustic metamaterial matching layer that acts as an inhomogeneous material with gradient acoustic impedance along the ultrasound propagation direction. When sandwiched between the piezoelectric material unit and the target medium, the acoustic metamaterial matching layer provides a broadband window to support extraordinary transmission of ultrasound over a wide frequency range. We fabricated the matching layer by etching the peeled silica optical fibre bundles with hydrofluoric acid solution. The experimental measurement of an ultrasound transducer equipped with this acoustic metamaterial matching layer shows that the corresponding -6 dB bandwidth is able to reach over 100%. This new material fully enables new high-end piezoelectric materials in the construction of high-performance ultrasound transducers and probes, leading to considerably improved resolutions in biomedical ultrasonography and compact harmonic imaging systems.

Phase II trials in heart failure: the role of cardiovascular imaging

The development of new therapies for heart failure (HF), especially acute HF, has proven to be quite challenging; and therapies evaluated in HF have greatly outnumbered treatments that are eventually successful in obtaining regulatory approval. Thus, the development of therapies for HF remains a vexing problem for pharmaceutical and device companies, clinical trialists, and health care professionals. Nowhere is this more apparent than in the phase II HF clinical trial, in which the goal is to determine whether an investigational agent should move forward to a phase III trial. Recent advancements in noninvasive cardiovascular imaging have allowed a new era of comprehensive phenotyping of cardiac structure and function in phase II HF trials. Besides using imaging parameters to predict success of subsequent phase III outcome studies, it is essential to also use imaging in phase II HF trials in a way that increases understanding of drug or device mechanism. Determination of the patients who would benefit most from a particular drug or device could decrease heterogeneity of phase III trial participants and lead to more successful HF clinical trials. In this review, we outline advantages and disadvantages of imaging various aspects of cardiac structure and function that are potential targets for therapy in HF, compare and contrast imaging modalities, provide practical advice for the use of cardiovascular imaging in drug development, and conclude with some novel uses of cardiac imaging in phase II HF trials.

Improved characterization of atherosclerotic plaques by gadolinium contrast during intravascular magnetic resonance imaging of human arteries

OBJECTIVES

To determine whether gadolinium-DTPA (Gd-DTPA) facilitates discrimination of fibrous, lipid or calcified constituents during intravascular magnetic resonance imaging (IVMRI) of human atherosclerotic arteries.

BACKGROUND

Atherosclerotic plaques that cause fatal thrombosis due to rupture have high content of lipid relative to fibrous tissue. We recently demonstrated that IVMRI identifies lipid, fibrous, and calcified components within atherosclerotic human arteries with favorable sensitivity and specificity. Gd-DTPA, a T1-shortening agent, selectively amplifies the signal from fibrous tissue on T1 weighted (T1w) surface MRI.

METHODS

A 0.030 in. diameter receiver coil coupled to a 1.5T MR scanner was positioned in iliac arteries of nine subjects with atherosclerosis. Previously validated multi-parametric analysis of T1w and moderate T2w images identified 137 fibrous, lipid and calcified regions of interest within 37 arterial segments. T1w imaging was repeated following 0.1 mmol/kg IV Gd-DTPA infusion.

RESULTS

Computer-derived mean gray value in fibrous regions increased by 34.2% with Gd-DTPA (95% CI 24.3-43.5%, p=0.0001) while lipid and calcified regions showed only a non-significant increase of 4.3% (95% CI -0.6 to 9.2%, p=0.0825) and 3.8% (95% CI -1.1 to 7.7%, p=0.103), respectively. The increase in mean gray value with Gd-DTPA was greater for fibrous than for lipid or calcified regions (p=0.0001).

CONCLUSIONS

Gd-DTPA selectively enhances signal intensity of fibrous constituents during IVMRI of human atherosclerotic arteries and thus identifies key tissue characteristics associated with plaque stability. These findings have important implications for the assessment of plaque-stabilizing therapies and ultimately for reducing cardiovascular events.

Plaque stabilization: Can we turn theory into evidence?

Coronary events often result from thrombi that form because of physical disruption of the atherosclerotic plaque. The dynamic nature of the plaque offers the opportunity to intervene to modify plaque biology with lifestyle changes and, if needed, pharmacologic measures. Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (statins) reduce levels of serum cholesterol and decrease the incidence of coronary events, but some of the benefits of statins may not depend on their effects on circulating lipids. Indeed, increasing evidence suggests that statins may also enhance plaque stability. Such evidence includes results of preclinical studies with experimental atherosclerosis as well as imaging data and analyses of proinflammatory and prothrombotic mediators in clinical trials. Currently, however, no studies have demonstrated conclusively the mechanisms underlying the unexpected magnitude and rapidity of statin benefits. This article reviews the evolution of the concept of plaque stabilization and reexamines the evidence for the role of statins in that process.

Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art

The ability to image obstructive arterial disease brought about a revolution in clinical cardiovascular care; the development of newer technologies that image arterial wall thicknesses, areas, volumes, and composition allows valid imaging of atherosclerosis for the first time. Development of noninvasive imaging of atherosclerosis has further led to a quantum shift in research in the field by enabling the study of asymptomatic populations and thus allowing investigators to focus on preclinical disease without the many biases associated with the study of symptomatic patients. These noninvasive investigations have broad implications for clinical care as well. Coronary angiography, computed tomographic (CT) imaging of coronary calcium, intravascular ultrasound, multidetector CT angiography, B mode ultrasound of the carotid arteries, and MRI of the carotid arteries all have unique strengths and weaknesses for imaging atherosclerosis. Certain of these techniques are extremely useful as outcome variables for clinical trials, and others are uniquely useful as predictors of the risk of cardiovascular disease. All are informative in one way or another with regard to the role of plaque remodeling and composition in disease causation. CT and MRI technology are advancing very rapidly, and research and clinical uses of these imaging modalities promise to further advance our understanding of atherosclerosis and its prevention.