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Zhao X, Hao Y, Zhao X, Zhang H, Wang X, Li F, Zhang W, Yang M, Chen H, Zhu Z, Tang Y, Miao L, Li W, Yang Q, Guo N, Chen B, He Y, Ye Y, Zeng Y. Comparison of intravascular ultrasound-guided with optical coherence tomography-guided percutaneous coronary intervention for left main distal bifurcation lesions: Rationale and design of the ISOLEDS trial. Contemp Clin Trials 2024; 146:107691. [PMID: 39277167 DOI: 10.1016/j.cct.2024.107691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/23/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) can provide benefits for anatomically suitable left main coronary artery (LMCA) lesions. When compared to traditional coronary angiography (CAG) -guided PCI, the use of intravascular ultrasound (IVUS) guidance has shown significant long-term prognostic improvements in LMCA PCI. Optical coherence tomography (OCT) offers a higher axial resolution than IVUS. However, there is currently a lack of relevant randomized controlled trials investigating the use of OCT specifically for left main distal bifurcation lesions. METHODS The ISOLEDS trial is an ongoing multicenter study that aims to compare IVUS-guided PCI with OCT-guided PCI for patients with true LMCA distal bifurcation lesions. This prospective, randomized, controlled, non-inferiority trial will enroll a total of 664 patients with visually-defined Medina 1,1,1 or 0,1,1 classification of left main distal bifurcation lesions. The patients will be randomly assigned in a 1:1 ratio to either IVUS-guided or OCT-guided PCI. The primary endpoint is to assess the occurrence of target lesion failure (TLF) within 12 months after the procedure. After undergoing PCI, patients are required to visit the hospital for a 12-month clinical follow-up. During this clinical assessment, CAG can be performed to evaluate the status of target lesions. DISCUSSION The ISOLEDS trial represents the first attempt to compare two distinct intracoronary imaging techniques for guiding PCI in patients with true LMCA distal bifurcation lesions. By evaluating and comparing the outcomes of these two imaging techniques, the trial results will aid operators in selection of the most effective approach for guiding PCI in these patients.
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Affiliation(s)
- Xiliang Zhao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiufeng Zhao
- Department of Cardiology, Handan First Hospital, Handan, China
| | - Haijun Zhang
- Department of Cardiology, Handan First Hospital, Handan, China
| | - Xianzhong Wang
- Department of Cardiology, Handan First Hospital, Handan, China
| | - Fangjiang Li
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Wenduo Zhang
- Department of Cardiology, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Yang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongyu Zhu
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China
| | - Yida Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Lifu Miao
- Heart Center, The First Hospital of Tsinghua University, Beijing, China
| | - Weiming Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qing Yang
- Department of Cardiology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Ning Guo
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Chen
- Department of Cardiology, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yicong Ye
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Yong Zeng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Girish MP, Gupta MD, Maehara A, Matsumura M, Bansal A, Kunal S, Batra V, Mohanty A, Qamar A, Mintz GS, Ali ZA, Yusuf J. OCT-based comparative evaluation of culprit lesion morphology in very young versus older adult patients with STEMI. ASIAINTERVENTION 2024; 10:177-185. [PMID: 39347107 PMCID: PMC11413641 DOI: 10.4244/aij-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/24/2024] [Indexed: 10/01/2024]
Abstract
Background The clinical and pathophysiological characteristics of coronary artery disease in very young adults are poorly described. Aims Using optical coherence tomography (OCT), we compared culprit lesion morphology in very young adult patients (≤35 years) versus older adult patients (>60 years) with ST-segment elevation myocardial infarction (STEMI). Methods Culprit lesion morphology was classified as plaque rupture, plaque erosion, or calcified nodule. Thrombus age was subclassified into acute (intraluminal thrombus with surface irregularity) or subacute (mostly mural thrombus with a smooth surface). Results A total of 61 patients who underwent thrombolysis within 24 hours from symptom onset were included, with 38 (59.7%) subjects ≤35 years and 23 (40.3%) subjects >60 years of age. As an underlying mechanism of STEMI thrombosis, plaque erosion was more common in very young patients (52.6% vs 21.7%; p=0.02) while plaque rupture was more common in elderly patients (65.2% vs 36.8%; p=0.03). Acute or subacute thrombus was identified in 68.9% (42/61) of patients, with red thrombus being more frequent in very young patients. In the entire patient cohort, acute thrombus was more frequent in plaque rupture compared with plaque erosion (62.0% vs 28.0%; p=0.01), whereas subacute thrombus was more common in plaque erosion versus plaque rupture (52.0% vs 10.3%; p=0.0008). Conclusions OCT showed that plaque erosion and plaque rupture were the most common underlying STEMI mechanisms in very young patients and older patients, respectively, and that subjects with plaque erosion had greater evidence of subacute thrombus.
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Affiliation(s)
- M P Girish
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Mohit D Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Akiko Maehara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Ankit Bansal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Shekhar Kunal
- Department of Cardiology, ESIC Medical College and Hospital, Faridabad, India
| | - Vishal Batra
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Arun Mohanty
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arman Qamar
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A Ali
- Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India
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Candreva A, Lodi Rizzini M, Calò K, Pagnoni M, Munhoz D, Chiastra C, Aben JP, Fournier S, Muller O, De Bruyne B, Collet C, Gallo D, Morbiducci U. Association Between Automated 3D Measurement of Coronary Luminal Narrowing and Risk of Future Myocardial Infarction. J Cardiovasc Transl Res 2024; 17:893-900. [PMID: 38427153 PMCID: PMC11371893 DOI: 10.1007/s12265-024-10500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
This study focuses on identifying anatomical markers with predictive capacity for long-term myocardial infarction (MI) in focal coronary artery disease (CAD). Eighty future culprit lesions (FCL) and 108 non-culprit lesions (NCL) from 80 patients underwent 3D quantitative coronary angiography. The minimum lumen area (MLA), minimum lumen ratio (MLR), and vessel fractional flow reserve (vFFR) were evaluated. MLR was defined as the ratio between MLA and the cross-sectional area at the proximal lesion edge, with lower values indicating more abrupt luminal narrowing. Significant differences were observed between FCL and NCL in MLR (0.41 vs. 0.53, p < 0.001). MLR correlated inversely with translesional vFFR (r = - 0.26, p = 0.0004) and was the strongest predictor of MI at 5 years (AUC = 0.75). Lesions with MLR < 0.40 had a fourfold increased MI incidence at 5 years. MLR is a robust predictor of future adverse coronary events.
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Affiliation(s)
- Alessandro Candreva
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Maurizio Lodi Rizzini
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy
| | - Karol Calò
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy
| | - Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Claudio Chiastra
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy
| | | | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy.
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Kwon Y, Kim N, Kim CY, Kim DH, Shin H, Jung MS, Park JS, Park YJ, Park BE, Kim HN, Jang SY, Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Cha KS, Hur SH, Hwang JY, Jeong MH. Long-term clinical outcomes of image-guided percutaneous coronary intervention in acute myocardial infarction from the Korea Acute Myocardial Infarction Registry. PLoS One 2024; 19:e0304843. [PMID: 38838047 DOI: 10.1371/journal.pone.0304843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024] Open
Abstract
Imaging modalities for percutaneous coronary intervention (PCI), such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT), have increased in the current PCI era. However, their clinical benefits in acute myocardial infarction (AMI) have not been fully elucidated. This study investigated the long-term outcomes of image-guided PCI in patients with AMI using data from the Korean Acute Myocardial Infarction Registry. A total of 9,271 patients with AMI, who underwent PCI with second-generation drug-eluting stents between November 2011 and December 2015, were retrospectively examined, and target lesion failure (TLF) at 3 years (defined as the composite of cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization) was evaluated. From the registry, 2,134 patients (23.0%) underwent image-guided PCI (IVUS-guided: n = 1,919 [20.6%]; OCT-guided: n = 215 patients [2.3%]). Based on propensity score matching, image-guided PCI was associated with a significant reduction in TLF (hazard ratio: 0.76; 95% confidence interval: 0.59-0.98, p = 0.035). In addition, the TLF incidence in the OCT-guided PCI group was comparable to that in the IVUS-guided PCI group (5.3% vs 4.7%, p = 0.903). Image-guided PCI, including IVUS and OCT, is associated with favorable clinical outcomes in patients with AMI at 3 years post-intervention. Additionally, OCT-guided PCI is not inferior to IVUS-guided PCI in patients with AMI.
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Affiliation(s)
- Youngjoon Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Namkyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang-Yeon Kim
- Department of Internal Medicine, School of Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Do-Hoon Kim
- Department of Nuclear Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Hyewon Shin
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
- Division of Biostatistics, Linical Korea Co., Ltd, Seoul, Republic of Korea
| | - Min-Su Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jong Sung Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yoon Jung Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Bo Eun Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hong Nyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kwang Soo Cha
- Pusan National University Hospital, Busan, Republic of Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Cardiovascular Medicine, Deagu, Republic of Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
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Hamed M, Mohamed S, Mahmoud M, Kahan J, Mohsen A, Rahman F, Kayani W, Alfonso F, Brilakis ES, Elgendy IY, Mamas MA, Elbadawi A. Intravascular Imaging-Guided Versus Coronary Angiography-Guided Complex PCI: A Meta-analysis of Randomized Controlled Trials. Cardiol Ther 2024; 13:379-399. [PMID: 38630393 PMCID: PMC11093926 DOI: 10.1007/s40119-024-00364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/04/2024] [Indexed: 05/15/2024] Open
Abstract
INTRODUCTION Trials evaluating the role of intravascular imaging in percutaneous coronary intervention (PCI) for complex coronary artery disease have yielded mixed results. This study aimed to compare the outcomes of intravascular imaging specifically intravascular ultrasound (IVUS) with those from conventional coronary angiography in complex PCI. METHODS Comprehensive electronic search of MEDLINE, EMBASE, and Cochrane databases was performed until March 2023 for randomized clinical trials (RCTs) comparing intravascular imaging with coronary angiography in patients undergoing complex PCI. Complex PCI was defined per each study, and included PCI for American College of Cardiology/American Heart Association (ACC/AHA) type B2/C lesions, unprotected left main coronary artery disease, or multivessel stenting. The primary study outcome was major adverse clinical events (MACE). RESULTS The meta-analysis included 10 RCTs with a total of 6615 patients (3576 in the intravascular imaging group and 3039 in the coronary angiography group). The weighted mean-follow up was 28.9 months. Compared with coronary angiography, intravascular imaging reduced MACE (8% vs. 13.3%; relative risk [RR] 0.63; 95% confidence interval [CI] 0.54-0.73), cardiac death (RR 0.47; 95% CI 0.31-0.73), definite/probable stent thrombosis (RR 0.48; 95% CI 0.24-0.97), target vessel revascularization (RR 0.62; 95% CI 0.46-0.83), and target lesion revascularization (RR 0.61; 95% CI 0.47-0.79). There was no difference between both groups in all-cause death (RR 0.79; 95% CI 0.53-1.18) and myocardial infarction (RR 0.80; 95% CI 0.61-1.04). CONCLUSION In patients undergoing complex PCI, intravascular imaging-specifically IVUS-reduced MACE by decreasing the incidence of cardiac death, stent thrombosis, and target vessel and target lesion revascularization.
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Affiliation(s)
- Mohamed Hamed
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheref Mohamed
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Mohamed Mahmoud
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan Kahan
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University, Loma Linda, CA, USA
| | - Faisal Rahman
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Waleed Kayani
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | | | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Ayman Elbadawi
- Division of Cardiology, Christus Good Shepherd Medical Center, Longview, TX, USA.
- Texas A&M School of Medicine, Bryan, TX, USA.
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den Dekker WK. Is intravascular imaging the future of percutaneous coronary intervention? Lancet 2024; 403:1822-1823. [PMID: 38604211 DOI: 10.1016/s0140-6736(24)00430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Wijnand K den Dekker
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam 3015GD, Netherlands.
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7
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Landi A, Milzi A, Valgimigli M. Intravascular Ultrasound Guidance during Primary Percutaneous Coronary Intervention: No Time for Excuses. Cardiology 2024; 149:193-195. [PMID: 38648733 DOI: 10.1159/000538600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Andrea Milzi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- University of Bern, Bern, Switzerland
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8
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Sato T, Matsumura M, Yamamoto K, Shlofmitz E, Moses JW, Khalique OK, Shin D, Dakroub A, Singh M, Malik S, Tsoulios A, Cohen DJ, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. Prevalence and anatomical factors associated with stent under-expansion in non-severely calcified lesions. Catheter Cardiovasc Interv 2024. [PMID: 38639137 DOI: 10.1002/ccd.31035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Stent underexpansion, typically related to lesion calcification, is the strongest predictor of adverse events after percutaneous coronary intervention (PCI). Although uncommon, underexpansion may also occur in non-severely calcified lesions. AIM We sought to identify the prevalence and anatomical characteristics of underexpansion in non-severely calcified lesions. METHODS We included 993 patients who underwent optical coherence tomography-guided PCI of 1051 de novo lesions with maximum calcium arc <180°. Negative remodeling (NR) was the smallest lesion site external elastic lamina diameter that was also smaller than the distal reference. Stent expansion was evaluated using a linear regression model accounting for vessel tapering; underexpansion required both stent expansion <70% and stent area <4.5mm2. RESULTS Underexpansion was observed in 3.6% of non-heavily calcified lesions (38/1051). Pre-stent maximum calcium arc and thickness were greater in lesions with versus without underexpansion (median 119° vs. 85°, p = 0.002; median 0.95 mm vs. 0.78 mm, p = 0.008). NR was also more common in lesions with underexpansion (44.7% vs. 24.5%, p = 0.007). In the multivariable logistic regression model, larger and thicker eccentric calcium, mid left anterior descending artery (LAD) location, and NR were associated with underexpansion in non-severely calcified lesions. The rate of underexpansion was especially high (30.7%) in lesions exhibiting all three morphologies. Two-year TLF tended to be higher in underexpanded versus non-underexpanded stents (9.7% vs. 3.7%, unadjusted hazard ratio [95% confidence interval] = 3.02 [0.92, 9.58], p = 0.06). CONCLUSION Although underexpansion in the absence of severe calcium (<180°) is uncommon, mid-LAD lesions with NR and large and thick eccentric calcium were associated with underexpansion.
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Affiliation(s)
- Takao Sato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Kei Yamamoto
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Omar K Khalique
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Doosup Shin
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ali Dakroub
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Mandeep Singh
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Sarah Malik
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Anna Tsoulios
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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9
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Dall’Orto CC, Ferreira Lopes RP, Eurípedes LV, Pinto Filho GV, da Silva MR. Acute Coronary Syndrome with Non-Obstructive Plaque on Angiography and Features of Vulnerable Plaque on Intracoronary Optical Coherence Tomography. Diagnostics (Basel) 2023; 13:3118. [PMID: 37835863 PMCID: PMC10572796 DOI: 10.3390/diagnostics13193118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Optical coherence tomography (OCT) has a high spatial resolution and is useful in identifying coronary lesions with high-risk features (vulnerable plaques). These plaques are strongly associated with acute coronary syndrome (ACS). In this report, we present the case of a 43-year-old male patient presenting with typical chest pain that began three hours prior to admission. The patient exhibited an elevation of the ST segments of the anterior and lateral walls. Invasive stratification revealed a 40% lesion in the middle segment of the left anterior descending (LAD) artery. The patient was given optimized clinical treatment as he had a nonobstructive lesion in the LAD at the time of angiography. During the treatment, the patient continued to complain of angina on exertion. A follow-up coronary angiography, along with OCT analysis of the middle-to-moderate lesion in the LAD, revealed a plaque predominantly rich in lipids with signs of vulnerability. A percutaneous coronary intervention was performed. The patient's recovery was uneventful, and he was discharged the day after the procedure. This case illustrates the evolution of intravascular imaging, particularly OCT, in the detection of vulnerable plaques.
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Affiliation(s)
- Clarissa Campo Dall’Orto
- Department of Hemodynamic and Interventional Cardiology of the Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas 45987-088, Bahia, Brazil
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Blasco-Turrión S, Gómez-López A, Morales-Ponce FJ, Casquero-Domínguez S, del Pozo-Contreras R. What eyes do not see the heart does not grieve over? The role of intracoronary imaging in acute myocardial infarction: a case report. Eur Heart J Case Rep 2023; 7:ytad444. [PMID: 37719005 PMCID: PMC10504859 DOI: 10.1093/ehjcr/ytad444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
Background The evaluation of a three-dimensional structure with a two-dimensional imaging technique makes intracoronary diagnostic techniques essential, especially in the setting of acute myocardial infarction (AMI) when no apparent coronary lesions are detected. Expert consensus recommend their use in certain scenarios such as angiographically ambiguous disease and identification of the culprit lesion. Although both intravascular ultrasound and optical coherence tomography (OCT) allow the characterization of the atherosclerotic plaque and assess the immediate and long-term results of stent implantation, they have their own benefits and limitations that make them ideal for different types of coronary lesions. Case summary We present the case of a lateral ST-elevation myocardial infarction with no evident coronary lesions in angiography, in which OCT not only allowed us to confirm a diagonal branch occlusion, but it also became crucial to locate the occlusion point and to guide the procedure, allowing complete revascularization of the culprit lesion that otherwise could have been missed. Discussion To know the actual limitations of conventional coronary angiography to adequately assess coronary disease, intracoronary diagnostic techniques are key to evaluate the underlying mechanisms of the event, especially in the setting of AMI when no clear culprit lesion has been identified. They can be of great value to locate and revascularize acute occlusions that could go unnoticed on the angiogram, guiding the revascularization and stent implantation and, therefore, preventing myocardial injury that could become irreversible when coronary disease is not treated promptly.
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Affiliation(s)
- Sara Blasco-Turrión
- Interventional Cardiology Unit, Puerto Real University Hospital, Calle Romería, 7, Puerto Real, Cádiz 11510, Spain
| | - Andrea Gómez-López
- Interventional Cardiology Unit, Puerto Real University Hospital, Calle Romería, 7, Puerto Real, Cádiz 11510, Spain
| | - Francisco J Morales-Ponce
- Interventional Cardiology Unit, Puerto Real University Hospital, Calle Romería, 7, Puerto Real, Cádiz 11510, Spain
| | - Sara Casquero-Domínguez
- Interventional Cardiology Unit, Puerto Real University Hospital, Calle Romería, 7, Puerto Real, Cádiz 11510, Spain
| | - Rocío del Pozo-Contreras
- Interventional Cardiology Unit, Puerto Real University Hospital, Calle Romería, 7, Puerto Real, Cádiz 11510, Spain
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11
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Ohashi H, Collison D, Mizukami T, Didagelos M, Sakai K, Aetesam-ur-Rahman M, Munhoz D, McCartney P, Ford TJ, Lindsay M, Shaukat A, Rocchiccioli P, Brogan R, Watkins S, McEntegart M, Good R, Robertson K, O’Boyle P, Davie A, Khan A, Hood S, Eteiba H, Amano T, Sonck J, Berry C, De Bruyne B, Oldroyd KG, Collet C. Fractional Flow Reserve-Guided Stent Optimisation in Focal and Diffuse Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2612. [PMID: 37568975 PMCID: PMC10417445 DOI: 10.3390/diagnostics13152612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs. diffuse disease on physiology-guided incremental optimisation strategy (PIOS) is unknown. This is a sub-study of the TARGET-FFR randomized clinical trial (NCT03259815). The study protocol directed that optimisation be attempted for patients in the PIOS arm when post-PCI FFR was <0.90. Overall, 114 patients (n = 61 PIOS and 53 controls) with both pre-PCI fractional flow reserve (FFR) pullbacks and post-PCI FFR were included. A PPG ≥ 0.74 defined focal CAD. The PPG correlated significantly with post-PCI FFR (r = 0.43; 95% CI 0.26 to 0.57; p-value < 0.001) and normalised delta FFR (r = 0.49; 95% CI 0.34 to 0.62; p-value < 0.001). PIOS was more frequently applied to vessels with diffuse CAD (6% focal vs. 42% diffuse; p-value = 0.006). In patients randomized to PIOS, those with focal disease achieved higher post-PCI FFR than patients with diffuse CAD (0.93 ± 0.05 vs. 0.83 ± 0.07, p < 0.001). There was a significant interaction between CAD patterns and the randomisation arm for post-PCI FFR (p-value for interaction = 0.004). Physiology-guided stent optimisation was applied more frequently to vessels with diffuse disease; however, patients with focal CAD at baseline achieved higher post-PCI FFR.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Cardiology, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo 157-8577, Japan
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu 500-8384, Japan
| | - Matthaios Didagelos
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Cardiology, Showa University Hospital, Tokyo 142-8666, Japan
| | - Muhammad Aetesam-ur-Rahman
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Peter McCartney
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Thomas J. Ford
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
- Faculty of Medicine, University of Newcastle, Central Coast Campus, Ourimbah, NSW 2258, Australia
| | - Mitchell Lindsay
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Aadil Shaukat
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Paul Rocchiccioli
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Richard Brogan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Stuart Watkins
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Margaret McEntegart
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Richard Good
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Keith Robertson
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Patrick O’Boyle
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Andrew Davie
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Adnan Khan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Stuart Hood
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Hany Eteiba
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
| | - Colin Berry
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Cardiology, Lausanne University Hospital, 1005 Lausanne, Switzerland
| | - Keith G. Oldroyd
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
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Okabe H, Inoue K, Tanaka M, Kakumori D, Setoyama K, Miura T, Anai R, Araki M, Sonoda S, Kataoka M. Effects of contrast medium viscosity into flushing port on artefacts during optical coherence tomography imaging. J Cardiol 2023:S0914-5087(23)00111-9. [PMID: 37209906 DOI: 10.1016/j.jjcc.2023.05.005] [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] [Received: 03/23/2023] [Revised: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is becoming the standard imaging modality for percutaneous coronary intervention (PCI) because of its high resolution. To perform appropriate OCT-guided PCI, it is necessary to avoid artefacts and obtain high-quality images. We investigated the relationship between artefacts and the viscosity of contrast media, which were used to remove air before OCT imaging catheter was inserted into guiding catheter. METHODS We retrospectively analyzed every pullback of OCT examinations from January 2020 to September 2021. Cases were divided into two groups according to the type of contrast media used for catheter flushing: low-viscosity (Iopamidol-300, Bayer, Nordrhein-Westfalen, Germany) vs. high-viscosity (Iopamidol-370, Bayer). We evaluated the artefacts and quality of each OCT image and performed ex vivo experiments to compare differences in artefact frequencies using the two contrast media. RESULTS A total of 140 pullbacks in the low-viscosity group and 73 pullbacks in the high-viscosity group were analyzed. The percentage of grade 2 and 3 images (with good quality) in the low-viscosity group was significantly lower (68.1 % vs. 94.5 %, p < 0.001). Rotational artefacts were significantly more common in the low-viscosity group (49.3 % vs. 8.2 %, p < 0.001). In multivariate analysis, using low-viscosity contrast media was a significant factor influencing the appearance of rotational artefacts and affecting image quality (odds ratio, 9.42; 95 % confidence interval, 3.58 to 24.8; p < 0.001). In ex vivo experiments, using low-viscosity contrast media was also a significant predictor of artefact occurrence during OCT (p < 0.01). CONCLUSIONS The viscosity of the contrast agent used while flushing the OCT imaging catheter contributes to the appearance of OCT artefacts.
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Affiliation(s)
- Hiroki Okabe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Konosuke Inoue
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masamitsu Tanaka
- Department of Clinical Engineering, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Daiki Kakumori
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koshi Setoyama
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiya Miura
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reo Anai
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Araki
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Fabris E, Kedhi E, Verdoia M, Ielasi A, Tespili M, Guagliumi G, De Luca G. Current Role of Intracoronary Imaging for Implementing Risk Stratification and Tailoring Culprit Lesion Treatment: A Narrative Review. J Clin Med 2023; 12:jcm12103393. [PMID: 37240499 DOI: 10.3390/jcm12103393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Our understanding of the pathophysiology of acute coronary syndrome and of the vascular biology of coronary atherosclerosis has made enormous progress with the implementation of intravascular imaging. Intravascular imaging contributes to overcoming the known limitations of coronary angiography and allows for the in vivo discrimination of plaque morphology giving insight into the underlying pathology of the disease process. The possibility of using intracoronary imaging to characterize lesion morphologies and correlate them with clinical presentations may influence the treatment of patients and improve risk stratification, offering the opportunity for tailored management. This review examines the current role of intravascular imaging and describes how intracoronary imaging represents a valuable tool for modern interventional cardiology in order to improve diagnostic accuracy and offer a tailored approach to the treatment of patients with coronary artery disease, especially in the acute setting.
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Affiliation(s)
- Enrico Fabris
- Cardiothoracovascular Department, University of Trieste, 34100 Trieste, Italy
| | - Elvin Kedhi
- Cardiology Division, Erasmus Hospital, Université libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department Medical, University of Silesia, 40-032 Katowice, Poland
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, 13875 Biella, Italy
| | - Alfonso Ielasi
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Maurizio Tespili
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Giulio Guagliumi
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Giuseppe De Luca
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
- Division of Cardiology, AOU "Policlinico G. Martino", and Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
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Sato T, Matsumura M, Yamamoto K, Shlofmitz E, Moses JW, Khalique OK, Thomas SV, Tsoulios A, Cohen DJ, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. Impact of Eruptive vs Noneruptive Calcified Nodule Morphology on Acute and Long-Term Outcomes After Stenting. JACC Cardiovasc Interv 2023; 16:1024-1035. [PMID: 37164599 DOI: 10.1016/j.jcin.2023.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Whether an eruptive or noneruptive target lesion calcified nodule (CN) portends worse acute and long-term clinical outcomes after stenting has not been established. OBJECTIVES The authors sought to compare acute and long-term clinical outcomes in eruptive CN vs noneruptive CN morphology. METHODS Using optical coherence tomography, an eruptive CN was defined as an accumulation of small calcium fragments protruding and disrupting the overlying fibrous cap, typically with small amount of thrombus. A noneruptive CN was defined as an accumulation of small calcium fragments with a smooth intact fibrous cap without an overlying thrombus. The primary endpoint was target lesion failure (TLF) including cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization in patients with ≥6-month follow-up. RESULTS Among 3,231 patients with evaluable pre- and postintervention OCT, 236 patients had lesions with CNs (7.3%). After eliminating 4 secondary lesions and 6 patients without ≥6-month follow-up, 126 (54.8%) lesions with eruptive CNs and 104 (45.2%) lesions with noneruptive CNs formed the current report. Compared with noneruptive CNs, eruptive CNs were independently associated with greater stent expansion (89.2% ± 18.7% vs. 81.5% ± 18.9%; P = 0.003) after adjusting for morphologic and procedural factors. At 2 years, eruptive CNs trended toward more TLF compared with noneruptive CNs (Kaplan-Meier estimates, 19.8% vs 12.5%; P = 0.11) and significantly more target lesion revascularization (18.3% vs 9.6%; P = 0.04). In the adjusted model, eruptive CNs were independently associated with 2-year TLF (HR: 2.07; 95% CI: 1.01-4.50; P = 0.048). CONCLUSIONS Compared with noneruptive CN morphology, lesions with an eruptive CN appearance on optical coherence tomography had a worse poststent long-term clinical outcome despite better acute stent expansion.
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Affiliation(s)
- Takao Sato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Kei Yamamoto
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Omar K Khalique
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Susan V Thomas
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Anna Tsoulios
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA.
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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Borzillo I, De Filippo O, Manai R, Bruno F, Ravetti E, Galanti AA, Vergallo R, Porto I, De Ferrari GM, D’Ascenzo F. Role of Intracoronary Imaging in Myocardial Infarction with Non-Obstructive Coronary Disease (MINOCA): A Review. J Clin Med 2023; 12:2129. [PMID: 36983131 PMCID: PMC10051698 DOI: 10.3390/jcm12062129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
Myocardial infarction with non-obstructive coronary artery disease occurs in 6% to 15% of all presentation of myocardial infarctions. The pathophysiologic mechanisms of MINOCA include epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, and coronary thrombus/embolism. The diagnosis is challenging, supported by intracoronary imaging with intravascular ultrasound (IVUS) and optical coherent tomography (OCT), coronary physiology testing, and cardiac magnetic resonance imaging (CMR). OCT is able to identify atherosclerotic causes of MINOCA (plaque erosion, plaque rupture, and calcified nodule) and nonatherosclerotic causes (spontaneous artery dissection, and spasm). In this review, we summarize the performance of the two intracoronary imaging modalities (IVUS and OCT) in MINOCA and discuss the importance of supplementing these modalities with CMR in order to drive target therapy.
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Affiliation(s)
- Irene Borzillo
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
| | - Rossella Manai
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Alma Andrea Galanti
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Rocco Vergallo
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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16
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Low AF, Wongpraparut N, Chunhamaneewat N, Jeamanukoolkit A, Jhung LT, Zhen-Vin L, Tan CT, Hwa HH, Rajagopal R, Yahya AF, Kaur R, Narang M, West NEJ. Clinical use of optical coherence tomography during percutaneous coronary intervention and coronary procedures in Southeast Asia: a survey-based expert consensus summary. ASIAINTERVENTION 2023; 9:25-31. [PMID: 36936105 PMCID: PMC10015489 DOI: 10.4244/aij-d-22-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 03/14/2023]
Abstract
Optical coherence tomography (OCT), an established intravascular imaging technique, enables rapid acquisition of high-resolution images during invasive coronary procedures to assist physician decision-making. OCT has utility in identifying plaque/lesion morphology (e.g., thrombus, degree of calcification, and presence of lipid) and vessel geometry (lesion length and vessel diameter) and in guiding stent optimisation through identification of malapposition and underexpansion. The use of OCT guidance during percutaneous coronary interventions (PCI) has demonstrated improved procedural and clinical outcomes in longitudinal registries, although randomised controlled trial data remain pending. Despite growing data and guideline endorsement to support OCT guidance during PCI, its use in different countries is not well established. This article is based on an advisory panel meeting that included experts from Southeast Asia (SEA) and is aimed at understanding the current clinical utility of intracoronary imaging and OCT, assessing the barriers and enablers of imaging and OCT adoption, and mapping a path for the future of intravascular imaging in SEA. This is the first Southeast Asian consensus that provides insights into the use of OCT from a clinician's point of view.
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Affiliation(s)
- Adrian F Low
- National University Heart Centre Singapore, National University Hospital, Singapore
| | - Nattawut Wongpraparut
- Cardiac Catheterisation Laboratory, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Lee Zhen-Vin
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | - Achmad Fauzi Yahya
- Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital- Bandung, Indonesia
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17
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Wan M, Lu Y, Mao B, Yu S, Ju P, Hu K, Xu Y, Li X, Zhuang J. Immature neutrophil is associated with coronary plaque vulnerability based on optical coherence tomography analysis. Int J Cardiol 2023; 374:89-93. [PMID: 36649888 DOI: 10.1016/j.ijcard.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION High neutrophil to lymphocyte ratio is considered to predict poor prognosis of acute coronary syndrome (ACS). However, the association of neutrophil subpopulation with plaque vulnerability and the incidence of ACS remains unknown. METHODS AND RESULTS Blood samples from 48 patients with unstable angina (UA), 31 with ST-segment elevation myocardial infarction (STEMI) and 33 healthy controls were collected at admission. The morphology of coronary plaques in 48 UA patients were further evaluated by optical coherence tomography (OCT). According to maturation stages of neutrophils and the expression of CD10 and CD101, circulating neutrophils could be divided into pre-neutrophils (CD101-CD10-), immature neutrophils (CD101+CD10-) and mature neutrophils (CD101+CD10+). While the number of pre-neutrophil was quite low in blood and comparable among three groups, the absolute counts and percentage of CD10- immature neutrophils were higher in peripheral bloods of UA and STEMI patients compared with those in healthy controls. The concentration of plasma myeloperoxidase was positively associated with the percentage of CD10- immature neutrophils. Furthermore, UA patients with thin-cap fibroatheroma (TCFA) observed by OCT had a higher proportion and larger number of immature neutrophils as compared to those without TCFA. The percentage of immature neutrophils also closely correlated with plaque rupture and the feature of vulnerable plaque, including thinner fibrous cap and larger lipid core, but did not associate with percent lumen stenosis. CONCLUSION Our findings emphasize that the abnormally increased level of CD10- immature neutrophils may sever as a promising marker of the incidence of ACS and plaque vulnerability.
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Affiliation(s)
- Minying Wan
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Lu
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Mao
- Buzhen Community Health Service Center, Shanghai, China
| | - Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peinan Ju
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kun Hu
- Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiankai Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Jianhui Zhuang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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18
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Huang J, Tu S, Masuda S, Ninomiya K, Dijkstra J, Chu M, Ding D, Hynes SO, O'Leary N, Onuma Y, Serruys PW, Wijns W. Plaque burden estimated from optical coherence tomography with deep learning: In vivo validation using co-registered intravascular ultrasound. Catheter Cardiovasc Interv 2023; 101:287-296. [PMID: 36519717 DOI: 10.1002/ccd.30525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The objective of the present study was to compare plaque burden (PB) calculated from optical coherence tomography (OCT) using deep learning (DL) with PB derived from co-registered intravascular ultrasound (IVUS). BACKGROUND A DL algorithm was developed for automated plaque characterization and PB quantification from OCT images. However, the performance of this algorithm for PB quantification has not been validated. METHODS Five-year follow-up OCT and IVUS images from 15 patients implanted with bioresorbable vascular scaffold (BVS) at baseline were analyzed. Precise co-registration for 72 anatomical slices was achieved utilizing unique BVS radiopaque markers. PB derived from OCT DL and IVUS were compared. OCT cross-sections were divided into four subgroups with different media visibility level. The impact of media visibility on the numerical difference between OCT-derived and IVUS-derived PB was investigated. The stent sizes selected by OCT DL and IVUS were compared. RESULTS Sixty-four paired OCT and IVUS cross-sections were compared. OCT DL showed good concordance with IVUS for PB assessment (ICC = 0.81, difference = -3.53 ± 6.17%, p < 0.001). The numerical difference between OCT DL-derived PB and IVUS-derived PB was not substantially impacted by missing segments of media visualization (p = 0.21). OCT DL showed a diagnostic accuracy of 92% in identifying PB > 65%. The stent sizes selected by OCT DL were smaller compared to the ones selected by IVUS (difference = 0.30 ± 0.34 mm, p < 0.001). CONCLUSIONS The DL algorithm provides a feasible and reliable method for automated PB estimation from OCT, irrespective of media visibility. OCT DL showed good diagnostic accuracy in identifying PB > 65%, revealing its potential to complement conventional OCT imaging.
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Affiliation(s)
- Jiayue Huang
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and CÚRAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | | | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and CÚRAM, University of Galway, Galway, Ireland
| | - Sean O Hynes
- Department of Histopathology, University Hospital Galway and University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland
- Cardiovascular Science Division, National Heart and Lung Institute, Imperial College London, London, UK
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and CÚRAM, University of Galway, Galway, Ireland
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19
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Doolub G, Kandoole-Kabwere V, Felekos I. Acute Coronary Syndromes Due to Atherosclerotic Coronary Artery Disease in Young Patients. Cardiol Rev 2022; 30:286-292. [PMID: 34224452 DOI: 10.1097/crd.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young patients represent about 4-10% of the population presenting with acute coronary syndrome. In this focused mini-review, we highlight the data regarding acute coronary syndromes in young patients with atherosclerotic coronary artery disease. Differences in the underlying pathologies and pathophysiological mechanisms should yield to different clinical management and treatment strategies.
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Affiliation(s)
- Gemina Doolub
- From the Bristol Heart Institute, University Hospitals Bristol NHS FT, Bristol, United Kingdom
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20
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 300] [Impact Index Per Article: 150.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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21
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Milzi A, Dettori R, Lubberich RK, Burgmaier K, Marx N, Reith S, Burgmaier M. Quantitative Flow Ratio Is Related to Anatomic Left Main Stem Lesion Parameters as Assessed by Intravascular Imaging. J Clin Med 2022; 11:jcm11206024. [PMID: 36294345 PMCID: PMC9604622 DOI: 10.3390/jcm11206024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Previously, an association between anatomic left main stem (LMS) lesion parameters, as described by intravascular ultrasound (IVUS) and fractional flow reserve (FFR), was shown. Quantitative flow ratio (QFR) is a novel, promising technique which can assess functional stenosis relevance based only on angiography. However, as little is known about the relationship between anatomic LMS parameters and QFR, it was thus investigated in this study. Methods: In 53 patients with LMS disease, we tested the association between anatomic assessment using OCT (n = 28) or IVUS (n = 25) on the one hand and functional assessment as determined by QFR on the other hand. LMS-QFR was measured using a dedicated approach, averaging QFR over left anterior descending (LAD) and circumflex (LCX) and manually limiting segment of interest to LMS. Results: The minimal luminal area of the LMS (LMS-MLA) as measured by intravascular imaging showed a consistent correlation with QFR (R = 0.61, p < 0.001). QFR could predict a LMS-MLA < 6 mm2 with very good diagnostic accuracy (AUC 0.919) and a LMS-MLA < 4.5 mm2 with good accuracy (AUC 0.798). Similar results were obtained for other stenosis parameters. Conclusions: QFR might be a valuable tool to assess LMS disease. Further studies focusing on patient outcomes are needed to further validate the effectiveness of this approach.
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Affiliation(s)
- Andrea Milzi
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-241-8036098
| | - Rosalia Dettori
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Richard Karl Lubberich
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Kathrin Burgmaier
- Department of Pediatrics, Faculty of Medicine, University of Cologne, University Hospital of Cologne, 50931 Cologne, Germany
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, 94469 Deggendorf, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Sebastian Reith
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, 94469 Deggendorf, Germany
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22
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Gupta A, Shrivastava A, Vijayvergiya R, Chhikara S, Datta R, Aziz A, Singh Meena D, Nath RK, Kumar JR. Optical Coherence Tomography: An Eye Into the Coronary Artery. Front Cardiovasc Med 2022; 9:854554. [PMID: 35647059 PMCID: PMC9130606 DOI: 10.3389/fcvm.2022.854554] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/24/2022] [Indexed: 01/20/2023] Open
Abstract
Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains subdued. However, upcoming newer trials and data have been encouraging for expanding the use of OCT to wider indications in clinical utility. During percutaneous coronary intervention (PCI), OCT provides the detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition) required for optimal stent deployment, which is the key to successfully reducing the major adverse cardiovascular event (MACE) and stent-related morbidities. The increasing use of OCT in complex bifurcation stenting involving the left main (LM) is being studied. Also, the traditional pitfalls of OCT, such as additional contrast load for image acquisition and stenting involving the ostial and proximal LM, have also been overcome recently. In this review, we discuss the interpretation of OCT images and its clinical impact on the outcome of procedures along with current barriers to its use and newer paradigms in which OCT is starting to become a promising tool for the interventionalist and what can be expected for the immediate future in the imaging world.
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Affiliation(s)
- Ankush Gupta
- Department of Cardiology, Military Hospital Jaipur, Jaipur, India
| | - Abhinav Shrivastava
- Department of Cardiology, Dr Ram Manohar Lohia (RML) Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
| | - Rajesh Vijayvergiya
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanya Chhikara
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Rajat Datta
- Director General Armed Forces Medical Services, O/o DGAFMS, Ministry of Defence, New Delhi, India
| | - Atiya Aziz
- Department of Cardiology, Military Hospital Jaipur, Jaipur, India
| | - Daulat Singh Meena
- Department of Cardiology, Jawahar Lal Nehru (J.L.N.) Medical College, Ajmer, India
| | - Ranjit Kumar Nath
- Department of Cardiology, Dr Ram Manohar Lohia (RML) Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
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23
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Capodanno D, Laudani C. Culprit Lesions Phenotypes in ST-Segment Elevation Acute Coronary Syndromes: A Call for Precision Medicine. JACC Cardiovasc Interv 2022; 15:857-860. [PMID: 35367171 DOI: 10.1016/j.jcin.2022.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy.
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
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24
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Gaudino M, Di Franco A, Cao D, Giustino G, Bairey Merz CN, Fremes SE, Kirtane AJ, Kunadian V, Lawton JS, Masterson Creber RM, Sandner S, Vogel B, Zwischenberger BA, Dangas GD, Mehran R. Sex-Related Outcomes of Medical, Percutaneous, and Surgical Interventions for Coronary Artery Disease: JACC Focus Seminar 3/7. J Am Coll Cardiol 2022; 79:1407-1425. [PMID: 35393023 DOI: 10.1016/j.jacc.2021.07.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
Biological and sociocultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the 2 sexes. Worse outcomes in women have been described following both conservative and invasive treatments of CAD. For example, increased levels of residual platelet reactivity during treatment with antiplatelet drugs, higher rates of adverse cardiovascular outcomes following percutaneous coronary revascularization, and higher operative and long-term mortality after coronary bypass surgery have been reported in women compared with in men. Despite the growing recognition of sex-specific determinants of outcomes, representation of women in clinical studies remains low and sex-specific management strategies are generally not provided in guidelines. This review summarizes the current evidence on sex-related differences in patients with CAD, focusing on the differential outcomes following medical therapy, percutaneous coronary interventions, and coronary artery bypass surgery.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ajay J Kirtane
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center and the Cardiovascular Research Foundation, New York, New York, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany A Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Rivero F, Marco V, Biccirè FG, Budassi S, Cuesta J, Del Val D, Bastante T, de la Fuente H, Prati F, Alfonso F. The double injection technique to improve visualization of severe coronary lesions with optical coherence tomography. Catheter Cardiovasc Interv 2022; 99:1511-1517. [PMID: 35238444 DOI: 10.1002/ccd.30138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a high-resolution imaging modality that provides a precise evaluation of coronary anatomy. However, the presence of severe coronary lesions can prevent the required adequate distal contrast flushing resultting in inadequate blood clearance and poor image quality or complete blood shadowing of the underlying vessel wall. OBJECTIVES The aim of this prospective study was to evaluate the feasibility and safety of a novel "double injection technique" (DIT) to overcome the limitations of the conventional technique (CT) in patients with severely stenotic lesions. METHODS Twenty-three patients with severe angiographic lesions were sequentially imaged before intervention with OCT with the CT and then with DIT. A total of 5125 OCT frames were carefully matched and analyzed by an independent central core lab. A semiquantitative image quality score was used to grade the number of quadrants (0-4) with vessel wall visualization. RESULTS Optimal OCT visualization (Grades 3-4) significantly improved by the DIT (68% vs. 38% of frames, p < 0.001). The DIT also improved the mean score (3.1 ± 0.6 vs. 2.0 ± 0.8; p < 0.05; mean improvement of 1.1 ± 0.5 per patient). There were no complications associated with the DIT. CONCLUSION The DIT significantly improved preintervention image quality of OCT in severe coronary lesions.
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Affiliation(s)
- Fernando Rivero
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Valeria Marco
- Centro per la Lotta Contro L' Infarto-CLI Foundation, Rome, Italy
| | | | - Simone Budassi
- Centro per la Lotta Contro L' Infarto-CLI Foundation, Rome, Italy
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Hortensia de la Fuente
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Francesco Prati
- Centro per la Lotta Contro L' Infarto-CLI Foundation, Rome, Italy.,UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
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Vinci R, Pedicino D, Bonanni A, d'Aiello A, Pisano E, Ponzo M, Severino A, Ciampi P, Canonico F, Russo G, Di Sario M, Vergallo R, Filomia S, Montone RA, Flego D, Stefanini L, Piacentini R, Conte C, Cribari F, Massetti M, Crea F, Liuzzo G. Monocyte-Platelet Aggregates Triggered by CD31 Molecule in Non-ST Elevation Myocardial Infarction: Clinical Implications in Plaque Rupture. Front Cardiovasc Med 2022; 8:741221. [PMID: 35146002 PMCID: PMC8821091 DOI: 10.3389/fcvm.2021.741221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the recent innovations in cardiovascular care, atherothrombosis is still a major complication of acute coronary syndromes (ACS). We evaluated the involvement of the CD31 molecule in thrombotic risk through the formation of monocyte-platelet (Mo-Plt) aggregates in patients with ACS with no-ST-segment elevation myocardial infarction (NSTEMI) on top of dual anti-platelet therapy (DAPT). We enrolled 19 control (CTRL) subjects, 46 stable angina (SA), and 86 patients with NSTEMI, of which, 16 with Intact Fibrous Cap (IFC) and 19 with Ruptured Fibrous Cap (RFC) as assessed by the Optical Coherence Tomography (OCT). The expression of CD31 on monocytes and platelets was measured. Following the coronary angiography, 52 NSTEMIs were further stratified according to thrombus grade (TG) evaluation. Finally, a series of ex vivo experiments verified whether the CD31 participates in Mo-Plt aggregate formation. In patients with NSTEMI, CD31 was reduced on monocytes and was increased on platelets, especially in NSTEMI presented with RFC plaques compared to those with IFC lesions, and in patients with high TG compared to those with zero/low TG. Ex vivo experiments documented an increase in Mo-Plt aggregates among NSTEMI, which significantly decreased after the CD31 ligation, particularly in patients with RFC plaques. In NSTEMI, CD31 participates in Mo-Plt aggregate formation in spite of optimal therapy and DAPT, suggesting the existence of alternative thrombotic pathways, as predominantly displayed in patients with RFC.
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Affiliation(s)
- Ramona Vinci
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Pedicino
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Daniela Pedicino
| | - Alice Bonanni
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia d'Aiello
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenia Pisano
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myriana Ponzo
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Severino
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pellegrino Ciampi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Canonico
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulio Russo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marianna Di Sario
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Filomia
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Flego
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Lucia Stefanini
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Roberto Piacentini
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Conte
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cribari
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Ostojic Z, Bulum J. Optical coherence tomography-guided percutaneous coronary intervention in a patient with an iatrogenic coronary artery stenosis. EUROINTERVENTION 2021; 17:e1007-e1008. [PMID: 34610903 PMCID: PMC9725059 DOI: 10.4244/eij-d-21-00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zvonimir Ostojic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Kišpatićeva ul. 12, 10000 Zagreb, Croatia. E-mail:
| | - Josko Bulum
- School of Medicine, University of Zagreb, Zagreb, Croatia
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28
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Vinci R, Pedicino D, Bonanni A, D'Aiello A, Severino A, Pisano E, Ponzo M, Canonico F, Ciampi P, Russo G, Di Sario M, Montone RA, Trani C, Conte C, Grimaldi MC, Cribari F, Massetti M, Crea F, Liuzzo G. A Novel Monocyte Subset as a Unique Signature of Atherosclerotic Plaque Rupture. Front Cell Dev Biol 2021; 9:753223. [PMID: 34712669 PMCID: PMC8545820 DOI: 10.3389/fcell.2021.753223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/03/2021] [Indexed: 12/28/2022] Open
Abstract
The evaluation of monocyte subset distribution among acute coronary syndrome (ACS) patients according to culprit coronary plaque morphology has never been explored. We evaluated whether there were significant differences in frequency of circulating monocyte subsets isolated from ACS patients according to optical coherence tomography (OCT) investigation of plaque erosion and rupture. We enrolled 74 patients with non-ST-elevation ACS (NSTE-ACS), 21 of them underwent OCT investigation of the culprit coronary plaque and local macrophage infiltration (MØI) assessment. As control, we enrolled 30 chronic coronary syndrome (CCS) patients. We assessed the frequency of monocyte subsets in the whole study population, in reliance on their CD14 and CD16 expression (classical, CM: CD14++CD16–; intermediates, IM: CD14++CD16+; non-classical, NCM: CD14+CD16++). Then, we tested the effect of lipopolysaccharide (LPS) (a CD14 ligand) on peripheral blood mononuclear cells (PBMCs) of NSTE-ACS patients, quantifying the inflammatory cytokine levels in cell-culture supernatants. Our data proved that monocyte subsets isolated from NSTE-ACS patients represent a peculiar biological signature of the pathophysiological mechanism lying beneath atherosclerotic plaque with a ruptured fibrous cap (RFC) as compared with plaque erosion. Moreover, the magnitude of LPS-mediated effects on IL-1β, IL-6, and IL-10 cytokine release in cell-culture supernatants appeared to be greater in NSTE-ACS patients with RFC. Finally, we described a fourth monocyte population never explored before in this clinical setting (pre-classical monocytes, PCM: CD14+CD16–) that was prevalent in NSTE-ACS patients as compared with CCS and, especially, in patients with RFC and culprit plaque with MØI.
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Affiliation(s)
- Ramona Vinci
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniela Pedicino
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessia D'Aiello
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Severino
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Eugenia Pisano
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myriana Ponzo
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Canonico
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pellegrino Ciampi
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulio Russo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marianna Di Sario
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Conte
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Chiara Grimaldi
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Cribari
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Ma Y, Xu L, Yin B, Shang J, Chen F, Xu J, Song ZL, Nan B, Song G, Zhang XB. Ratiometric Semiconducting Polymer Nanoparticle for Reliable Photoacoustic Imaging of Pneumonia-Induced Vulnerable Atherosclerotic Plaque in Vivo. NANO LETTERS 2021; 21:4484-4493. [PMID: 33978427 DOI: 10.1021/acs.nanolett.1c01359] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute pneumonia can greatly increase the vulnerable risk of atherosclerotic plaque and contribute to the mortality of cardiovascular disease. To accurately assess the rupture risk caused by acute pneumonia, we developed a novel kind of ratiometric semiconducting polymer nanoparticle (RSPN) for photoacoustic imaging of vulnerable plaque in apolipoprotein E-deficient mice complicated with pneumonia. Specifically, RSPN can react with O2•- and exhibit the enhanced photoacoustic signals at about 690 nm, while 800 nm is regarded as an internal photoacoustic reference. As a result, RSPN can provide reliable determination of O2•- within aortic atherosclerosis by analyzing the ratios of photoacoustic signals, which can successfully reflect the oxidative stress level in vulnerable plaque. Therefore, RSPN enable to specifically distinguish plaque-bearing mice and plaque-bearing mice complicated with pneumonia from healthy mice, which provides a promising tool to predict the vulnerability of plaque for reducing the mortality of atherosclerotic-induced cardiovascular disease.
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Affiliation(s)
- Yuan Ma
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Li Xu
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Baoli Yin
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Jinhui Shang
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Fangfang Chen
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Juntao Xu
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Zhi-Ling Song
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science MOE Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Bin Nan
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Guosheng Song
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Xiao-Bing Zhang
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
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30
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Morphology and phenotype characteristics of atherosclerotic plaque in patients with acute coronary syndrome: contemporary optical coherence tomography findings. Coron Artery Dis 2021; 32:698-705. [PMID: 33587362 DOI: 10.1097/mca.0000000000001027] [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: 11/27/2022]
Abstract
BACKGROUND Contemporary optical coherence tomography (OCT) findings in patients with acute coronary syndromes (ACS) are still subject of controversy. We sought to use OCT to evaluate plaque morphology and phenotype classification in patients with ACS. METHODS Using optical coherence tomography, culprit lesions were morphologically classified as plaque rupture, plaque erosion, calcified nodule, thin-cap fibroatheroma, thick-cap fibroatheroma (TCFA) or fibrotic, fibrocalcific or fibrolipidic plaque. Quantitative and qualitative analyses also included cholesterol crystals, neovascularization, spotty calcification and thrombus. RESULTS Of the 110 lesions imaged from June 2012 to April 2016, 54 (49%) were in patients with unstable angina (UA), 31 (28%) were in non-ST-elevation myocardial infarction (STEMI) patients and 25 (23%) were in STEMI patients. Compared with STEMI patients, patients with UA/non-STEMI were older and had more hypertension, hypercholesterolemia, known coronary artery disease, prior myocardial infarction and higher use of antiplatelet therapy. More patients with STEMI had lipidic arc >90% (36.6 versus 70.8%, P = 0.003), red and mixed thrombus (12.9 versus 28.0% and 7.1 versus 44.0%, respectively, all P < 0.001), plaque rupture (29.4 versus 76.0%, P < 0.001) and TCFA (57.1 versus 84.0%; P = 0.01). Predictors of plaque rupture were STEMI at presentation (odds ratio: 9.35, 95% confidence interval: 1.66-52.61, P = 0.01) and diabetes mellitus (odds ratio: 6.16, 95% confidence interval: 1.33-28.58, P = 0.02). CONCLUSIONS In this single-center study, the culprit lesion of patients with STEMI had more lipid, red and mixed thrombus, plaque rupture and TCFA versus patients with UA/non-STEMI. Clinical presentation may be driven by distinct pathophysiologic mechanisms in patients with ACS.
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31
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Omatsu T, Sotomi Y, Kobayashi T, Hamanaka Y, Hirata A, Hirayama A, Ueda Y, Sakata Y, Higuchi Y. Quantitative Validation of the Coronary Angioscopic Yellow Plaque with Lipid Core Burden Index Assessed by Intracoronary Near-Infrared Spectroscopy. J Atheroscler Thromb 2021; 29:362-369. [PMID: 33487618 PMCID: PMC8894116 DOI: 10.5551/jat.60566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim:
We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate each other’s drawbacks.
Methods:
This is a single-center prospective observational study. Patients undergoing a planned follow-up coronary angiography after percutaneous coronary intervention were prospectively enrolled from January 2018 to April 2019. The major three vessels were examined by NIRS-intravascular ultrasound, followed by coronary angioscopic evaluation. Yellow color grade on angioscopy was classified into four grades (0, white; 1, slight yellow; 2, yellow; and 3, intensive yellow) at a location of maximal lipid core burden index over 4 mm [LCBI (4)] on NIRS in each vessel.
Results:
A total of 95 lesions in 44 patients (72.6±6.7 years, 75% male) were analyzed. LCBI (4) was significantly different among different yellow color grades by coronary angioscopy (ANOVA,
p
<0.001). Positive correlation was found between angioscopic yellow color grade and LCBI (4) (beta coefficient 164.8, 95% confidence interval 122.9–206.7;
p
<0.001). The best cutoff value of LCBI (4) to predict the presence of yellow plaque (yellow color grade ≥ 2) was 448 (sensitivity 79.3%, specificity 69.7%, C-statistic 0.800, 95% confidence interval 0.713–0.887,
p
<0.001).
Conclusion:
The qualitative angioscopic assessment was objectively validated by the quantitative NIRS evaluation, which would be helpful for the reinterpretation of the existing evidences of both imaging modalities.
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Affiliation(s)
| | - Yohei Sotomi
- Cardiovascular Division, Osaka Police Hospital.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | | | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Dettori R, Milzi A, Burgmaier K, Almalla M, Hellmich M, Marx N, Reith S, Burgmaier M. Prognostic irrelevance of plaque vulnerability following plaque sealing in high-risk patients with type 2 diabetes: an optical coherence tomography study. Cardiovasc Diabetol 2020; 19:192. [PMID: 33183273 PMCID: PMC7664108 DOI: 10.1186/s12933-020-01168-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. However, patients with T2DM exhibit also an increased risk following percutaneous coronary intervention (PCI). It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. In this study, we aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM. Methods 81 patients with T2DM and OCT-guided PCI were recruited. Pre-interventional OCT and systematic follow-up of median 66.0 (IQR = 8.0) months were performed. Results During follow-up, 24 patients (29.6%) died. The clinical parameters age (HR 1.16 per year, 95% CI 1.07–1.26, p < 0.001), diabetic polyneuropathy (HR 3.58, 95% CI 1.44–8.93, p = 0.006) and insulin therapy (HR 3.25, 95% CI 1.21–8.70, p = 0.019) predicted mortality in T2DM patients independently. Among OCT parameters only calcium-volume-index (HR 1.71 per 1000°*mm, 95% CI 1.21–2.41, p = 0.002) and lesion length (HR 1.93 per 10 mm, 95% CI 1.02–3.67, p = 0.044) as parameters describing atherosclerosis extent were significant independent predictors of mortality. However, classical features of plaque vulnerability, such as thickness of the fibrous cap, the extent of the necrotic lipid core and the presence of macrophages had no significant predictive value (all p = ns). Conclusion Clinical parameters including those describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability predict mortality in T2DM patients following PCI. These data suggest that PCI may provide effective plaque sealing resulting in limited importance of local target lesion vulnerability for future cardiovascular events in high-risk patients with T2DM.
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Affiliation(s)
- Rosalia Dettori
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andrea Milzi
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital of Cologne, Cologne, Germany
| | - Mohammad Almalla
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sebastian Reith
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Refaat H, Tantawy A. Low Plasma Adiponectin Levels Are Associated With Vulnerable Plaque Features in Patients With Acute Coronary Syndrome: An Optical Coherence Tomography Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:63-71. [PMID: 33097459 DOI: 10.1016/j.carrev.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vulnerable plaques are the primary cause of acute coronary syndrome (ACS). The association between in-vivo plaque vulnerability and adiponectin levels in ACS still remains to be determined. OBJECTIVE The purpose of this study was to investigate the correlation between adiponectin levels and vulnerable plaque features in ACS patients. METHODS We enrolled 107 ACS patients admitted to our institution; 83 with Non-ST elevation ACS (NSTE-ACS) and 24 with ST-elevation myocardial infarction (STEMI). Adiponectin levels were measured in these patients. Coronary angiography and subsequent optical coherence tomography (OCT) analysis of culprit lesions were performed. RESULTS Adiponectin level was lower in patients with complex angiographic lesions, compared to those with non-complex lesions (7.13 ± 3.04 vs. 8.94 ± 2.84 μg/ml, P = 0.002). Adiponectin level was lower in patients with plaque rupture (PR), micro-thrombi, and thin cap fibroatheroma (TCFA), compared to those with non-vulnerable features (7.19 ± 2.95 vs 8.79 ± 3.02 μg/ml, P = 0.007 & 7.29 ± 2.97 vs 8.44 ± 3.09 μg/ml, P = 0.04 and 4.76 ± 0.65 vs 9.74 ± 2.35 μg/ml, P < 0.001 μg/ml respectively). There was a significant negative correlation between adiponectin levels and lipid rich plaque extent and maximum lipid arc (r = -0.05, P < 0.001 & r = -0.03, P = 0.03, respectively). However, a significant positive correlation was observed between adiponectin levels and fibrous cap thickness (r = 0.95, P < 0.001). CONCLUSION Low adiponectin levels were associated with complex angiographic lesions and vulnerable plaque features in ACS patients, where there was a significant correlation between it and PR, TCFA, and lipid rich plaque.
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Affiliation(s)
- Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Ayman Tantawy
- Cardiology Department, Zagazig University, Zagazig, Egypt
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Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography. J Interv Cardiol 2020; 2020:8263923. [PMID: 32774188 PMCID: PMC7395998 DOI: 10.1155/2020/8263923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. Results Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41–63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36–46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. Conclusions OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.
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35
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Alfonso F, Virmani R. Intracoronary imaging for the diagnosis of the underlying substrate and clinical management of acute coronary syndromes: from evidence to expert consensus … and back! EUROINTERVENTION 2019; 15:392-395. [DOI: 10.4244/eijv15i5a71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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