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Sakellariou XM, Katsouras CS, Papafaklis MI, Floros C, Michalis LK, Karmpaliotis D. Absolute zero-contrast percutaneous coronary interventions: An intravascular ultrasound-guided case series and literature review. Cardiovasc Revasc Med 2024; 62:95-104. [PMID: 38135569 DOI: 10.1016/j.carrev.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Contrast media (CM)-associated adverse effects including mainly acute kidney injury and hypersensitivity reactions still remain a significant treatment burden to vulnerable patients requiring percutaneous coronary intervention (PCI). The complete omission of CM administration accompanied by intravascular ultrasound (IVUS) guidance may offer an appropriate revascularization treatment. METHODS We hereby present a case series of four patients with challenging coronary lesions and relative/absolute contraindications to CM use [(hypersensitivity reaction owning to CM, history of contrast-induced acute kidney injury, solitary kidney, or advanced chronic kidney disease (CKD)] who underwent absolute zero-contrast IVUS-guided PCI following a predetermined protocol. RESULTS The initial diagnostic angiography was reviewed for landmark identification, and multiple guidewires created a metallic road map providing additional landmarks and protected side branches. IVUS imaging was performed to determine lesion length, reference segments and landing zones, assess stent expansion/apposition and identify major complications. All procedures were successfully completed without any CM administration, renal function deterioration, pericardial effusion, or stent edge dissection. CONCLUSIONS We demonstrated the feasibility of absolute zero-contrast IVUS-guided PCI in patients with complex coronary lesions susceptible to CM-associated adverse effects. Since the safety of this strategy is well-documented in patients with CKD and challenging lesions morphology even in acute settings, evidence-based validation of this approach is capable of changing the otherwise conservative treatment of vulnerable patients where even minimum doses of CM may have detrimental effects. SUMMARY FOR THE ANNOTATED TABLE OF CONTENTS Patients with vulnerable renal function as well as former hypersensitivity reaction to contrast media encounter a significant treatment burden regarding coronary artery disease. Zero-contrast IVUS-guided strategy based on a predetermined protocol provides a feasible alternative approach in patients susceptible to contrast media-associated adverse effects even in the presence of complex coronary lesions.
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Affiliation(s)
| | - Christos S Katsouras
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | | | - Christos Floros
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Author Correction: Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2024; 21:348. [PMID: 38110566 DOI: 10.1038/s41569-023-00982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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Nikopoulos S, Papafaklis MI, Tsompou P, Sakellarios A, Siogkas P, Sioros S, Fotiadis DI, Katsouras CS, Naka KK, Nikas D, Michalis L. Virtual Hemodynamic Assessment of Coronary Lesions: The Advent of Functional Angiography and Coronary Imaging. J Clin Med 2024; 13:2243. [PMID: 38673515 PMCID: PMC11050877 DOI: 10.3390/jcm13082243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The fractional flow reserve (FFR) is well recognized as a gold standard measure for the estimation of functional coronary stenosis. Technological progressions in image processing have empowered the reconstruction of three-dimensional models of the coronary arteries via both non-invasive and invasive imaging modalities. The application of computational fluid dynamics (CFD) techniques to coronary 3D anatomical models allows the virtual evaluation of the hemodynamic significance of a coronary lesion with high diagnostic accuracy. METHODS Search of the bibliographic database for articles published from 2011 to 2023 using the following search terms: invasive FFR and non-invasive FFR. Pooled analysis of the sensitivity and specificity, with the corresponding confidence intervals from 32% to 94%. In addition, the summary processing times were determined. RESULTS In total, 24 studies published between 2011 and 2023 were included, with a total of 13,591 patients and 3345 vessels. The diagnostic accuracy of the invasive and non-invasive techniques at the per-patient level was 89% (95% CI, 85-92%) and 76% (95% CI, 61-80%), respectively, while on the per-vessel basis, it was 92% (95% CI, 82-88%) and 81% (95% CI, 75-87%), respectively. CONCLUSION These opportunities providing hemodynamic information based on anatomy have given rise to a new era of functional angiography and coronary imaging. However, further validations are needed to overcome several scientific and computational challenges before these methods are applied in everyday clinical practice.
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Affiliation(s)
- Sotirios Nikopoulos
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.S.); (C.S.K.); (K.K.N.); (D.N.); (L.M.)
| | | | - Panagiota Tsompou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology-FORTH, University Campus of Ioannina, 45115 Ioannina, Greece; (P.T.); (P.S.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Antonis Sakellarios
- Department of Mechanical Engineering and Aeronautics, University of Patras, 26504 Rio, Greece;
| | - Panagiotis Siogkas
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology-FORTH, University Campus of Ioannina, 45115 Ioannina, Greece; (P.T.); (P.S.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Spyros Sioros
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.S.); (C.S.K.); (K.K.N.); (D.N.); (L.M.)
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology-FORTH, University Campus of Ioannina, 45115 Ioannina, Greece; (P.T.); (P.S.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Christos S. Katsouras
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.S.); (C.S.K.); (K.K.N.); (D.N.); (L.M.)
| | - Katerina K. Naka
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.S.); (C.S.K.); (K.K.N.); (D.N.); (L.M.)
| | - Dimitrios Nikas
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.S.); (C.S.K.); (K.K.N.); (D.N.); (L.M.)
| | - Lampros Michalis
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.S.); (C.S.K.); (K.K.N.); (D.N.); (L.M.)
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Domouzoglou EM, Vlahos AP, Papafaklis MI, Cholevas VK, Chaliasos N, Siomou E, Michalis LK, Tsatsoulis A, Naka KK. Role of FGF21 and Leptin for the Diagnosis of Metabolic Health in Children with and without Obesity. J Pers Med 2023; 13:1680. [PMID: 38138907 PMCID: PMC10744927 DOI: 10.3390/jpm13121680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Obesity and unfavorable metabolic profiles increase the risk for cardiovascular complications in adults. Although it is important to distinguish different metabolic health states at an early stage, there are limited data on the related value of biomarkers in childhood. We aimed to identify biomarkers for the detection of different metabolic health states in children with and without obesity. The serum levels of metabolic regulators (fibroblast growth factor 21 [FGF21], leptin, adiponectin and insulin-like growth factor binding protein 1) and vascular indices (flow-mediated dilation [FMD] and carotid intima-media thickness) were assessed in 78 children. Differences between the metabolically healthy and unhealthy state within children with normal weight (MHN vs. MUN), and within children with overweight/obesity (MHO vs. MUO) were investigated; the discriminatory power of the biomarkers was studied. Both MUN and MUO groups expressed altered lipid and glucose homeostasis compared to their healthy counterparts. The metabolic unhealthy state in children with normal weight was linked to higher FGF21 levels which had good discriminatory ability (area under the curve [AUC]: 0.71, 95% CI: 0.54-0.88; p = 0.044). In overweight/obese children, leptin was increased in the metabolically unhealthy subgroup (AUC: 0.81, 95% CI: 0.68-0.95; p = 0.01). There was a decrease in FMD indicating worse endothelial function in overweight/obese children versus those with normal weight. Distinct states of metabolic health exist in both children with normal weight and overweight/obese children. FGF21 and leptin may help to identify the metabolic unhealthy state in children with normal weight and in overweight/obese children, respectively, early in life.
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Affiliation(s)
- Eleni M. Domouzoglou
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece
| | - Antonios P. Vlahos
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece
| | - Michail I. Papafaklis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece; (M.I.P.); (K.K.N.)
| | - Vasileios K. Cholevas
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece
| | - Nikolaos Chaliasos
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece
| | - Ekaterini Siomou
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece
| | - Lampros K. Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece; (M.I.P.); (K.K.N.)
| | - Agathocles Tsatsoulis
- Department of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece
| | - Katerina K. Naka
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou, 45110 Ioannina, Greece; (M.I.P.); (K.K.N.)
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Hakim D, Pinilla-Echeverri N, Coskun AU, Pu Z, Kajander OA, Rupert D, Maynard C, Cefalo N, Siasos G, Papafaklis MI, Kostas S, Michalis LK, Jolly S, Mehta SR, Sheth T, Croce K, Stone PH. The role of endothelial shear stress, shear stress gradient, and plaque topography in plaque erosion. Atherosclerosis 2023; 376:11-18. [PMID: 37257352 PMCID: PMC10937042 DOI: 10.1016/j.atherosclerosis.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Plaque erosion is a common underlying cause of acute coronary syndromes. The role of endothelial shear stress (ESS) and endothelial shear stress gradient (ESSG) in plaque erosion remains unknown. We aimed to determine the role of ESS metrics and maximum plaque slope steepness in plaques with erosion versus stable plaques. METHODS This analysis included 46 patients/plaques from TOTAL and COMPLETE trials and Brigham and Women's Hospital's database who underwent angiography and OCT. Plaques were divided into those with erosion (n = 24) and matched stable coronary plaques (n = 22). Angiographic views were used to generate a 3-D arterial reconstruction, with centerlines merged from angiography and OCT pullback. Local ESS metrics were assessed by computational fluid dynamics. Among plaque erosions, the up- and down-slope (Δ lumen area/frame) was calculated for each culprit plaque. RESULTS Compared with stable plaque controls, plaques with an erosion were associated with higher max ESS (8.3 ± 4.8 vs. 5.0 ± 1.9 Pa, p = 0.02) and max ESSG any direction (9.2 ± 7.5 vs. 4.3 ± 3.11 Pa/mm, p = 0.005). Proximal erosion was associated with a steeper plaque upslope while distal erosion with a steeper plaque downslope. Max ESS and Max ESSG any direction were independent factors in the development of plaque erosion (OR 1.32, 95%CI 1.06-1.65, p = 0.014; OR 1.22, 95% CI 1.03-1.45, p = 0.009, respectively). CONCLUSIONS In plaques with similar luminal stenosis, plaque erosion was strongly associated with higher ESS, ESS gradients, and plaque slope as compared with stable plaques. These data support that ESS and slope metrics play a key role in the development of plaque erosion and may help prognosticate individual plaques at risk for future erosion.
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Affiliation(s)
- Diaa Hakim
- Cardiovascular Division, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Natalia Pinilla-Echeverri
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Ahmet U Coskun
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Zhongyue Pu
- Department of Medical Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Olli A Kajander
- Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland
| | - Deborah Rupert
- Medical Scientist Training Program, Stonybrook University, New York, NY, USA
| | - Charles Maynard
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Nicholas Cefalo
- Cardiovascular Division, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Gerasimos Siasos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Stefanu Kostas
- Cardiology Department, University of Ioannina, Ioannina, Greece
| | | | - Sanjit Jolly
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Shamir R Mehta
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Tej Sheth
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Kevin Croce
- Cardiovascular Division, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA.
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Tsigkas G, Papanikolaou A, Apostolos A, Kramvis A, Timpilis F, Latta A, Papafaklis MI, Aminian A, Davlouros P. Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations. J Cardiovasc Dev Dis 2023; 10:283. [PMID: 37504539 PMCID: PMC10380353 DOI: 10.3390/jcdd10070283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Amalia Papanikolaou
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Angelos Kramvis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Filippos Timpilis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasia Latta
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | | | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
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Seitun S, Porto I, Papafaklis MI. Editorial: Advances in predicting future adverse coronary events: the role of cardiovascular imaging and coronary physiology indices. Front Cardiovasc Med 2023; 10:1206076. [PMID: 37229226 PMCID: PMC10203547 DOI: 10.3389/fcvm.2023.1206076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Sara Seitun
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiology Unit, Cardio-Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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8
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Emfietzoglou M, Mavrogiannis MC, García-García HM, Stamatelopoulos K, Kanakakis I, Papafaklis MI. Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept. Life (Basel) 2023; 13:life13030696. [PMID: 36983851 PMCID: PMC10052113 DOI: 10.3390/life13030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Despite major advances in pharmacotherapy and interventional procedures, coronary artery disease (CAD) remains a principal cause of morbidity and mortality worldwide. Invasive coronary imaging along with the computation of hemodynamic forces, primarily endothelial shear stress and plaque structural stress, have enabled a comprehensive identification of atherosclerotic plaque components, providing a unique insight into the understanding of plaque vulnerability and progression, which may help guide patient treatment. However, the invasive-only approach to CAD has failed to show high predictive value. Meanwhile, it is becoming increasingly evident that along with the “vulnerable plaque”, the presence of a “vulnerable patient” state is also necessary to precipitate an acute coronary thrombotic event. Non-invasive imaging techniques have also evolved, providing new opportunities for the identification of high-risk plaques, the study of atherosclerosis in asymptomatic individuals, and general population screening. Additionally, risk stratification scores, circulating biomarkers, immunology, and genetics also complete the armamentarium of a broader “vulnerable plaque and patient” concept approach. In the current review article, the invasive and non-invasive modalities used for the detection of high-risk plaques in patients with CAD are summarized and critically appraised. The challenges of the vulnerable plaque concept are also discussed, highlighting the need to shift towards a more interdisciplinary approach that can identify the “vulnerable plaque” in a “vulnerable patient”.
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Affiliation(s)
| | - Michail C. Mavrogiannis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Hector M. García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Kimon Stamatelopoulos
- Department of Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Ioannis Kanakakis
- Catheterization and Hemodynamic Unit, Alexandra University Hospital, 115 28 Athens, Greece
| | - Michail I. Papafaklis
- Catheterization and Hemodynamic Unit, Alexandra University Hospital, 115 28 Athens, Greece
- Correspondence: ; Tel.: +30-6944376572
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Katsouras CS, Papafaklis MI, Giannopoulos S, Karapanayiotides T, Tsivgoulis G, Michalis LK. Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction? J Clin Neurol 2023; 19:1-11. [PMID: 36606641 PMCID: PMC9833878 DOI: 10.3988/jcn.2023.19.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/04/2023] Open
Abstract
Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.
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Affiliation(s)
- Christos S Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Faculty of Health Sciences, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
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10
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Tsiknakis N, Spanakis C, Tsoumpou P, Karanasiou G, Karanasiou G, Sakellarios A, Rigas G, Kyriakidis S, Papafaklis MI, Nikopoulos S, Gijsen F, Michalis L, Fotiadis DI, Marias K. OCT sequence registration before and after percutaneous coronary intervention (stent implantation). Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2022; 19:684-703. [PMID: 35449407 PMCID: PMC9982688 DOI: 10.1038/s41569-022-00687-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.
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Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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Wentzel JJ, Papafaklis MI, Antoniadis AP, Takahashi S, Cefalo NV, Cormier M, Saito S, Coskun AU, Stone PH. Sex-related differences in plaque characteristics and endothelial shear stress related plaque-progression in human coronary arteries. Atherosclerosis 2021; 342:9-18. [PMID: 34999306 DOI: 10.1016/j.atherosclerosis.2021.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Clinical atherosclerosis manifestations are different in women compared to men. Since endothelial shear stress (ESS) is known to play a critical role in coronary atherosclerosis development, we investigated differences in anatomical characteristics and endothelial shear stress (ESS)-related plaque growth in human coronary arteries in men compared to women. METHODS 1183 coronary arteries (male/female: 944/239) from the PREDICTION study were studied for differences in artery/plaque and ESS characteristics, and ESS-related plaque progression (6-10 months follow-up) among men and women and after stratification for age. All characteristics were derived from IVUS-based vascular profiling and reported per 3 mm-segments (13,030 3-mm-segments (male/female: 10,465/2,565)). RESULTS Coronary arteries and plaques were significantly smaller in females compared to males; but no important differences were observed in plaque burden, ESS and rate of plaque progression. Change in plaque burden was inversely related to ESS (p<0.001) with no difference between women versus men (β: -0.62 ± 0.13 vs -0.68 ± 0.05, p=0.62). However, stratification for age demonstrated that ESS-related plaque growth was more marked in young women compared to men (<55 years, β: -2.02 ± 0.61 vs -0.33 ± 0.10, p=0.007), reducing in magnitude over the age-categories up till 75 years. CONCLUSIONS Coronary artery and plaque size are smaller in women compared to men, but ESS and ESS- related plaque progression were similar. Sex-related differences in ESS-related plaque growth were evident after stratification for age. These observations suggest that although the fundamental processes of atherosclerosis progression are similar in men versus women, plaque progression may be influenced by age within gender.
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Affiliation(s)
- Jolanda J Wentzel
- Biomedical Engineering, Department of Cardiology, ErasmusMC, University Medical Center Rotterdam, the Netherlands.
| | | | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Nicholas V Cefalo
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle Cormier
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Domouzoglou EM, Vlahos AP, Cholevas VK, Papafaklis MI, Chaliasos N, Siomou E, Michalis LK, Tsatsoulis A, Naka KK. Association of fibroblast growth factor 21 with metabolic syndrome and endothelial function in children: a prospective cross-sectional study on novel biomarkers. Ann Pediatr Endocrinol Metab 2021; 26:242-251. [PMID: 34015901 PMCID: PMC8749025 DOI: 10.6065/apem.2040258.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/05/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Metabolic and cardiovascular disease prevention starting in childhood is critical for reducing morbidity later in life. In the present study, the association of novel biomarkers with metabolic syndrome (MS) and vascular function/structure indices of early atherosclerosis in children was investigated. METHODS This was a prospective study of 78 children (8-16 years of age) grouped based on the presence or absence of MS. The serum biomarkers investigated included fibroblast growth factor 21 (FGF21), leptin, adiponectin, and insulinlike growth factor binding protein-1 (IGFBP1). Endothelial function and carotid atherosclerosis were assessed based on brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness, respectively. RESULTS Children with MS (n=12) had higher levels of FGF21 (median [interquartile range]: 128 [76-189] pg/mL vs. 60 [20-98] pg/mL, P=0.003) and leptin (18.1 [11-34.8] pg/mL vs. 7.5 [1.9-16.5] ng/mL, P=0.003), and lower levels of IGFBP1 (1.5 [1.2-2.1] ng/mL vs. 2.3 [1.5-6] ng/mL, P=0.028) compared with children without MS. FMD inversely correlated with FGF21 (Spearman rho= -0.24, P=0.035) and leptin (rho= -0.24, P=0.002) in all children. The best cutoff value of FGF21 levels for MS diagnosis was above 121.3 pg/mL (sensitivity/specificity, 58/86%). Only FGF21 was significantly associated with the presence of MS after adjustment for body mass index, age, and sex (odds ratio per 10 pg/mL increase: 1.10 [95% confidence interval, 1.01-1.22]; P=0.043). CONCLUSION Increased FGF21 levels were associated with the presence of MS and worse endothelial function in children. Larger studies are needed to evaluate the potential value of FGF21 as a biomarker that could predict future metabolic/cardiovascular disease at an early stage.
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Affiliation(s)
- Eleni M. Domouzoglou
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece,Address for correspondence: Eleni M. Domouzoglou Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Stavrou Niarchou 45110, Greece ,
| | - Antonios P. Vlahos
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Vasileios K. Cholevas
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Michail I. Papafaklis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Chaliasos
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ekaterini Siomou
- Child Health Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Lampros K. Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Agathocles Tsatsoulis
- Department of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Katerina K. Naka
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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14
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Samara I, Tsiara S, Papafaklis MI, Pappas K, Kolios G, Vryzas N, Michalis LK, Bairaktari ET, Katsouras CS. Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function. World J Cardiol 2021; 13:566-573. [PMID: 34754401 PMCID: PMC8554362 DOI: 10.4330/wjc.v13.i10.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-sensitivity cardiac troponin (hs-cTn) levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events. However, most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.
AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.
METHODS In this retrospective study, we selected patients who were aged ≥ 65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons. Eligible patients were those who had hs-cTnI concentrations ≥ 100 ng/L. We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.
RESULTS One hundred and forty-six patients (59% female) were selected with an age range from 65 to 100 (mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. For 72 (49%) patients the diagnosis of hospitalization was an infectious disease. The overall in-hospital mortality was 32% (47 patients). Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive (median: 314.8 vs 282.5 ng/L; P = 0.565). There was no difference in mortality in patients with infectious vs non-infectious disease (29% vs 35%). Multivariable analysis showed that age (OR 1.062 per 1 year increase, 95%CI: 1.000-1.127; P = 0.048) and creatinine levels (OR 2.065 per 1 mg/dL increase, 95%CI: 1.383-3.085; P < 0.001) were the only independent predictors of death. Mortality was 49% in patients with eGFR < 30 mL/min/1.73 m2.
CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons. The presence of severe renal impairment is a marker of extremely high in-hospital mortality.
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Affiliation(s)
- Ioanna Samara
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Stavroula Tsiara
- Second Department of Internal Medicine, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Michail I Papafaklis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Konstantinos Pappas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Georgios Kolios
- Laboratory of Biochemistry, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Nikolaos Vryzas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Eleni T Bairaktari
- Laboratory of Clinical Chemistry, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
| | - Christos S Katsouras
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
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15
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Sakellariou XM, Papafaklis MI, Domouzoglou EM, Katsouras CS, Michalis LK, Naka KK. Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease. World J Cardiol 2021; 13:399-415. [PMID: 34621486 PMCID: PMC8462042 DOI: 10.4330/wjc.v13.i9.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/30/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Exercise exerts direct effects on the vasculature via the impact of hemodynamic forces on the endothelium, thereby leading to functional and structural adaptations that lower cardiovascular risk. The patterns of blood flow and endothelial shear stress during exercise lead to atheroprotective hemodynamic stimuli on the endothelium and contribute to adaptations in vascular function and structure. The structural adaptations observed in arterial lumen dimensions after prolonged exercise supplant the need for acute functional vasodilatation in case of an increase in endothelial shear stress due to repeated exercise bouts. In contrast, wall thickness is affected by rather systemic factors, such as transmural pressure modulated during exercise by generalized changes in blood pressure. Several mechanisms have been proposed to explain the exercise-induced benefits in patients with coronary artery disease (CAD). They include decreased progression of coronary plaques in CAD, recruitment of collaterals, enhanced blood rheological properties, improvement of vascular smooth muscle cell and endothelial function, and coronary blood flow. This review describes how exercise via alterations in hemodynamic factors influences vascular function and structure which contributes to cardiovascular risk reduction, and highlights which mechanisms are involved in the positive effects of exercise on CAD.
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Affiliation(s)
- Xenofon M Sakellariou
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
| | - Michail I Papafaklis
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Eleni M Domouzoglou
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- Department of Pediatrics, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Christos S Katsouras
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Lampros K Michalis
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
| | - Katerina K Naka
- Michailideion Cardiac Centre, University of Ioannina, Ioannina 45100, Epirus, Greece
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45100, Epirus, Greece
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16
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Siogkas PK, Lakkas L, Sakellarios AI, Rigas G, Kyriakidis S, Stefanou KA, Anagnostopoulos CD, Clemente A, Rocchiccioli S, Pelosi G, Parodi O, Papafaklis MI, Naka KK, Michalis LK, Neglia D, Fotiadis DI. SmartFFR, a New Functional Index of Coronary Stenosis: Comparison With Invasive FFR Data. Front Cardiovasc Med 2021; 8:714471. [PMID: 34490377 PMCID: PMC8418116 DOI: 10.3389/fcvm.2021.714471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Aims: In this study, we evaluate the efficacy of SmartFFR, a new functional index of coronary stenosis severity compared with gold standard invasive measurement of fractional flow reserve (FFR). We also assess the influence of the type of simulation employed on smartFFR (i.e. Fluid Structure Interaction vs. rigid wall assumption). Methods and Results: In a dataset of 167 patients undergoing either computed tomography coronary angiography (CTCA) and invasive coronary angiography or only invasive coronary angiography (ICA), as well as invasive FFR measurement, SmartFFR was computed after the 3D reconstruction of the vessels of interest and the subsequent blood flow simulations. 202 vessels were analyzed with a mean total computational time of seven minutes. SmartFFR was used to process all models reconstructed by either method. The mean FFR value of the examined dataset was 0.846 ± 0.089 with 95% CI for the mean of 0.833-0.858, whereas the mean SmartFFR value was 0.853 ± 0.095 with 95% CI for the mean of 0.84-0.866. SmartFFR was significantly correlated with invasive FFR values (RCCTA = 0.86, p CCTA < 0.0001, RICA = 0.84, p ICA < 0.0001, R overall = 0.833, p overall < 0.0001), showing good agreement as depicted by the Bland-Altman method of analysis. The optimal SmartFFR threshold to diagnose ischemia was ≤0.83 for the overall dataset, ≤0.83 for the CTCA-derived dataset and ≤0.81 for the ICA-derived dataset, as defined by a ROC analysis (AUCoverall = 0.956, p < 0.001, AUCICA = 0.975, p < 0.001, AUCCCTA = 0.952, p < 0.001). Conclusion: SmartFFR is a fast and accurate on-site index of hemodynamic significance of coronary stenosis both at single coronary segment and at two or more branches level simultaneously, which can be applied to all CTCA or ICA sequences of acceptable quality.
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Affiliation(s)
- Panagiotis K Siogkas
- Biomedical Research Institute, Foundation for Research and Technology Hellas, Ioannina, Greece.,Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Lampros Lakkas
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Antonis I Sakellarios
- Biomedical Research Institute, Foundation for Research and Technology Hellas, Ioannina, Greece
| | - George Rigas
- Biomedical Research Institute, Foundation for Research and Technology Hellas, Ioannina, Greece
| | - Savvas Kyriakidis
- Biomedical Research Institute, Foundation for Research and Technology Hellas, Ioannina, Greece
| | - Kostas A Stefanou
- Biomedical Research Institute, Foundation for Research and Technology Hellas, Ioannina, Greece
| | - Constantinos D Anagnostopoulos
- PET-CT Department & Preclinical Imaging Unit, Center for Experimental Surgery, Clinical & Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Alberto Clemente
- Fondazione Toscana G. Monasterio and Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Silvia Rocchiccioli
- Fondazione Toscana G. Monasterio and Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Gualtiero Pelosi
- Fondazione Toscana G. Monasterio and Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Oberdan Parodi
- Fondazione Toscana G. Monasterio and Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy.,Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Michail I Papafaklis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio and Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Dimitrios I Fotiadis
- Biomedical Research Institute, Foundation for Research and Technology Hellas, Ioannina, Greece.,Materials Science and Engineering, University of Ioannina, Ioannina, Greece
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17
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Varshney AS, Coskun AU, Siasos G, Maynard CC, Pu Z, Croce KJ, Cefalo NV, Cormier MA, Fotiadis D, Stefanou K, Papafaklis MI, Michalis L, VanOosterhout S, Mulder A, Madder RD, Stone PH. Spatial relationships among hemodynamic, anatomic, and biochemical plaque characteristics in patients with coronary artery disease. Atherosclerosis 2020; 320:98-104. [PMID: 33468315 DOI: 10.1016/j.atherosclerosis.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS We aimed to characterize the spatial proximity of plaque destabilizing features local endothelial shear stress (ESS), minimal luminal area (MLA), plaque burden (PB), and near-infrared spectroscopy (NIRS) lipid signal in high- vs. low-risk plaques. METHODS Coronary arteries imaged with angiography and NIRS-intravascular ultrasound (IVUS) underwent 3D reconstruction and computational fluid dynamics calculations of local ESS. ESS, PB, MLA, and lipid core burden index (LCBI), for each 3-mm arterial segment were obtained in arteries with large lipid-rich plaque (LRP) vs. arteries with smaller LRP. The locations of the MLA, minimum ESS (minESS), maximum ESS (maxESS), maximum PB (maxPB), and maximum LCBI in a 4-mm segment (maxLCBI4mm) were determined along the length of each plaque. RESULTS The spatial distributions of minESS, maxESS, maxPB, and maxLCBI4mm, in reference to the MLA, were significantly heterogeneous within and between each variable. The location of maxLCBI4mm was spatially discordant from sites of the MLA (p<0.0001), minESS (p = 0.003), and maxESS (p = 0.003) in arteries with large LRP (maxLCBI4mm ≥ 400) and non-large LRP. Large LRP arteries had higher maxESS (9.31 ± 4.78 vs. 6.32 ± 5.54 Pa; p = 0.023), lower minESS (0.41 ± 0.16 vs. 0.61 ± 0.26 Pa; p = 0.007), smaller MLA (3.54 ± 1.22 vs. 5.14 ± 2.65 mm2; p = 0.002), and larger maxPB (70.64 ± 9.95% vs. 56.70 ± 13.34%, p<0.001) compared with non-large LRP arteries. CONCLUSIONS There is significant spatial heterogeneity of destabilizing plaque features along the course of both large and non-large LRPs. Large LRPs exhibit significantly more abnormal destabilizing plaque features than non-large LRPs. Prospective, longitudinal studies are required to determine which patterns of heterogeneous destabilizing features act synergistically to cause plaque destabilization.
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Affiliation(s)
- Anubodh S Varshney
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ahmet U Coskun
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | | | - Zhongyue Pu
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kevin J Croce
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nicholas V Cefalo
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA
| | | | | | - Kostas Stefanou
- Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | | | - Stacie VanOosterhout
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Abbey Mulder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Peter H Stone
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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18
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Papafaklis MI, Katsouras CS, Tsigkas G, Toutouzas K, Davlouros P, Hahalis GN, Kousta MS, Styliadis IG, Triantafyllou K, Pappas L, Tsiourantani F, Varytimiadi E, Anyfantakis ZA, Iakovis N, Grammata P, Karvounis H, Ziakas A, Sianos G, Tziakas D, Pappa E, Dagre A, Patsilinakos S, Trikas A, Lamprou T, Mamarelis I, Katsimagklis G, Karmpaliotis D, Naka K, Michalis LK. "Missing" acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence? Clin Cardiol 2020; 43:1142-1149. [PMID: 32691901 PMCID: PMC7404667 DOI: 10.1002/clc.23424] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 01/06/2023] Open
Abstract
Background Reports from countries severely hit by the COVID‐19 pandemic suggest a decline in acute coronary syndrome (ACS)‐related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID‐19 incidence are not known. Hypothesis ACS admissions were reduced in a country spared by COVID‐19. Methods We conducted a nationwide study on the incidence rates of ACS‐related admissions during a 6‐week period of the COVID‐19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID‐19 incidence, and no excess in mortality. Results ACS admissions in the COVID‐19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, P < .001) and for each ACS type (ST‐segment elevation myocardial infarction [STEMI]: IRR: 0.76, P = .001; non‐STEMI: IRR: 0.74, P < .001; and unstable angina [UA]: IRR: 0.63, P = .002). The decrease in STEMI admissions was stable throughout the COVID‐19 period (temporal correlation; R2 = 0.11, P = .53), whereas there was a gradual decline in non‐STEMI/UA admissions (R2 = 0.75, P = .026) following the progressively stricter social measures. During the COVID‐19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; P < .001). Conclusions We observed a reduction in ACS hospitalizations during the COVID‐19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self‐isolation/quarantining may have also played a role.
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Affiliation(s)
| | | | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | | | | | - George N Hahalis
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - Maria S Kousta
- Cardiology Department, General Hospital "G. Gennimatas", Athens, Greece
| | - Ioannis G Styliadis
- 2nd Department of Cardiology, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | | | - Loukas Pappas
- 2nd Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
| | | | | | | | - Nikolaos Iakovis
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece
| | - Paraskevi Grammata
- Department of Cardiology, "Sismanogleio" General Hospital, Athens, Greece
| | | | - Antonios Ziakas
- Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece
| | - George Sianos
- Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece
| | - Dimitrios Tziakas
- Department of Cardiology, University Hospital of Alexandroupolis, Thrace, Greece
| | - Evgenia Pappa
- Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece
| | - Anna Dagre
- Department of Cardiology, "Thriasion" General Hospital of Elefsina, Attiki, Greece
| | | | | | - Thomais Lamprou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", Piraeus, Greece
| | | | | | - Dimitri Karmpaliotis
- Department of Cardiology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Katerina Naka
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
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19
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Koutsias S, Karaolanis GI, Papafaklis MI, Peroulis M, Tzimas P, Lakkas L, Mitsis M, Naka KK, Michalis LK. Simultaneous Transcatheter Aortic Valve Implantation and Infrarenal Aortic Aneurysm Repair for Severe Aortic Stenosis and Abdominal Aortic Aneurysm: Report of 2 Cases and Literature Review. Vasc Endovascular Surg 2020; 54:544-548. [PMID: 32458751 DOI: 10.1177/1538574420927864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of concomitant abdominal aortic aneurysm (AAA) and severe aortic stenosis (AS) has been increasing in the elderly population. Both conditions have adverse outcomes, if not adequately managed. No clear recommendations are available in the literature until today, in regards of the management sequence making thus the decision-making challenging. We report 2 cases of AAA and significant AS treated with endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI) during the same procedure and a review of the literature on this topic. Based on our experience, the combined procedure with TAVI followed by EVAR seems to be feasible, safe, and effective while detailed preoperative planning and a carefully tailored management strategy by a multidisciplinary team are essential.
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Affiliation(s)
- Stylianos Koutsias
- Vascular Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Georgios I Karaolanis
- Vascular Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Michail Peroulis
- Vascular Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Petros Tzimas
- Department of Anesthesiology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros Lakkas
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Michail Mitsis
- Vascular Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
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20
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Anagnostopoulos CD, Siogkas PK, Liga R, Benetos G, Maaniitty T, Sakellarios AI, Koutagiar I, Karakitsios I, Papafaklis MI, Berti V, Sciagrà R, Scholte AJHA, Michalis LK, Gaemperli O, Kaufmann PA, Pelosi G, Parodi O, Knuuti J, Fotiadis DI, Neglia D. Characterization of functionally significant coronary artery disease by a coronary computed tomography angiography-based index: a comparison with positron emission tomography. Eur Heart J Cardiovasc Imaging 2019; 20:897-905. [PMID: 30629151 DOI: 10.1093/ehjci/jey199] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Abstract
Aims
To test the hypothesis that virtual functional assessment index (vFAI) is related with regional flow parameters derived by quantitative positron emission tomography (PET) and can be used to assess abnormal vasodilating capability in coronary vessels with stenotic lesions at coronary computed tomography angiography (CCTA).
Methods and results
vFAI, stress myocardial blood flow (MBF), and myocardial flow reserve (MFR) were assessed in 78 patients (mean age 62.2 ± 7.7 years) with intermediate pre-test likelihood of coronary artery disease (CAD). Coronary stenoses ≥50% were considered angiographically significant. PET was considered positive for significant CAD, when more than one contiguous segments showed stress MBF ≤2.3 mL/g/min for 15O-water or <1.79 mL/g/min for 13N-ammonia. MFR thresholds were ≤2.5 and ≤2.0, respectively. vFAI was lower in vessels with abnormal stress MBF (0.76 ± 0.10 vs. 0.89 ± 0.07, P < 0.001) or MFR (0.80 ± 0.10 vs. 0.89 ± 0.07, P < 0.001). vFAI had an accuracy of 78.6% and 75% in unmasking abnormal stress MBF and MFR in 15O-water and 82.7% and 71.2% in 13N-ammonia studies, respectively. Addition of vFAI to anatomical CCTA data increased the ability for predicting abnormal stress MBF and MFR in 15O-water studies [AUCccta + vfai = 0.866, 95% confidence interval (CI) 0.783–0.949; P = 0.013 and AUCccta + vfai = 0.737, 95% CI 0.648–0.825; P = 0.007, respectively]. An incremental value was also demonstrated for prediction of stress MBF (AUCccta + vfai = 0.887, 95% CI 0.799–0.974; P = 0.001) in 13N-ammonia studies. A similar trend was recorded for MFR (AUCccta + vfai = 0.780, 95% CI 0.632–0.929; P = 0.13).
Conclusion
vFAI identifies accurately the presence of impaired vasodilating capability. In combination with anatomical data, vFAI enhances the diagnostic performance of CCTA.
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Affiliation(s)
| | - Panagiotis K Siogkas
- University of Ioannina, Materials Science and Engineering, Ioannina, Greece
- Biomedical Research Institute, FORTH, Ioannina, Greece
| | - Riccardo Liga
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
| | - Georgios Benetos
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University Medical School, Athens, Greece
| | | | | | - Iosif Koutagiar
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University Medical School, Athens, Greece
| | - Ioannis Karakitsios
- Biomedical Research Foundation of Academy of Athens, 4 Soranou Ephesiou, Athens, Greece
| | | | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences, Mario Serio, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, Florence, FI, Italy
| | - Roberto Sciagrà
- Department of Biomedical, Experimental and Clinical Sciences, Mario Serio, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, Florence, FI, Italy
| | | | | | | | | | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
| | - Oberdan Parodi
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
| | | | - Dimitrios I Fotiadis
- University of Ioannina, Materials Science and Engineering, Ioannina, Greece
- Biomedical Research Institute, FORTH, Ioannina, Greece
| | - Danilo Neglia
- Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, IT, Italy
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21
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Panoulas VF, Keramida K, Boleti O, Papafaklis MI, Flessas D, Petropoulou M, Nihoyannopoulos P. Association between fractional flow reserve, instantaneous wave-free ratio and dobutamine stress echocardiography in patients with stable coronary artery disease. EUROINTERVENTION 2019; 13:1959-1966. [PMID: 28966160 DOI: 10.4244/eij-d-17-00594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The association between fractional flow reserve (FFR) and dobutamine stress echocardiography (DSE) in real-world stable angina patients is scant and controversial whereas no such comparison exists with instantaneous wave-free ratio (iFR). The current retrospective study aimed to investigate the associations among these modalities in patients with stable coronary artery disease (CAD) and intermediate coronary lesions. METHODS AND RESULTS We studied 62 consecutive stable angina patients who underwent DSE and subsequently coronary angiography with FFR (in all 62) and iFR (in 46/62 patients) assessment of intermediate single-vessel lesions between 2014 and 2015. Using receiver operating characteristic (ROC) curves we sought to identify the optimal FFR and iFR cut-off points with the highest discriminative power to predict the DSE result. The kappa coefficient was used to assess the agreement between FFR, iFR and DSE. The mean age of the study cohort was 63.5±12 years and 35 (56.5%) were males. Thirteen (21%) lesions were adjudicated as causing reversible ischaemia on DSE. Using ROC (FFR predicting DSE result), the area under the curve was 0.952 (95% CI: 0.902 to 1), whereas for iFR it was 0.743 (95% CI: 0.560 to 0.927), pAUC comparison=0.03. The optimal FFR cut-off point predicting positive DSE was 0.80. There was strong agreement between DSE and FFR (kappa 0.682, p<0.001). There was only modest agreement between iFR and DSE (kappa 0.258, p=0.068) using a cut-off value of 0.9. CONCLUSIONS In patients referred for evaluation of stable CAD, there was good agreement between DSE and FFR (87%) but less so with iFR (71.7%).
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Affiliation(s)
- Vasileios F Panoulas
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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22
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Siogkas PK, Papafaklis MI, Lakkas L, Exarchos TP, Karmpaliotis D, Ali ZA, Pelosi G, Parodi O, Katsouras CS, Fotiadis DI, Michalis LK. Virtual Functional Assessment of Coronary Stenoses Using Intravascular Ultrasound Imaging: A Proof-of-Concept Pilot Study. Heart Lung Circ 2019; 28:e33-e36. [PMID: 29895487 DOI: 10.1016/j.hlc.2018.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/19/2017] [Accepted: 02/11/2018] [Indexed: 11/27/2022]
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23
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Affiliation(s)
| | - Andreas Baumbach
- Barts Heart Centre, St Bartholomew's Hospital, London, UK (M.I.P., A.B.).,William Harvey Research Institute, Queen Mary University of London, UK (A.B.)
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24
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Siogkas PK, Stefanou KA, Athanasiou LS, Papafaklis MI, Michalis LK, Fotiadis DI. Art care: A multi-modality coronary 3D reconstruction and hemodynamic status assessment software. Technol Health Care 2018; 26:187-193. [PMID: 29060945 DOI: 10.3233/thc-170881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Due to the incremental increase of clinical interest in the development of software that allows the 3-dimensional (3D) reconstruction and the functional assessment of the coronary vasculature, several software packages have been developed and are available today. OBJECTIVE Taking this into consideration, we have developed an innovative suite of software modules that perform 3D reconstruction of coronary arterial segments using different coronary imaging modalities such as IntraVascular UltraSound (IVUS) and invasive coronary angiography images (ICA), Optical Coherence Tomography (OCT) and ICA images, or plain ICA images and can safely and accurately assess the hemodynamic status of the artery of interest. METHODS The user can perform automated or manual segmentation of the IVUS or OCT images, visualize in 3D the reconstructed vessel and export it to formats, which are compatible with other Computer Aided Design (CAD) software systems. We employ finite elements to provide the capability to assess the hemodynamic functionality of the reconstructed vessels by calculating the virtual functional assessment index (vFAI), an index that corresponds and has been shown to correlate well to the actual fractional flow reserve (FFR) value. RESULTS All the modules of the proposed system have been thoroughly validated. In brief, the 3D-QCA module, compared to a successful commercial software of the same genre, presented very good correlation using several validation metrics, with a Pearson's correlation coefficient (R) for the calculated volumes, vFAI, length and minimum lumen diameter of 0.99, 0.99, 0.99 and 0.88, respectively. Moreover, the automatic lumen detection modules for IVUS and OCT presented very high accuracy compared to the annotations by medical experts with the Pearson's correlation coefficient reaching the values of 0.94 and 0.99, respectively. CONCLUSIONS In this study, we have presented a user-friendly software for the 3D reconstruction of coronary arterial segments and the accurate hemodynamic assessment of the severity of existing stenosis.
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Affiliation(s)
- Panagiotis K Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Kostas A Stefanou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Lambros S Athanasiou
- Harvard - MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michail I Papafaklis
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.,Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.,Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
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25
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Antoniadis AP, Papafaklis MI, Takahashi S, Shishido K, Andreou I, Chatzizisis YS, Tsuda M, Mizuno S, Makita Y, Domei T, Ikemoto T, Coskun AU, Honye J, Nakamura S, Saito S, Edelman ER, Feldman CL, Stone PH. Arterial Remodeling and Endothelial Shear Stress Exhibit Significant Longitudinal Heterogeneity Along the Length of Coronary Plaques. JACC Cardiovasc Imaging 2018; 9:1007-9. [PMID: 27491487 DOI: 10.1016/j.jcmg.2016.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 11/20/2022]
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26
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Papafaklis MI, Mavrogiannis MC, Siogkas PK, Lakkas LS, Katsouras CS, Fotiadis DI, Michalis LK. Functional assessment of lesion severity without using the pressure wire: coronary imaging and blood flow simulation. Expert Rev Cardiovasc Ther 2017; 15:863-877. [PMID: 28902523 DOI: 10.1080/14779072.2017.1379899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michail I. Papafaklis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
- Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Panagiotis K. Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Lampros S. Lakkas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Dimitrios I. Fotiadis
- Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Lampros K. Michalis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
- Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece
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Siogkas PK, Rigas G, Exarchos TP, Sakellarios AI, Papafaklis MI, Pelosi G, Parodi O, Michalis LK, Fotiadis DI. Computational estimation of the hemodynamic significance of coronary stenoses in arterial branches deriving from CCTA: A proof-of-concept study. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:1348-1351. [PMID: 29060126 DOI: 10.1109/embc.2017.8037082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The development of non-invasive methods for the accurate hemodynamic assessment of the coronary vasculature has become a non-trivial matter for the everyday clinical practice. Virtual Functional Assessment Index has already been suggested as a valid alternative to the invasively measured FFR but only on coronary arterial segments. In this work, we propose a novel method for the estimation of the severity of coronary lesions in arterial branches from CCTA derived images. Four left arterial branches were reconstructed in 3D using our in-house developed 3D reconstruction algorithm, and were subjected to computational blood flow simulations for the final calculation of the vFAI through the whole arterial branch. Strong correlation was found (r=0.82) between the two methods. A small relative error of 3.2% and a small trend of overestimation (0.023, SD=0.088) were also observed. All pathological cases presenting ischemia, were correctly discriminated by our method as hemodynamically significant lesions.
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Papafaklis MI, Muramatsu T, Ishibashi Y, Bourantas CV, Fotiadis DI, Brilakis ES, Garcia-Garcia HM, Escaned J, Serruys PW, Michalis LK. Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve. Heart Lung Circ 2017; 27:377-380. [PMID: 28506646 DOI: 10.1016/j.hlc.2017.03.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. METHODS Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. RESULTS The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (p<0.001) versus 3D-QCA %area stenosis (AUC: 77.5% [95% CI: 69.8-85.3%]). There was a good correlation between virtual resting Pd/Pa and FFR (r=0.69, p<0.001). CONCLUSIONS Virtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice.
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Affiliation(s)
- Michail I Papafaklis
- Second Department of Cardiology, Medical School, University of Ioannina, Greece.
| | | | - Yuki Ishibashi
- Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Emmanouil S Brilakis
- Veterans Administration North Texas Healthcare System and University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | | | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands; International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Lampros K Michalis
- Second Department of Cardiology, Medical School, University of Ioannina, Greece
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Siogkas PK, Papafaklis MI, Gogas BD, Samady H, Michalis LK, Fotiadis DI. Computational estimation of the severity of coronary lesions with intravascular ultrasound images: a pilot study. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:2664-2667. [PMID: 28268869 DOI: 10.1109/embc.2016.7591278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The fast and accurate hemodynamic functional assessment of the coronary vasculature is of utmost importance in clinical practice due to the fact that Cardiovascular Diseases have become the leading cause of death globally. In this work we propose a novel method that combines two of the most efficient methods of hemodynamic status assessment of coronary arteries, Intravascular UtraSound and virtual Functional Assessment Index, an index that correlates well to the measured Fractional Flow Reserve. One Left Anterior Descending segment was reconstructed both in a straight manner (using only IVUS images) as well as using the actual 3D geometry of the vessel (using IvUS images combined with the respective coronary angiographic images [2]). The generated vFAI values were almost identical (Straight=0.80, 3D=0.79), presenting a relative error of 1.27%, thus proving the efficacy of the proposed method. We also calculated the Endothelial Shear Stress for the two models under rest (i.e. flow rate of 1 ml/s), observing a similar trend throughout the artery, but with a statistically important relative error of 13.49%, as expected.
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Zaromytidou M, Antoniadis AP, Siasos G, Coskun AU, Andreou I, Papafaklis MI, Lucier M, Feldman CL, Stone PH. Heterogeneity of Coronary Plaque Morphology and Natural History: Current Understanding and Clinical Significance. Curr Atheroscler Rep 2016; 18:80. [PMID: 27822680 DOI: 10.1007/s11883-016-0626-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Sakellarios AI, Bizopoulos P, Papafaklis MI, Athanasiou L, Exarchos T, Bourantas CV, Naka KK, Patterson AJ, Young VEL, Gillard JH, Parodi O, Michalis LK, Fotiadis DI. Natural History of Carotid Atherosclerosis in Relation to the Hemodynamic Environment. Angiology 2016; 68:109-118. [PMID: 27081091 DOI: 10.1177/0003319716644138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid atherosclerosis may lead to devastating clinical outcomes such as stroke. Data on the value of local factors in predicting progression in carotid atherosclerosis are limited. Our aim was to investigate the association of local endothelial shear stress (ESS) and low-density lipoprotein (LDL) accumulation with the natural history of atherosclerotic disease using a series of 3 time points of human magnetic resonance data. Three-dimensional lumen/wall reconstruction was performed in 12 carotids, and blood flow and LDL mass transport modeling were performed. Our results showed that an increase in plaque thickness and a decrease in lumen size were associated with low ESS and high LDL accumulation in the arterial wall. Low ESS (odds ratio [OR]: 2.99; 95% confidence interval [CI]: 2.31-3.88; P < .001 vs higher ESS) and high LDL concentration (OR: 3.26; 95% CI: 2.44-4.36; P < .001 vs higher LDL concentration) were significantly associated with substantial local plaque growth. Low ESS and high LDL accumulation both presented a diagnostic accuracy of 67% for predicting plaque growth regions. Modeling of blood flow and LDL mass transport show promise in predicting progression of carotid atherosclerosis.
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Affiliation(s)
- Antonis I Sakellarios
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Paschalis Bizopoulos
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2 Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece.,3 Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.,4 Institute for Medical Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lambros Athanasiou
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.,4 Institute for Medical Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,5 Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Themis Exarchos
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.,6 Department of Biomedical Research Institute, Institute of Molecular Biology and Biotechnology, FORTH, University Campus of Ioannina, Ioannina, Greece
| | - Christos V Bourantas
- 7 Department of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Katerina K Naka
- 2 Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece.,3 Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Andrew J Patterson
- 8 Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Victoria E L Young
- 8 Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan H Gillard
- 8 Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Oberdan Parodi
- 9 Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lampros K Michalis
- 2 Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece.,3 Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.,6 Department of Biomedical Research Institute, Institute of Molecular Biology and Biotechnology, FORTH, University Campus of Ioannina, Ioannina, Greece
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Shishido K, Antoniadis AP, Takahashi S, Tsuda M, Mizuno S, Andreou I, Papafaklis MI, Coskun AU, O'Brien C, Feldman CL, Saito S, Edelman ER, Stone PH. Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans. J Am Heart Assoc 2016; 5:JAHA.115.002949. [PMID: 27628570 PMCID: PMC5079004 DOI: 10.1161/jaha.115.002949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background In‐stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three‐dimensional coronary reconstruction was performed in 374 post‐PCI patients at baseline and 6 to 10 months follow‐up as part of the PREDICTION Study. Each vessel was divided into 1.5‐mm‐long segments, and we calculated the local ESS within each stented segment at baseline. At follow‐up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in‐stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare‐metal stents (BMS), 104 (42.3%) sirolimus‐eluting stents, and 42 (17.1%) paclitaxel‐eluting stents. In BMS, low ESS post‐PCI at baseline was independently associated with ISH (β=1.47 mm2 per 1‐Pa decrease; 95% CI, 0.38–2.56; P<0.01). ISH was minimal in drug‐eluting stents. During follow‐up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post‐PCI ESS and in‐stent restenosis requiring PCI. Conclusions Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug‐eluting stents. Post‐PCI ESS is not associated with in‐stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in‐stent restenosis is likely attributed to factors other than ESS within the stent.
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Affiliation(s)
- Koki Shishido
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA
| | - Caroline O'Brien
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Elazer R Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Andreou I, Takahashi S, Tsuda M, Shishido K, Antoniadis AP, Papafaklis MI, Mizuno S, Coskun AU, Saito S, Feldman CL, Edelman ER, Stone PH. Atherosclerotic plaque behind the stent changes after bare-metal and drug-eluting stent implantation in humans: Implications for late stent failure? Atherosclerosis 2016; 252:9-14. [PMID: 27494445 DOI: 10.1016/j.atherosclerosis.2016.07.914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/31/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS The natural history and the role of atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared to first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH). METHODS Three-dimensional coronary reconstruction by angiography and intravascular ultrasound was performed after intervention and at 6-10-month follow-up in 157 patients with 188 lesions treated with BMS (n = 89) and DES (n = 99). RESULTS There was a significant decrease in PBS area (-7.2%; p < 0.001) and vessel area (-1.7%; p < 0.001) after BMS and a respective increase in both areas after DES implantation (6.1%; p < 0.001 and 4.1%; p < 0.001, respectively). The decrease in PBS area significantly predicted neointimal area at follow-up after BMS (β: 0.15; 95% confidence interval [CI]: 0.10-0.20, p < 0.001) and DES (β: 0.09; 95% CI: 0.07-0.11; p < 0.001) implantation. The decrease in PBS area was the most powerful predictor of significant NIH after BMS implantation (odds ratio: 1.13; 95% CI: 1.02-1.26; p = 0.02). CONCLUSIONS The decrease in PBS area after stent implantation is significantly associated with the magnitude of NIH development at follow-up. This finding raises the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis and late/very late stent thrombosis.
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Affiliation(s)
- Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Saeko Takahashi
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masaya Tsuda
- Department of Cardiovascular Medicine, Hokkaido University, Sapporo, Japan
| | - Koki Shishido
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shingo Mizuno
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Shigeru Saito
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elazer R Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Papafaklis MI, Bourantas CV, Yonetsu T, Vergallo R, Kotsia A, Nakatani S, Lakkas LS, Athanasiou LS, Naka KK, Fotiadis DI, Feldman CL, Stone PH, Serruys PW, Jang IK, Michalis LK. Anatomically correct three-dimensional coronary artery reconstruction using frequency domain optical coherence tomographic and angiographic data: head-to-head comparison with intravascular ultrasound for endothelial shear stress assessment in humans. EUROINTERVENTION 2016; 11:407-15. [PMID: 24974809 DOI: 10.4244/eijy14m06_11] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To develop a methodology that permits accurate 3-dimensional (3D) reconstruction from FD-OCT and angiographic data enabling reliable evaluation of the ESS distribution, and to compare the FD-OCT-derived models against the established models based on angiography/IVUS. METHODS AND RESULTS Fifteen patients (17 coronary arteries) who underwent angiography, FD-OCT and IVUS examination during the same procedure were studied. The FD-OCT and IVUS lumen borders were placed onto the 3D luminal centreline derived from angiographic data. Three-dimensional geometry algorithms and anatomical landmarks were used to estimate the orientation of the borders appropriately. ESS was calculated using computational fluid dynamics. In 188 corresponding consecutive 3-mm segments, FD-OCT- and IVUS-derived models were highly correlated for lumen area (r=0.96) and local ESS (r=0.89) measurements. FD-OCT-based 3D reconstructions had a high diagnostic accuracy for detecting regions exposed to proatherogenic low ESS identified on the IVUS-based 3D models, considered as the gold standard (receiver operator characteristic area under the curve: 94.9%). CONCLUSIONS FD-OCT-based 3D coronary reconstruction provides anatomically correct models and permits reliable ESS computation. ESS assessment in combination with the superior definition of plaque characteristics by FD-OCT is expected to provide valuable insights into the effect of the haemodynamic environment on the development and destabilisation of high-risk plaques.
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Affiliation(s)
- Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Papafaklis MI. Characterizing the Hyperemia-Induced Mechanical Stress Acting on the Plaque. JACC Cardiovasc Imaging 2016; 9:760-1. [PMID: 26971009 DOI: 10.1016/j.jcmg.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Papafaklis MI, Mavrogiannis MC, Michalis LK. Prolonged dual antiplatelet therapy: a potential mitigator of the adverse effects of local haemodynamic shear stress in high-risk coronary regions? EUROINTERVENTION 2016; 11:e1218-e1220. [PMID: 26865439 DOI: 10.4244/eijv11i11a242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Siogkas PK, Athanasiou LS, Sakellarios AI, Stefanou KA, Exarchos TP, Papafaklis MI, Naka KK, Parodi O, Michalis LK, Fotiadis DI. Validation study of a 3D-QCA coronary reconstruction method using a hybrid intravascular ultrasound and angiography reconstruction method and patient-specific Fractional Flow Reserve data. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:973-6. [PMID: 26736426 DOI: 10.1109/embc.2015.7318526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The estimation of the severity of coronary lesions is of utmost importance in today's clinical practice, since Cardiovascular diseases often have fatal consequences. The most efficient method to estimate the severity of a lesion is the calculation of the Fractional Flow Reserve. The necessary use of a pressure wire, however, makes this method invasive and strenuous for the patient. In this work, we present a novel 3-Dimensional Quantitative Coronary Analysis coronary reconstruction method and a framework for the computation of the virtual Functional Assessment Index (vFAI). In a dataset of 5 coronary arterial segments, we use the aforementioned method to reconstruct them in 3D, and compare them to the respective 3D models reconstructed from our already validated hybrid IVUS-angiography reconstruction method [2]. The obtained results indicate a high correlation between the two methods in terms of the calculated FFR values, presenting a difference of 3.19% in the worst case scenario. Furthermore, when compared to the actual FFR values that derive from a pressure wire, the differences were statistically insignificant.
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Sakellarios AI, Bizopoulos P, Stefanou K, Athanasiou LS, Papafaklis MI, Bourantas CV, Naka KK, Michalis LK, Fotiadis DI. A proof-of-concept study for predicting the region of atherosclerotic plaque development based on plaque growth modeling in carotid arteries. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:6552-5. [PMID: 26737794 DOI: 10.1109/embc.2015.7319894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this work, we present a computational model for plaque growth utilizing magnetic resonance data of a patient's carotid artery. More specifically, we model blood flow utilizing the Navier-Stokes equations, as well as LDL and HDL transport using the convection-diffusion equation in the arterial lumen. The accumulated LDL in the arterial wall is oxidized considering the protective effect of HDL. Macrophages recruitment and foam cells formation are the final step of the proposed multi-level modeling approach of the plaque growth. The simulated results of our model are compared with the follow-up MRI findings in 12 months regarding the change to the arterial wall thickness. WSS and LDL may indicate potential regions of plaque growth (R(2)=0.35), but the contribution of foam cells formation, macrophages and oxidized LDL increased the prediction significantly (R(2)=0.75).
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Papafaklis MI, Mizuno S, Takahashi S, Coskun AU, Antoniadis AP, Tsuda M, Feldman CL, Saito S, Stone PH. Incremental predictive value of combined endothelial shear stress, plaque necrotic core, and plaque burden for future cardiac events: A post-hoc analysis of the PREDICTION study. Int J Cardiol 2016; 202:64-6. [PMID: 26386924 DOI: 10.1016/j.ijcard.2015.08.208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/26/2015] [Indexed: 12/01/2022]
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Karanasiou GS, Conway C, Papafaklis MI, Lopes AC, Stefanou KA, Athanasiou LS, Michalis LK, Edelman ER, Fotiadis DI. Finite element analysis of stent implantation in a three-dimensional reconstructed arterial segment. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:5623-6. [PMID: 25571270 DOI: 10.1109/embc.2014.6944902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular stent deployment is a mechanical procedure used to rehabilitate a diseased arterial segment by restoring blood flow in occluded regions. The success or failure of the stent implantation depends on the stent device and the deployment technique. The optimal stent deployment can be predicted by investigating the factors that influence this minimally invasive procedure. In this study, we propose a methodology which evaluates the alterations in the arterial environment caused by stent deployment. A finite element model of a reconstructed right coronary artery with a stenosis was created based on anatomical information provided by intravascular ultrasound and angiography. The model was used to consider placement and performance after intervention with a commercially available Leader Plus stent. The performance of the stent, within this patient-specific arterial segment is presented, as well as the induced arterial deformation and straightening. The arterial stress distribution is analyzed with respect to possible regions of arterial injury. Our approach can be used to optimize stent deployment and to provide cardiologists with a valuable tool to visually select the position and deploy stents in patient-specific reconstructed arterial segments, thereby enabling new methods for optimal cardiovascular stent positioning.
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Stone P, Maehara A, Coskun AU, Maynard C, Andreou I, Siasos G, Marina zaromitidou, Fotiadis DI, Stefanou K, Papafaklis MI, Michalis LK, Lansky A, Mintz GS, Serruys PW, Feldman CL, Stone GW. TCT-317 Local Low Endothelial Shear Stress (ESS) Provides Incremental Prediction of Non-culprit MACE in Addition to Plaque Burden, Minimal Lumen Area, and Plaque Morphology: The PROSPECT Study. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bourantas CV, Papadopoulou SL, Serruys PW, Sakellarios A, Kitslaar PH, Bizopoulos P, Girasis C, Zhang YJ, de Vries T, Boersma E, Papafaklis MI, Naka KK, Fotiadis DI, Stone GW, Reiber JHC, Michalis LK, de Feyter PJ, Garcia-Garcia HM. Noninvasive Prediction of Atherosclerotic Progression: The PROSPECT-MSCT Study. JACC Cardiovasc Imaging 2015; 9:1009-11. [PMID: 26363836 DOI: 10.1016/j.jcmg.2015.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/29/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
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43
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Domouzoglou EM, Naka KK, Vlahos AP, Papafaklis MI, Michalis LK, Tsatsoulis A, Maratos-Flier E. Fibroblast growth factors in cardiovascular disease: The emerging role of FGF21. Am J Physiol Heart Circ Physiol 2015; 309:H1029-38. [PMID: 26232236 DOI: 10.1152/ajpheart.00527.2015] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/22/2015] [Indexed: 01/07/2023]
Abstract
Early detection of risk factors for enhanced primary prevention and novel therapies for treating the chronic consequences of cardiovascular disease are of the utmost importance for reducing morbidity. Recently, fibroblast growth factors (FGFs) have been intensively studied as potential new molecules in the prevention and treatment of cardiovascular disease mainly attributable to metabolic effects and angiogenic actions. Members of the endocrine FGF family have been shown to increase metabolic rate, decrease adiposity, and restore glucose homeostasis, suggesting a multiple metabolic role. Serum levels of FGFs have been associated with established cardiovascular risk factors as well as with the severity and extent of coronary artery disease and could be useful for prediction of cardiovascular death. Furthermore, preclinical investigations and clinical trials have tested FGF administration for therapeutic angiogenesis in ischemic vascular disease, demonstrating a potential role in improving angina and limb function. FGF21 has lately emerged as a potent metabolic regulator with multiple effects that ultimately improve the lipoprotein profile. Early studies show that FGF21 is associated with the presence of atherosclerosis and may play a protective role against plaque formation by improving endothelial function. The present review highlights recent investigations suggesting that FGFs, in particular FGF21, may be useful as markers of cardiovascular risk and may also serve as protective/therapeutic agents in cardiovascular disease.
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Affiliation(s)
- Eleni M Domouzoglou
- Department of Pediatrics, Medical School, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Antonios P Vlahos
- Department of Pediatrics, Medical School, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Agathoklis Tsatsoulis
- Department of Endocrinology, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleftheria Maratos-Flier
- Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Siogkas PK, Papafaklis MI, Sakellarios AI, Stefanou KA, Bourantas CV, Athanasiou LM, Bellos CV, Exarchos TP, Naka KK, Michalis LK, Parodi O, Fotiadis DI. Computational assessment of the fractional flow reserve from intravascular ultrasound and coronary angiography data: a pilot study. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:3885-8. [PMID: 24110580 DOI: 10.1109/embc.2013.6610393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiovascular disease is one of the primary causes of morbidity and mortality around the globe. Thus, the diagnosis of critical lesions in coronary arteries is of utmost importance in clinical practice. One useful and efficient method to assess the functional severity of one or multiple lesions in a coronary artery is the calculation of the fractional flow reserve (FFR). In the current work, we present a method which allows the calculation of the FFR value computationally, without the use of a pressure wire and the induction of hyperemia, using intravascular ultrasound (IVUS) and biplane angiography images for three-dimensional (3D) coronary artery reconstruction and measurements of the volumetric flow rate derived from angiographic sequences. The simulated FFR values were compared to the invasively measured FFR values in 7 cases, presenting high correlation (r=0.85) and good agreement (mean difference=0.002). FFR assessment without employing a pressure wire and the induction of hyperemia is feasible using 3D reconstructed coronary artery models from angiographic and IVUS data coupled with computational fluid dynamics.
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Bourantas CV, Papafaklis MI, Athanasiou L, Kalatzis FG, Naka KK, Siogkas PK, Takahashi S, Saito S, Fotiadis DI, Feldman CL, Stone PH, Michalis LK. A new methodology for accurate 3-dimensional coronary artery reconstruction using routine intravascular ultrasound and angiographic data: implications for widespread assessment of endothelial shear stress in humans. EUROINTERVENTION 2015; 9:582-93. [PMID: 23608530 DOI: 10.4244/eijv9i5a94] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To develop and validate a new methodology that allows accurate 3-dimensional (3-D) coronary artery reconstruction using standard, simple angiographic and intravascular ultrasound (IVUS) data acquired during routine catheterisation enabling reliable assessment of the endothelial shear stress (ESS) distribution. METHODS AND RESULTS Twenty-two patients (22 arteries: 7 LAD; 7 LCx; 8 RCA) who underwent angiography and IVUS examination were included. The acquired data were used for 3-D reconstruction using a conventional method and a new methodology that utilised the luminal 3-D centreline to place the detected IVUS borders and anatomical landmarks to estimate their orientation. The local ESS distribution was assessed by computational fluid dynamics. In corresponding consecutive 3 mm segments, lumen, plaque and ESS measurements in the 3-D models derived by the centreline approach were highly correlated to those derived from the conventional method (r>0.98 for all). The centreline methodology had a 99.5% diagnostic accuracy for identifying segments exposed to low ESS and provided similar estimations to the conventional method for the association between the change in plaque burden and ESS (centreline method: slope= -1.65%/Pa, p=0.078; conventional method: slope= -1.64%/Pa, p=0.084; p =0.69 for difference between the two methodologies). CONCLUSIONS The centreline methodology provides geometrically correct models and permits reliable ESS computation. The ability to utilise data acquired during routine coronary angiography and IVUS examination will facilitate clinical investigation of the role of local ESS patterns in the natural history of coronary atherosclerosis.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Academic Unit, University of Hull, Kingston-upon-Hull, United Kingdom
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46
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Bourantas CV, Räber L, Zaugg S, Sakellarios A, Taniwaki M, Heg D, Moschovitis A, Radu M, Papafaklis MI, Kalatzis F, Naka KK, Fotiadis DI, Michalis LK, Serruys PW, Garcia Garcia HM, Windecker S. Impact of local endothelial shear stress on neointima and plaque following stent implantation in patients with ST-elevation myocardial infarction: A subgroup-analysis of the COMFORTABLE AMI–IBIS 4 trial. Int J Cardiol 2015; 186:178-85. [PMID: 25828109 DOI: 10.1016/j.ijcard.2015.03.160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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47
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Kotsia AP, Papafaklis MI, Michael TT, Rangan BV, Peltz M, Roesle M, Jessen M, Willis B, Christopoulos G, Nakas G, Giannitsi S, Michalis LK, Fotiadis DI, Banerjee S, Brilakis ES. Serial Multimodality Evaluation of Aortocoronary Bypass Grafts During the First Year After CABG Surgery. JACC Cardiovasc Imaging 2015; 8:1341-3. [PMID: 25797131 DOI: 10.1016/j.jcmg.2014.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022]
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48
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Papafaklis MI, Takahashi S, Antoniadis AP, Coskun AU, Tsuda M, Mizuno S, Andreou I, Nakamura S, Makita Y, Hirohata A, Saito S, Feldman CL, Stone PH. Effect of the local hemodynamic environment on the de novo development and progression of eccentric coronary atherosclerosis in humans: insights from PREDICTION. Atherosclerosis 2015; 240:205-11. [PMID: 25801012 DOI: 10.1016/j.atherosclerosis.2015.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/17/2015] [Accepted: 03/10/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Eccentric distribution of atheroma has been associated with plaques likely to rupture and cause an acute coronary syndrome, but the factors responsible for the development of eccentricity remain unknown. Endothelial shear stress (ESS) drives plaque formation. We aimed to investigate the role of the local ESS characteristics in the de novo development and progressive worsening of plaque eccentricity in humans. METHODS Vascular profiling (3-vessel 3D coronary reconstruction by angiography/intravascular ultrasound, and blood flow simulation for ESS computation) was performed in 374 patients at baseline & 6-10 months follow-up. At baseline, we identified (i) disease-free segments (n=2157), and (ii) diseased regions of luminal obstructions (n=408). RESULTS In disease-free regions, baseline low ESS magnitude (p<0.001), marked ESS circumferential heterogeneity (p=0.001), and their interaction (p=0.026) were associated with an increased probability of de novo eccentric plaque formation at follow-up. In diseased regions, baseline low ESS (odds ratio [OR]: 2.33, p=0.003) and large plaque burden (OR: 2.46, p=0.002) were independent predictors of substantially increasing plaque eccentricity index with worsening lumen encroachment. This combined outcome was more frequent in obstructions with both features vs. all others (33 vs. 12%; p<0.001). The incidence of percutaneous coronary intervention in worsening obstructions with increasing plaque eccentricity was higher (13.3 vs. 4.3%, p=0.011). CONCLUSIONS The local hemodynamic environment has a critical effect on the development of eccentric coronary plaques at both an early and advanced stage of atherosclerosis. Local ESS assessment could help in predicting sites prone to plaque disruption and acute coronary syndromes in humans.
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Affiliation(s)
- Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Masaya Tsuda
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shingo Mizuno
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Siogkas PK, Sakellarios AI, Papafaklis MI, Stefanou KA, Athanasiou LM, Exarchos TP, Naka KK, Michalis LK, Fotiadis DI. Assessing the hemodynamic influence between multiple lesions in a realistic right coronary artery segment: A computational study. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:5643-6. [PMID: 25571275 DOI: 10.1109/embc.2014.6944907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary artery disease is the primary cause of morbidity and mortality worldwide. Therefore, detailed assessment of lesions in the coronary vasculature is critical in current clinical practice. Fractional flow reserve (FFR) has been proven as an efficient method for assessing the hemodynamic severity of a coronary stenosis. However, functional assessment of a coronary segment with multiple stenoses (≥ 2) remains complex for guiding the strategy of percutaneous coronary intervention due to the hemodynamic interplay between adjacent stenoses. In this work, we created four 3-dimensional (3D) arterial models that derive from a healthy patient-specific right coronary artery segment. The initial healthy model was reconstructed using fusion of intravascular ultrasound (IVUS) and biplane angiographic patient data. The healthy 3D model presented a measured FFR value of 0.96 (pressure-wire) and a simulated FFR value of 0.98. We then created diseased models with two artificial sequential stenoses of 90% lumen area reduction or with the proximal and distal stenosis separately. We calculated the FFR value for each case: 0.65 for the case with the two stenoses, 0.73 for the case with the distal stenosis and 0.90 for the case with the proximal stenosis. This leads to the conclusion that although both stenoses had the same degree of lumen area stenosis, there was a large difference in hemodynamic severity, thereby indicating that angiographic lumen assessment by itself is often not adequate for accurate assessment of coronary lesions.
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50
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Vergallo R, Papafaklis MI, Yonetsu T, Bourantas CV, Andreou I, Wang Z, Fujimoto JG, McNulty I, Lee H, Biasucci LM, Crea F, Feldman CL, Michalis LK, Stone PH, Jang IK. Endothelial Shear Stress and Coronary Plaque Characteristics in Humans. Circ Cardiovasc Imaging 2014; 7:905-11. [PMID: 25190591 DOI: 10.1161/circimaging.114.001932] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background—
Despite the exposure of the entire vasculature to the atherogenic effects of systemic risk factors, atherosclerotic plaques preferentially develop at sites with disturbed flow. This study aimed at exploring in vivo the relationship between local endothelial shear stress (ESS) and coronary plaque characteristics in humans using computational fluid dynamics and frequency-domain optical coherence tomography.
Methods and Results—
Three-dimensional coronary artery reconstruction was performed in 21 patients (24 arteries) presenting with acute coronary syndrome using frequency-domain optical coherence tomography and coronary angiography. Each coronary artery was divided into sequential 3-mm segments and analyzed for the assessment of local ESS and plaque characteristics. A total of 146 nonculprit segments were evaluated. Compared with segments with higher ESS [≥1 Pascal (Pa)], those with low ESS (<1 Pa) showed higher prevalence of lipid-rich plaques (37.5% versus 20.0%;
P
=0.019) and thin-cap fibroatheroma (12.5% versus 2.0%;
P
=0.037). Overall, lipid plaques in segments with low ESS had thinner fibrous cap (115 μm [63–166] versus 170 μm [107–219];
P
=0.004) and higher macrophage density (normalized standard deviation: 8.4% [4.8–12.6] versus 6.2% [4.2–8.8];
P
=0.017). Segments with low ESS showed more superficial calcifications (minimum calcification depth: 93 μm [50–140] versus 152 μm [105–258];
P
=0.049) and tended to have higher prevalence of spotty calcifications (26.0% versus 12.0%;
P
=0.076).
Conclusions—
Coronary regions exposed to low ESS are associated with larger lipid burden, thinner fibrous cap, and higher prevalence of thin-cap fibroatheroma in humans. Frequency-domain optical coherence tomography–based assessment of ESS and wall characteristics may be useful in identifying vulnerable coronary regions.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01110538.
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Affiliation(s)
- Rocco Vergallo
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Michail I. Papafaklis
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Taishi Yonetsu
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Christos V. Bourantas
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Ioannis Andreou
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Zhao Wang
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - James G. Fujimoto
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Iris McNulty
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Hang Lee
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Luigi M. Biasucci
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Filippo Crea
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Charles L. Feldman
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Lampros K. Michalis
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Peter H. Stone
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Ik-Kyung Jang
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
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