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Otsuka K. Newer-Generation Drug-Eluting Stents in Patients Undergoing Complex Percutaneous Coronary Intervention. JACC. ASIA 2021; 1:342-344. [PMID: 36341215 PMCID: PMC9627896 DOI: 10.1016/j.jacasi.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Otsuka K, Ishikawa H, Yamaura H, Shirasawa K, Kasayuki N. Epicardial adipose tissue volume is associated with low-attenuation plaque volume in subjects with or without increased visceral fat: a 3-vessel coronary artery analysis with CT angiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Low-attenuation plaque (LAP) with a CT value of less than or equal 30 HU on coronary CT angiography (CCTA) is a marker of high-risk plaque features that leads to future acute coronary syndromes. Perivascular and epicardial adipose tissue (EAT) have been shown to be associated with progression of high-risk coronary plaques through metabolic and inflammatory mechanisms. However, association of EAT with LAP volume in three coronary arteries in subjects with or without visceral obesity remain unclear.
Aims
This study aimed to investigate the association of EAT volume (EAV) and coronary 3-vessel LAP volume in subjects with or without visceral obesity who underwent CCTA.
Methods
Patients who underwent CCTA without known coronary artery disease were included in the study (525 patients). Study subjects were classified as having non-obstructive or obstructive coronary artery disease according to the degree of coronary artery stenosis on CCTA. The plaque volume and EAV of the main vessel of the left anterior descending artery, left circumflex artery, and right coronary artery were measured with VINCENT software. Coronary plaque composition was classified as calcified plaque (CP, >150HU), noncalcified plaque (NCP, 30–150HU), and Lap (<30HU). The %LAP volume of the three coronary arteries was classified into quartiles. Multiple logistic regression analysis was used to analyze the factors associated with the %LAP volume.
Results
Compared with subjects without increase visceral fat, subjects with increased visceral fat had a significantly higher BMI, a greater total plaque volume, a greater total %LAP volume, a greater EAV, and a lower mean CT value of EAT. A significant correlation was observed between EAV and %LAP volume (R=0.24, p<0.001). EAV (odds ratio; 1.83, 95% confidence interval 1.071–3.141, p-value 0.027) and type 2 diabetes mellitus (odds ratio 1.76, 95%confidence interval 1.042–3.000, p-value 0.034) appeared to be independent predictors of %LAP volume (Q4), when adjusted by age, gender, BMI>25 kg/m2, visceral fat >100cm2, LogCRP, coronary artery calcium score>300, and obstructive coronary artery disease requiring revascularization.
Conclusion
This study suggests that LAP volume, which reflects the high-risk plaques in the three coronary arteries, is associated with EAV in subjects with or without increased visceral fat. Further research is needed whether pharmacological therapeutic intervention enables the prevention of coronary plaque progression and destabilization through the reduction of EAV in patients.
Funding Acknowledgement
Type of funding sources: None.
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Otsuka K, Ishikawa H, Kono Y, Shirasawa K, Hirata K, Kasayuki N. Clinical significance of aortic arch plaques simultaneously assessed with coronary atherosclerosis on cardiovascular outcomes in patients undergoing coronary CT angiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Computed tomography (CT) coronary angiography is a useful diagnostic imaging modality in assessing presence, severity, and extent of coronary artery disease (CAD). Aortic arch plaques have been shown to be an underlying cause of embolic stroke and also related to increased risk of cardiovascular events. Yet, conventional CTCA imaging protocol does not include aortic arch for the reduction of radiation exposure. This study aimed to investigate prevalence of aortic arch plaques simultaneously assessed by CTCA and their clinical significance in combination with the presence of obstructive CAD for prediction of CVD events in patients with suspected CAD.
Methods
This study consisted of 310 (mean age, 66 years old, 42% female) patients with suspected CAD undergoing CTCA between 2017 and 2019. All CTCA examination was performed with 320-row detector scanner using ECG-triggered prospective gating method. Aortic arch images were simultaneously acquired during CTCA scanning without an increase of contrast media. Using Agatston method, coronary artery calcium score (CACS) was categorized into either of the groups having CACS of 0, 0–99, 100–299, or more than 300. The presence of CAD was reported as non-obstructive or obstructive CAD. High-risk featured aortic plaque was defined as large plaques >4 mm in thickness showing ulceration or protrusion. A composite event of cardiovascular disease, including all-cause mortality, non-fatal myocardial infarction, unplanned hospitalization requiring revascularization or stroke was defined as the primary endpoint.
Results
Patients having CACS of 0, 0–99, 100–299, and >300 were found in 41%, 24%, 15%, 20%%, respectively, where obstructive CAD was diagnosed in 11%. Aortic HRPs in ascending aorta, aortic arch, and thoracic descending aorta were observed in 1.6%, 6.9%, and 15%, respectively. During a mean follow-up period of 2.2 years, the primary endpoint was observed in 27 patients (8.7%). Cox regression hazard model demonstrated an independent association of aortic arch high-risk plaques (HR; 3.2, 95% CI; 1.20–8.64, p=0.02) and obstructive CAD (HR; 3.3, 95% CI; 1.45–7.92, P=0.005) when adjusted by age, CACS, and chronic kidney disease. Kaplan-Meier curve analysis showed a worse outcome of patients with aortic HRP and obstructive CAD compared to those without aortic plaques and obstructive CAD (p<0.001).
Conclusion
This study demonstrated an independent association of aortic arch high-risk featured plaques with CVD events. Further study is warranted whether pharmacological interventional therapies can reduce future CVD risks in patients with CAD and aortic arch plaques.
Funding Acknowledgement
Type of funding sources: None.
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van Zandvoort LJC, Otsuka K, Villiger M, Neleman T, Dijkstra J, Zijlstra F, van Mieghem NM, Bouma BE, Daemen J. Polarimetric Signatures of Coronary Thrombus in Patients With Acute Coronary Syndrome. Circ J 2021; 85:1806-1813. [PMID: 33828020 PMCID: PMC10782573 DOI: 10.1253/circj.cj-20-0862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intravascular polarization-sensitive optical frequency domain imaging (PS-OFDI) offers a novel approach to measure tissue birefringence, which is elevated in collagen and smooth muscle cells, that in turn plays a critical role in healing coronary thrombus (HCT). This study aimed to quantitatively assess polarization properties of coronary fresh and organizing thrombus with PS-OFDI in patients with acute coronary syndrome (ACS).Methods and Results:The POLARIS-I prospective registry enrolled 32 patients with ACS. Pre-procedural PS-OFDI pullbacks using conventional imaging catheters revealed 26 thrombus-regions in 21 patients. Thrombus was manually delineated in conventional OFDI cross-sections separated by 0.5 mm and categorized into fresh thrombus caused by plaque rupture, stent thrombosis, or erosion in 18 thrombus-regions (182 frames) or into HCT for 8 thrombus-regions (141 frames). Birefringence of coronary thrombus was compared between the 2 categories. Birefringence in HCTs was significantly higher than in fresh thrombus (∆n=0.47 (0.37-0.72) vs. ∆n=0.25 (0.17-0.29), P=0.007). In a subgroup analysis, when only using thrombus-regions from culprit lesions, ischemic time was a significant predictor for birefringence (ß (∆n)=0.001 per hour, 95% CI [0.0002-0.002], P=0.023). CONCLUSIONS Intravascular PS-OFDI offers the opportunity to quantitatively assess the polarimetric properties of fresh and organizing coronary thrombus, providing new insights into vascular healing and plaque stability.
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Kono Y, Otsuka K, Hirata K, Shimada K. Parachute-Like Structure Oscillating Between Left Ventricular Outflow Tract and Sinus of Valsalva. Circ Rep 2021; 3:478-479. [PMID: 34414340 PMCID: PMC8339568 DOI: 10.1253/circrep.cr-21-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022] Open
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Ren J, Shishkov M, Villiger ML, Otsuka K, Nadkarni SK, Bouma BE. Single-catheter dual-modality intravascular imaging combining IVUS and OFDI: A holistic structural visualization of coronary arteries. EUROINTERVENTION 2021; 17:e919-e922. [PMID: 34219665 DOI: 10.4244/eij-d-20-00990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Van Zandvoort L, Otsuka K, Bouma B, Daemen J. Intracoronary polarimetry of a honeycomb-like structure. EUROINTERVENTION 2021; 16:1422-1423. [PMID: 31403462 PMCID: PMC7238317 DOI: 10.4244/eij-d-19-00431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Otsuka K, Villiger M, Van Zandvoort L, Neleman T, Karanasos A, Dijikstra J, Van Soest G, Regar E, Nadkarni S, Daemen J, Bouma B. Intracoronary polarimetry for characterizing coronary plaque vulnerability in patients with coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Intracoronary polarimetry with polarization-sensitive (PS-) optical frequency domain imaging (OFDI) measures polarization properties, including birefringence and depolarization, in parallel with structural features of conventional OFDI (Figure 1A). Collagen, which imparts mechanical integrity to fibrous caps, and collagen-synthesizing smooth muscle cells exhibit elevated birefringence. Depolarization is increased by the presence of macrophages and lipid/necrotic cores.
Purpose
This study aimed to compare conventional OFDI and polarimetric signatures of coronary lesions between patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Furthermore, we aimed to determine a birefringence cut-off value for identifying which fibrous caps belong to ACS culprit lesions.
Methods
This study consisted of 37 patients with ACS (n=23) or CCS (n=14). ACS culprit lesions (ACS-lesions) and CCS stenotic lesions (CCS-lesions) were included in the analysis (820 mm). Qualitative and quantitative conventional OFDI analysis included the presence of plaque rupture, macrophage infiltration, micro-vessels, thrombus, stenosis severity, fibrous cap thickness (FCT), lipid arc, lipid-burden and calcium-burden index. Birefringence and depolarization of the coronary lesions and fibrous caps were measured in the cross-sectional images showing the minimum FCT or minimum luminal area. Predictors of ACS-lesions were investigated by multivariate regression analysis. Receiver operating characteristic (ROC) analysis was used to determine the birefringence cut-off value identifying ACS fibrous caps (ACS-caps).
Results
There were no significant differences in clinical characteristics between the two groups, except for previous history of coronary artery disease. Compared to CCS-lesions, ACS-lesions featured higher lipid-burden index and maximum lipid arc (both p<0.05). ACS-lesions featured lower birefringence and higher depolarization than CCS-lesions (p<0.05). Multivariable regression demonstrated an independent association of birefringence with ACS-lesions (p<0.05), even after adjusting for the conventional OFDI findings. Limiting the analysis to the fibrous caps, ACS-caps exhibited significantly lower birefringence (p<0.05) and higher depolarization (p<0.05) that CCS-caps. ROC analysis for differentiating ACS-caps from CCS-caps found that a birefringence value of 0.0004 results in a sensitivity and specificity of 88% and 82%, respectively (Figure 1B, AUC = 0.82).
Conclusions
Intracoronary polarimetry provides quantitative assessment of coronary lesions related to their composition. Birefringence was an independent robust predictor of ACS-lesions. Decreased birefringence and pronounced depolarization within the ACS-caps may indicate increased collagenolytic activity and macrophage infiltration, respectively. These results suggest that polarization properties may serve as quantitative imaging markers for assessing plaque vulnerability.
Figure 1
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by the National Institutes of Health and by Terumo Corporation.
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Otsuka K, Villiger M, Van Zandvoort L, Neleman T, Karanasos A, Dijkstra J, Nadkarni S, Regar E, Daemen J, Bouma B. Polarization-sensitive OFDI findings of vascular tissue response following drug-eluting stent implantation in patients with coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Intravascular polarimetry (IVP) with polarization-sensitive (PS-) optical frequency domain imaging (OFDI) measures polarization properties of the coronary arterial wall in parallel with the conventional OFDI images (Figure 1A). Tissues rich in collagen and smooth muscle cells (SMCs) appear birefringent, while the presence of lipid and macrophages causes depolarization. Because drug-eluting stents (DES) are designed to prevent SMC proliferation and collagen deposition, we hypothesized that neointimal tissue would exhibit low birefringence. The accumulation of lipid-laden macrophages characteristic of neoatherosclerosis should result in notable depolarization.
Methods
This study included 19 DES imaged with PS-OFDI in 13 patients (median follow-up period of 1.5 years). Coronary segments stented >90 days were analyzed every 1 mm. We analyzed polarization properties of the neointima in a total of 455 frames, and in additional 97 frames of native atherosclerosis remote from the stented segments. Neointima, delineated by the lumen and the inner boundary of the stent, was manually segmented in the intensity images using MATLAB. The median birefringence in all areas of the segmented neointima featuring a depolarization of ≤0.2 and the median depolarization across the entire neointima were computed for each frame after masking the guidewire shadow. Frames presenting intensity features of macrophages, lipid or calcifications extending to at least one adjacent frame were classified as neoatherosclerosis (n=112), and otherwise as normal neointima (n=343). For comparison with neoatherosclerosis, polarization properties of native atherosclerosis (n=97) were measured. We also categorized all frames of a stented segment according to the presence of in-stent restenosis (ISR) and/or stent thrombosis (ST) (204 frames from 5 patients). A generalized linear model using a generalized estimating equation or one-way ANOVA was used for statistical analysis.
Results
The major findings of the present study are: 1) neoatherosclerosis exhibited lower birefringence than native atherosclerosis (p<0.001, Figure-1B); 2) depolarization was positively associated with neoatherosclerosis (β=0.86, p<0.001) and ISR/ST (β=0.72, p=0.002), while birefringence was not (Figure 1C); 3) birefringence was positively correlated with the duration after DES implantation (β=5.22×10–3, p<0.001, Figure 1D). For the detection of neointimas within stents with ISR, the best cut-off value for depolarization was 0.033 with a sensitivity of 77% and a specificity of 57% (AUC=0.72). For comparison, using only conventional OFDI parameters to detect stents with ISR, the AUC were 0.52 for calcium area, 0.62 for lipid arc, and 0.63 for macrophage accumulations.
Conclusions
This study suggests that IVP provides quantitative assessment of vascular healing after DES implantation and may help clinical decision making in patients at high risk of stent failure.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by the National Institutes of Health.
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Otsuka K, Villiger M, Nadkarni SK, Bouma BE. Intravascular Polarimetry: Clinical Translation and Future Applications of Catheter-Based Polarization Sensitive Optical Frequency Domain Imaging. Front Cardiovasc Med 2020; 7:146. [PMID: 33005632 PMCID: PMC7485575 DOI: 10.3389/fcvm.2020.00146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) visualize the coronary artery wall and plaque morphology in great detail. The advent of these high-resolution intracoronary imaging modalities has propelled our understanding of coronary atherosclerosis and provided enhanced guidance for percutaneous coronary intervention. Yet, the lack of contrast between distinct tissue types and plaque compositions impedes further elucidation of the complex mechanisms that contribute to acute coronary syndrome (ACS) and hinders the prospective identification of plaques susceptible to rupture. Intravascular polarimetry with polarization-sensitive OFDI measures polarization properties of the coronary arterial wall using conventional intravascular imaging catheters. The quantitative polarization metrics display notable image contrast between several relevant coronary plaque microstructures that are difficult to identify with conventional OCT and OFDI. Tissues rich in collagen and smooth muscle cells exhibit birefringence, while lipid and macrophages cause depolarization. In this review, we describe the basic principles of intravascular polarimetry, discuss the interpretation of the polarization signatures, and outline promising avenues for future research and clinical implications.
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Otsuka K, Villiger M, van Zandvoort LJC, Neleman T, Karanasos A, Dijkstra J, van Soest G, Regar E, Nadkarni SK, Daemen J, Bouma BE. Polarimetric Signatures of Vascular Tissue Response to Drug-Eluting Stent Implantation in Patients. JACC Cardiovasc Imaging 2020; 13:2695-2696. [PMID: 32828773 DOI: 10.1016/j.jcmg.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 01/17/2023]
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Sena Y, Matsumoto S, Silman C, Otsuka K, Kiyota T. Physiological 18F-FDG uptake in the normal adult anal canal: evaluation by PET/CT. Ann Nucl Med 2020; 34:538-544. [PMID: 32430619 DOI: 10.1007/s12149-020-01480-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite their benefit for detecting primary tumors, data for normal 18F-fluoro-2-deoxy-D-glucose (FDG) uptake in the anal canal are insufficient. Here we used positron emission tomography-computed tomography (PET/CT) to determine the uptake of FDG in the normal adult anal canal (AC) and to evaluate its clinical significance compared with that of anal cancer. METHODS We conducted a retrospective study of-PET/CT images in the anal region, of 201 consecutive patients without symptoms or pathology taken from January 2015 to August 2019, after excluding two patients (one each with Crohn's disease and hemorrhoid). These patients were included in the normal group, and data of eight patients with anal cancer were collected from January 2011 to August 2019 for comparison. FDG uptake was quantitatively evaluated (compared with the maximum standardized uptake value [SUVmax] to the SUVmax values of liver and distal rectum) and qualitatively (compared with background) in early and delayed phases. Normal grade 3 uptake was qualitatively defined as FDG uptake higher than the surrounding muscles. RESULTS In the normal group, mean anal canal SUVmax of early phase was: 2.26 (range 1.00-6.30), and delayed phase: 2.52 (range 1.00-8.80). Their ratios to liver SUVmax were early: 0.74 (range 0.24-2.25), and delayed: 0.81 (range 0.23-2.32); ratios to rectal SUVmax were early: 0.87 (range 0.30-1.89), and delayed: 0.90 (range 0.30-1.27). Qualitatively, 25 patients (15.4%) had normal grade 3 uptake during the early and delayed phases. In contrast, qualitative data showed that all patients with anal cancer exhibited high FDG uptake in the anal canal. The mean early- and delayed-phase values of SUVmax of the anal canal and anal cancer group were 11.09 (range 5.40-17.73) and 14.23 (range 6.70-22.85), respectively. There was a significant difference between the mean-early and -delayed anal SUVmax values of the normal grade 3 and anal cancer groups. Furthermore, the ratios to liver SUVmax were significantly different between the two groups. CONCLUSIONS PET/CT scans occasionally showed high FDG uptake in the anal canal of healthy adults. Comparing the SUVmax values of liver FDG uptake may help differentiate between normal tissue and anal cancer.
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Doradla P, Otsuka K, Nadkarni A, Villiger M, Karanasos A, van Zandvoort L, Dijkstra J, Zijlstra F, van Soest G, Daemen J, Regar E, Bouma BE, Nadkarni SK. Biomechanical Stress Profiling of Coronary Atherosclerosis: Identifying a Multifactorial Metric to Evaluate Plaque Rupture Risk. JACC Cardiovasc Imaging 2020; 13:804-816. [PMID: 31005542 PMCID: PMC9919872 DOI: 10.1016/j.jcmg.2019.01.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary plaque morphology, likely related to the propensity of plaque rupture in patients. BACKGROUND Plaque rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element modeling (FEM), typically used to calculate tensile stress, is computationally intensive and impractical as a clinical tool for locating rupture-prone plaques. This study derived a multifactorial stress equation (MSE) that accurately computes peak stress in NCFAs by combining the influence of several morphological parameters. METHODS Intravascular ultrasound and optical frequency domain imaging were conducted in 30 patients, and plaque morphological parameters were defined in 61 NCFAs. Multivariate regression analysis was applied to derive the MSE and compute a peak stress metric (PSM) that was based on the analysis of plaque morphological parameters. The accuracy of the MSE was determined by comparing PSM with FEM-derived peak stress values. The ability of the PSM in locating plaque rupture sites was tested in 3 additional patients. RESULTS The following parameters were found to be independently associated with peak stress: fibrous cap thickness (p < 0.0001), necrotic core angle (p = 0.024), necrotic core thickness (p < 0.0001), lumen area (p < 0.0001), necrotic core including calcium areas (p = 0.017), and plaque area (p = 0.003). The PSM showed excellent correlation (R = 0.85; p < 0.0001) with FEM-derived peak stress, thus confirming the accuracy of the MSE. In only 56% (n = 34) of plaques, the thinnest fibrous cap thickness was a determining parameter in identifying the cross section with highest PSM. In coronary segments with plaque ruptures, the MSE precisely located the rupture site. CONCLUSIONS The MSE shows potential to calculate the PSM in coronary lesions rapidly. However, further studies are warranted to investigate the use of biomechanical stress profiling for the prognostic evaluation of patients with atherosclerosis.
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Otsuka K, Villiger M, van Zandvoort L, Neleman T, Karanasos A, Dijkstra J, Regar E, Nadkarni S, Daemen J, Bouma B. POLARIMETRIC SIGNATURES OF VASCULAR TISSUE RESPONSE FOLLOWING DRUG-ELUTING STENT IMPLANTATION IN PATIENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Otsuka K, Villiger M, van Zandvoort L, Neleman T, Karanasos A, Dijkstra J, Nadkarni S, Regar E, Daemen J, Bouma B. FIBROUS CAP COMPOSITION IN PATIENTS WITH ACUTE OR CHRONIC CORONARY SYNDROMES: INSIGHTS FROM INTRAVASCULAR POLARIMETRY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hata S, Sakai K, Otsuka K, Kusumoto S, Sonoda K, Muroya T, Shinboku H, Ikeda S, Maemura K. P176 Left ventricular diastolic function by gated myocardial perfusion SPECT strongly reflects NT-ProBNP. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The importance of left ventricle diastolic dysfunction (LVDD) has been recognized widely, as it is well established that heart failure with preserved ejection fraction has a poor prognosis. Furthermore, N-terminal pro–B-type natriuretic peptide (NT-ProBNP) is used as a marker of heart failure. However, the association between LVDD and NT-proBNP is unclear.
Purpose
The aim of this study was to clarify the association between LVDD and NT-ProBNP.
Methods
In this study, an index based on gated myocardial perfusion SPECT using CardioREPO software for the diagnosis of LVDD was used. Out of the 171 patients who underwent myocardial perfusion imaging (MPI) between January 2015 and December 2018, 163 individuals (116 men and 47 women) completed MPI and NT-ProBNP. Patients were classified into 4 groups: NT-ProBNP levels below 125 pg/ml (n = 52), NT-ProBNP levels 125 to 400 pg/ml (n = 33), NT-ProBNP levels 400 to 900 pg/ml (n = 23), and NT-ProBNP levels over 900 pg/ml (n = 37). CardioREPO parameters (peak filling rate (PFR), 1/3 mean filling rate (MFR), and time to peak filling rate/R-R (TTPFR)) were compared between the 4 NT-ProBNP groups.
Results
Of the 163 patients, 55 had LVDD. The PFR and 1/3MFR were associated with LVDD. There was a statistically significant difference in PFR and 1/3 MFR between the NT-ProBNP levels below 125 pg/ml group and the NT-ProBNP levels 400 to 900 pg/ml group (PFR = 2.51+/-1.11 vs. 1.80+/-0.65, p = 0.001; 1/3 MFR = 1.41+/-0.55 vs. 1.06+/-0.47, p = 0.006, Table).
Conclusions
The MPI indices obtained by CardioREPO software were useful in the diagnosis of LVDD. The evaluation of LVDD by MPI correlated with NT-Pro BNP level is thought to have a clinical utility in the diagnosis and management of LVDD.
Variable: NT-ProBNP 0-125 (n = 52) 125-400 (n = 33) 400-900 (n = 23) 900- (n = 37) p Age 66 ± 11 72 ± 11 68 ± 17 70 ± 12 0.133 Male 40 (77%) 22 (12%) 18 (78%) 23 (62%) 0.36 Left ventricular diastolic dysfunction 8 (15%) 4 (12%) 10 (43%) 27 (73%) <0.001 E/A 0.9 ± 0.3 0.8 ± 0.2 1.1 ± 0.7 1.4 ± 0.9 (35) <0.001 E/e" 10.27 ± 3.69 (20) 8.83 ± 3.56 (10) 12.46 ± 3.75 (12) 20.25 ± 8.30 (25) <0.001 rest-PFR /s 2.51 ± 1.11 2.06 ± 0.58 2.16 ± 0.65 1.80 ± 0.65 0.001 rest-1/3 MFR /s 1.41 ± 0.55 1.19 ± 0.41 1.16 ± 0.50 1.06 ±0.47 0.008 rest-TTPFR ms 177 ± 53 181 ± 69 198 ± 80 166 ± 85 0.38 rest-TTPFR / R-R 0.19 ± 0.06 0.20 ± 0.11 0.21 ±0.09 0.21 ± 0.15 0.92
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Otsuka K, Villiger M, Nadkarni SK, Bouma BE. Intravascular Polarimetry for Tissue Characterization of Coronary Atherosclerosis. Circ Rep 2019; 1:550-557. [PMID: 32432174 PMCID: PMC7236778 DOI: 10.1253/circrep.cr-19-0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 01/20/2023] Open
Abstract
The microscopic tissue structure and organization influence the polarization of light. Intravascular polarimetry leverages this compelling intrinsic contrast mechanism by using polarization-sensitive optical frequency domain imaging to measure the polarization properties of the coronary arterial wall. Tissues rich in collagen and smooth muscle cells appear birefringent, while the presence of lipid causes depolarization, offering quantitative metrics related to the presence of important components of coronary atherosclerosis. Here, we review the basic principle, the interpretation of polarization signatures, and first clinical investigations of intravascular polarimetry and discuss how this extension of contemporary intravascular imaging may advance our knowledge and improve clinical practice in the future.
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Otsuka K, Shimada K, Ishikawa H, Nakamura H, Katayama H, Takeda H, Fujimoto K, Kasayuki N, Yoshiyama M. Usefulness of pre- and post-stent optical frequency domain imaging findings in the prediction of periprocedural cardiac troponin elevation in patients with coronary artery disease. Heart Vessels 2019; 35:451-462. [DOI: 10.1007/s00380-019-01512-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/20/2019] [Indexed: 01/25/2023]
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Otsuka K, Villiger M, Karanasos A, van Zandvoort LJC, Doradla P, Ren J, Lippok N, Daemen J, Diletti R, van Geuns RJ, Zijlstra F, van Soest G, Dijkstra J, Nadkarni SK, Regar E, Bouma BE. Intravascular Polarimetry in Patients With Coronary Artery Disease. JACC Cardiovasc Imaging 2019; 13:790-801. [PMID: 31422135 DOI: 10.1016/j.jcmg.2019.06.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aims of this first-in-human pilot study of intravascular polarimetry were to investigate polarization properties of coronary plaques in patients and to examine the relationship of these features with established structural characteristics available to conventional optical frequency domain imaging (OFDI) and with clinical presentation. BACKGROUND Polarization-sensitive OFDI measures birefringence and depolarization of tissue together with conventional cross-sectional optical frequency domain images of subsurface microstructure. METHODS Thirty patients undergoing polarization-sensitive OFDI (acute coronary syndrome, n = 12; stable angina pectoris, n = 18) participated in this study. Three hundred forty-two cross-sectional images evenly distributed along all imaged coronary arteries were classified into 1 of 7 plaque categories according to conventional OFDI. Polarization features averaged over the entire intimal area of each cross section were compared among plaque types and with structural parameters. Furthermore, the polarization properties in cross sections (n = 244) of the fibrous caps of acute coronary syndrome and stable angina pectoris culprit lesions were assessed and compared with structural features using a generalized linear model. RESULTS The median birefringence and depolarization showed statistically significant differences among plaque types (p < 0.001 for both, one-way analysis of variance). Depolarization differed significantly among individual plaque types (p < 0.05), except between normal arteries and fibrous plaques and between fibrofatty and fibrocalcified plaques. Caps of acute coronary syndrome lesions and ruptured caps exhibited lower birefringence than caps of stable angina pectoris lesions (p < 0.01). In addition to clinical presentation, cap birefringence was also associated with macrophage accumulation as assessed using normalized SD. CONCLUSIONS Intravascular polarimetry provides quantitative metrics that help characterize coronary arterial tissues and may offer refined insight into coronary arterial atherosclerotic lesions in patients.
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Otsuka K, Nakanishi K, Shimada K, Nakamura H, Inanami H, Nishioka H, Fujimoto K, Kasayuki N, Yoshiyama M. Ankle-brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end-stage kidney disease. Clin Cardiol 2019; 42:656-662. [PMID: 31020665 PMCID: PMC6605000 DOI: 10.1002/clc.23188] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end-stage kidney disease (ESKD). HYPOTHESIS We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. METHODS This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain-natriuretic peptide, high-sensitive cardiac troponin T (hs-cTnT), and high-sensitive C-reactive protein (hs-CRP). MACE was defined as a composite event of all-cause death, acute coronary syndrome, and stroke. RESULTS During a mean follow-up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs-cTnT (adjusted HR, 2.77; P < .05), and hs-CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs-CRP, 4.42 for abnormal ABI + hs-cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). CONCLUSION Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.
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Gonai T, Toya Y, Nakamura S, Kawasaki K, Yanai S, Fujita Y, Uesugi N, Kimura T, Otsuka K, Sugai T, Matsumoto T. Gastrointestinal: Idiopathic myointimal hyperplasia of mesenteric veins. J Gastroenterol Hepatol 2018; 33:1939. [PMID: 30084114 DOI: 10.1111/jgh.14384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/09/2018] [Indexed: 12/09/2022]
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Otsuka K, Shimada K, Katayama H, Nakamura H, Ishikawa H, Takeda H, Fujimoto K, Kasayuki N, Yoshiyama M. Prognostic significance of renal dysfunction and its change pattern on outcomes in patients with acute coronary syndrome treated with emergent percutaneous coronary intervention. Heart Vessels 2018; 34:735-744. [DOI: 10.1007/s00380-018-1291-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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Villiger M, Otsuka K, Karanasos A, Doradla P, Ren J, Lippok N, Shishkov M, Daemen J, Diletti R, van Geuns RJ, Zijlstra F, van Soest G, Libby P, Regar E, Nadkarni SK, Bouma BE. Coronary Plaque Microstructure and Composition Modify Optical Polarization: A New Endogenous Contrast Mechanism for Optical Frequency Domain Imaging. JACC Cardiovasc Imaging 2018; 11:1666-1676. [PMID: 29248662 PMCID: PMC5994172 DOI: 10.1016/j.jcmg.2017.09.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to evaluate whether polarimetry, performed using a modified optical frequency domain imaging (OFDI) system, can improve the assessment of histological features relevant to characterizing human coronary atherosclerosis. BACKGROUND The microscopic structure and organization of the arterial wall influence the polarization of the infrared light used by OFDI. Modification of the OFDI apparatus, along with recently developed image reconstruction methods, permits polarimetric measurements simultaneously with conventional OFDI cross-sectional imaging through standard intravascular imaging catheters. METHODS The main coronary arteries of 5 cadaveric human hearts were imaged with an OFDI system capable of providing polarimetric assessment. Cross-sectional views of tissue birefringence, measured in refractive index units, and depolarization, expressed as the ratio of depolarized signal to total intensity, were reconstructed, together with conventional OFDI images. Following imaging, the vessels underwent histological evaluation to enable interpretation of the observed polarization features of individual tissue components. RESULTS Birefringence in fibrous tissue was significantly higher than in intimal tissue with minimal abnormality (0.44 × 10-3 vs. 0.33 × 10-3; p < 0.0001). Birefringence was highest in the tunica media (p < 0.0001), consistent with its high smooth muscle cell content, cells known to associate with birefringence. In fibrous areas, birefringence showed fine spatial features and close correspondence with the histological appearance of collagen. In contrast, necrotic cores and regions rich in lipid elicited significant depolarization (p < 0.0001). Depolarization was also evident in locations of cholesterol crystals and macrophages. CONCLUSIONS Intravascular measurements of birefringence and depolarization can be obtained using conventional OFDI catheters in conjunction with a modified console and signal processing algorithms. Polarimetric measurements enhance conventional OFDI by providing additional information related to the tissue composition and offer quantitative metrics enabling characterization of plaque features.
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Villiger M, Braaf B, Lippok N, Otsuka K, Nadkarni SK, Bouma BE. Optic axis mapping with catheter-based polarization-sensitive optical coherence tomography. OPTICA 2018; 5:1329-1337. [PMID: 31214632 PMCID: PMC6581518 DOI: 10.1364/optica.5.001329] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Birefringence offers an intrinsic contrast mechanism related to the microstructure and arrangement of fibrillary tissue components. Here we present a reconstruction strategy to recover not only the scalar amount of birefringence but also its optic axis orientation as a function of depth in tissue from measurements with catheter-based polarization sensitive optical coherence tomography. A polarization symmetry constraint, intrinsic to imaging in the backscatter direction, facilitates the required compensation for wavelength-dependent transmission through system elements, the rotating catheter, and overlying tissue layers. Applied to intravascular imaging of coronary atherosclerosis in human patients, the optic axis affords refined interpretation of plaque architecture.
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Taniguchi Y, Tamiya A, Inagaki Y, Saijo N, Naoki Y, Otsuka K, Nakao K, Okishio K, Atagi S. P3.01-99 Effect of Pembrolizumab on Patients Harboring Uncommon Epidermal Growth Factor Receptor Mutations. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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