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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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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] [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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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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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] [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: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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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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] [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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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] [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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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] [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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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] [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] [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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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] [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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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 PMCID: PMC4747916 DOI: 10.1152/ajpheart.00527.2015] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [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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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] [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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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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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] [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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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] [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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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] [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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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: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [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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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. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 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] [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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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] [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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