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Ekström K, Jensen MRJ, Holmvang L, Joshi FR, Iversen AZ, Madsen PL, Olsen NT, Pedersen F, Sørensen R, Tilsted HH, Engstrøm T, Lønborg J. Organized thrombus is a frequent underlying feature in culprit lesion morphology in non-ST-elevation myocardial infarction. A study using optical coherence tomography and magnetic resonance imaging. Int J Cardiovasc Imaging 2024; 40:441-449. [PMID: 38123868 PMCID: PMC10884357 DOI: 10.1007/s10554-023-03005-7] [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] [Received: 08/03/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
The concept that the culprit lesion in non-ST segment elevation myocardial infarction (NSTEMI) is caused by sudden plaque rupture with acute thrombus formation has recently been challenged. While angiography is an old gold-standard for culprit identification it merely visualizes the lumen contour. Optical coherence tomography (OCT) provides a detailed view of culprit features. Combined with myocardial edema on cardiac magnetic resonance (CMR), indicating acute ischemia and thus culprit location, we aimed to characterize culprit lesions using OCT. Patients with NSTEMI referred for angiography were prospectively enrolled. OCT was performed on angiographic stenoses ≥50% and on operator-suspected culprit lesions. Hierarchical OCT-culprit identifiers were defined in case of multiple unstable lesions, including OCT-defined thrombus age. An OCT-based definition of an organizing thrombus as corresponding to histological early healing stage was introduced. Lesions were classified as OCT-culprit or non-culprit, and characteristics compared. CMR was performed in a subset of patients. We included 65 patients with 97 lesions, of which 49 patients (75%) had 53 (54%) OCT-culprit lesions. The most common OCT-culprit identifiers were the presence of acute (66%) and organizing thrombus (19%). Plaque rupture was visible in 45% of OCT-culprit lesions. CMR performed in 38 patients revealed myocardial oedema in the corresponding territories of 67% of acute thrombi and 50% of organizing thrombi. A culprit lesion was identified by OCT in 75% patients with NSTEMI. Acute thrombus was the most frequent feature followed by organizing thrombus. Applying specific OCT-criteria to identify the culprit could prove valuable in ambiguous cases.
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Affiliation(s)
- Kathrine Ekström
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark.
| | - Maria Radu Juul Jensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark
| | - Francis Richard Joshi
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark
| | - Allan Zeeberg Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Frants Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Hans-Henrik Tilsted
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark.
| | - Jacob Lønborg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark
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Uddin MN, Emran TB. Prevention of Progression and Remission in Public Health Sectors: Bangladesh Perspectives. ATLANTIS HIGHLIGHTS IN CHEMISTRY AND PHARMACEUTICAL SCIENCES 2023:131-150. [DOI: 10.2991/978-94-6463-130-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Effect of Extended Lipid Core on the Hemodynamic Parameters: A Fluid-Structure Interaction Approach. Appl Bionics Biomech 2022; 2022:2047549. [PMID: 35342456 PMCID: PMC8947935 DOI: 10.1155/2022/2047549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Myocardial infarction is one of the leading causes of death in the developed countries. A majority of myocardial infarctions are caused by the rupture of coronary artery plaques. In order to achieve a better understanding of the effect of the extension of the lipid core into the artery wall on the change of flow field and its effect on plaque vulnerability, we have studied the hemodynamic parameters by utilizing a finite element method and taking into account the fluid-structure interaction (FSI). Four groups of stenosis models with different sizes of lipid core were used in the study. The fully developed pulsatile velocity profile of the right coronary artery was used as the inlet boundary condition, and the pressure pulse was applied as the outlet boundary condition. The non-Newtonian Carreau model was used to simulate the non-Newtonian behavior of blood. Results indicate that the extension of the lipid core into the artery wall influences the flow field; subsequently, creates favorable conditions for additional development of the lipid core which can lead to a higher risk of plaque rupture.
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Won SY, Cha J, Choi HS, Kim YD, Nam HS, Heo JH, Lee SK. High-Resolution Intracranial Vessel Wall MRI Findings Among Different Middle Cerebral Artery Territory Infarction Types. Korean J Radiol 2022; 23:333-342. [PMID: 35213096 PMCID: PMC8876648 DOI: 10.3348/kjr.2021.0615] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/13/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Intracranial atherosclerotic stroke occurs through various mechanisms, mainly by artery-to-artery embolism (AA) or branch occlusive disease (BOD). This study evaluated the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries among different MCA territory infarction types using vessel wall magnetic resonance imaging (VW-MRI). Materials and Methods We retrospectively enrolled patients with acute MCA infarction who underwent VW-MRI. Thirty-four patients were divided into three groups according to infarction pattern: 1) BOD, 2) both BOD and AA (BOD-AA), and 3) AA. To determine the factors related to BOD, the BOD and BOD-AA groups were combined into one group (with striatocapsular infarction [BOD+]) and compared with the AA group. To determine the factors related to AA, the BOD-AA and AA groups were combined into another group (with cortical infarction [AA+]) and compared with the BOD group. Plaque morphology and the spatial relationship between the perforating artery orifice and plaque were evaluated both quantitatively and qualitatively. Results The plaque margin in the BOD+ group was closer to the perforating artery orifice than that in the AA group (p = 0.011), with less enhancing plaque (p = 0.030). In the BOD group, plaques were mainly located on the dorsal (41.2%) and superior (41.2%) sides where the perforating arteries mainly arose. No patient in the AA group had overlapping plaques with perforating arteries at the cross-section where the perforator arose. Perforating arteries associated with culprit plaques were most frequently located in the middle two-thirds of the M1 segment (41.4%). The AA+ group had more stenosis (%) than the BOD group (39.73 ± 24.52 vs. 14.42 ± 20.96; p = 0.003). Conclusion The spatial relationship between the perforating artery orifice and plaque varied among different types of MCA territory infarctions. In patients with BOD, the plaque margin was closer and blocked the perforating artery orifice, and stenosis degree and enhancement were less than those in patients with AA.
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Affiliation(s)
- So Yeon Won
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Cha
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Hyun Seok Choi
- Department of Radiology, Seoul Medical Center, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zhang X, Cheng M, Gao N, Li Y, Yan C, Tian X, Liu D, Qiu M, Wang X, Luan B, Deng J, Wang S, Tian H, Wang G, Ma X, Stone GW, Han Y. Utility of S100A12 as an Early Biomarker in Patients With ST-Segment Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:747511. [PMID: 34977174 PMCID: PMC8718434 DOI: 10.3389/fcvm.2021.747511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 01/16/2023] Open
Abstract
Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral events (MACCE) defined as a composite of all-cause death, MI, stroke, or hospitalization for heart failure.Results: A total of 438/1023 patients (42.8%) in the diagnosis cohort were adjudicated as STEMI, among whom plasma S100A12 levels increased within 30 min and peaked 1–2 h after symptom onset. Compared with high-sensitivity cardiac troponin T and creatine kinase-MB isoenzyme, S100A12 more accurately identified STEMI, especially within the first 2 h after symptom onset (area under the curve 0.963 compared with 0.860 for hscTnT and 0.711 for CK-MB, both P < 0.05). These results were consistent in the 243-patient validation cohort. The 1-year rate of MACCE was greatest in patients in the highest peak S100A12 tertile, intermediate in the middle tertile and least in the lowest tertile (9.3 vs. 5.7 vs. 3.0% respectively, Ptrend = 0.0006). By multivariable analysis the peak plasma concentration of S100A12 was an independent predictor of MACCE within 1 year after STEMI (HR, 1.001, 95%CI, 1.000–1.002; P = 0.0104).Conclusions and Relevance: S100A12 rapidly identified patients with STEMI, more accurately than other cardiac biomarkers, especially within the first 2 h after symptom onset. The peak plasma S100A12 level was a strong predictor of 1-year prognosis after STEMI.
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Affiliation(s)
- Xiaolin Zhang
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Minghui Cheng
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Naijing Gao
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Chenghui Yan
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaoxiang Tian
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Dan Liu
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Miaohan Qiu
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Bo Luan
- Department of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Jie Deng
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shouli Wang
- Department of Cardiology, General Hospital of the Strategic Support Force of the Chinese People's Liberation Army, Beijing, China
| | - Hongyan Tian
- Department of Cardiology First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Geng Wang
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xinliang Ma
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart and the Cardiovascular Research Foundation, New York, NY, United States
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Yaling Han
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Fang C, Yin Y, Jiang S, Zhang S, Wang J, Wang Y, Li L, Wang Y, Guo J, Yu H, Wei G, Lei F, Chen T, Ren X, Tan J, Xing L, Hou J, Dai J, Yu B. Increased Vulnerability and Distinct Layered Phenotype at Culprit and Nonculprit Lesions in STEMI Versus NSTEMI. JACC Cardiovasc Imaging 2021; 15:672-681. [PMID: 34538628 DOI: 10.1016/j.jcmg.2021.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to investigate the pancoronary plaque vulnerability (including culprit and nonculprit lesions) and layered phenotype in patients with ST-segment elevation myocardial infarction (STEMI) vs non-STEMI (NSTEMI). BACKGROUND Pancoronary vulnerability should account for distinct clinical manifestations of acute myocardial infarction (AMI). Layered plaque is indicative of previous coronary destabilization and thrombosis. METHODS A total of 464 patients with AMI who underwent 3-vessel optical coherence tomography imaging were consecutively studied and divided into a STEMI group (318 patients; 318 culprit and 1,187 nonculprit plaques) and a NSTEMI group (146 patients; 146 culprit and 560 nonculprit plaques). Patients were followed up for a median period of 2 years. RESULTS Compared with NSTEMI, culprit lesions in STEMI had more plaque rupture, thrombus, thin-cap fibroatheroma (TCFA), calcification, macrophage accumulation, and microvessels. The prevalence of plaque rupture (8.2% vs 4.8%; P = 0.018), microvessels (57.5% vs 45.2%; P < 0.001), and calcification (40.7% vs 30.2%; P = 0.003) at nonculprit lesions was higher in STEMI than NSTEMI. The layer area and thickness at the culprit and nonculprit lesions were significantly larger in STEMI than in NSTEMI. Multivariate analyses showed that culprit layer area (odds ratio: 1.443; 95% CI: 1.138-1.830; P = 0.002) was predictive of STEMI (vs NSTEMI), in addition to culprit TCFA, culprit thrombus, and non-left circumflex artery location of the culprit lesion. Although the type of AMI was not related to clinical outcomes, high-sensitivity C-reactive protein, culprit calcified nodule, and nonculprit TCFA predicted the 2-year major adverse cardiovascular events in patients with AMI. CONCLUSIONS Patients with STEMI had increased plaque vulnerability (ie, more plaque rupture and microvessels) and distinct layered phenotype at the culprit and nonculprit lesions compared with NSTEMI patients. Culprit lesion features of large layer area, TCFA, thrombus, and non-left circumflex artery location predicted the clinical presentation of STEMI.
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Affiliation(s)
- Chao Fang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yanwei Yin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Senqing Jiang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shaotao Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jifei Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yidan Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Junchen Guo
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Guo Wei
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Fangmeng Lei
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tao Chen
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xuefeng Ren
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jinfeng Tan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lei Xing
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
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Chezar-Azerrad C, Garcia-Garcia HM, Dan K, Barriola R, Kuku KO, Beyene SS, Melaku GD, Shlofmitz E, Yerasi C, Case BC, Forrestal BJ, Ben-Dor I, Medranda GA, Hashim H, De Maria GL, Campos CM, Bourantas C, Waksman R. Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome. Expert Rev Cardiovasc Ther 2021; 19:141-149. [PMID: 33261531 DOI: 10.1080/14779072.2021.1857732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Areas covered:In this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients.Expert opinion:Although the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases of plaque erosion, which generally occurs in younger patients presenting with an acute coronary syndrome that have TIMI flow of 2/3 and either a small or large burden of thrombus and underlying stenosis of less than 50%.
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Affiliation(s)
- Chava Chezar-Azerrad
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kazuhiro Dan
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Rodrigo Barriola
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Solomon S Beyene
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gebremedhin D Melaku
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Evan Shlofmitz
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Giorgio A Medranda
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Giovanni Luigi De Maria
- Cardiology Department, Heart Centre - John Radcliffe Hospital - Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Carlos M Campos
- Hospital Israelita Albert Einstein, São Paulo, Brazil and Instituto Do Coração (Incor), Faculdade De Medicina Da Universidade De São Paulo, São Paulo, SP, Brazil
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, UK
| | - Ron Waksman
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
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Association of systemic inflammatory biomarkers with morphological characteristics of coronary atherosclerotic plaque by intravascular optical coherence tomography. Hellenic J Cardiol 2020; 62:101-106. [PMID: 32628997 DOI: 10.1016/j.hjc.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite significant advances in preventive, medical, and interventional management, coronary artery disease remains the leading cause of death worldwide. We now know that in the majority of acute coronary syndromes, a thrombotic event is triggered either by the rupture or erosion of the so-called high-risk or 'vulnerable' plaque. However, accurately identifying the individual who is at significant risk of acute event remains the holy grail of preventive cardiology. To better stratify an individual's risk of developing and suffering a cardiovascular event, biomarkers are needed that can accurately predict coronary events and, if possible, monitor disease activity in response to medical or interventional therapies. In order to be able to understand the association of these biomarkers with the morphological substrate of high-risk plaques, intravascular imaging modalities can provide invaluable assistance. Novel imaging tools such as optical coherence tomography (OCT) have not only helped in identifying atherosclerotic plaque characteristics that are unstable but also in estimating global plaque burden. In this study, we provide an overview of our current knowledge of association of various inflammatory markers with atherosclerotic plaque characteristics seen on OCT.
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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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Affiliation(s)
- Pallavi Doradla
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenichiro Otsuka
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhijay Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonios Karanasos
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laurens van Zandvoort
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jouke Dijkstra
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thorax center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Brett E. Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,,Harvard-Massachusetts Institute of Technology, Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Seemantini K. Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,,Address for correspondence: Seemantini K. Nadkarni, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA, 02114, , Phone: 617-724-1381, Fax: 617-726-4103
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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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Affiliation(s)
- Kenichiro Otsuka
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonios Karanasos
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
| | - Laurens J C van Zandvoort
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pallavi Doradla
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jian Ren
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Norman Lippok
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roberto Diletti
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert-Jan van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiology of Radboud UMC, Nijmegen, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gijs van Soest
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Seemantini K Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Brett E Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Lee KY, Chang K. Understanding Vulnerable Plaques: Current Status and Future Directions. Korean Circ J 2019; 49:1115-1122. [PMID: 31760703 PMCID: PMC6875591 DOI: 10.4070/kcj.2019.0211] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
The main cause of acute myocardial infarction is plaque rupture accompanied by superimposed coronary thrombosis. Thin-cap fibroatheromas (TCFAs) have been suggested as a type of lesion with a vulnerability that can cause plaque rupture. However, not only the existence of a TCFA but also the fine and complex interactions of other anatomical and hemodynamic factors, such as microcalcification in the fibrous cap, cholesterol crystal-induced inflammasome activation, the apoptosis of intraplaque macrophages, and endothelial shear stress distribution should precede a clinical event caused by plaque rupture. Recent studies are being conducted to identify these mechanisms through molecular imaging and hemodynamic assessment using computational fluid dynamics, which will result in better clinical results through selective coronary interventions.
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Affiliation(s)
- Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Relation of coronary culprit lesion morphology determined by optical coherence tomography and cardiac outcomes to preinfarction angina in patients with acute myocardial infarction. Int J Cardiol 2018; 269:356-361. [PMID: 30060967 DOI: 10.1016/j.ijcard.2018.07.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/01/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND While preinfarction angina pectoris (pre-IA) is recognized as favorable effects on acute myocardial infarction (AMI), the detail has not been fully investigated. The aims of the current study were to clarify patient characteristics, lesion morphologies determined by optical coherence tomography (OCT), and cardiac outcomes related to pre-IA in patients with AMI. METHODS Clinical data and outcomes were compared between AMI patients with pre-IA (pre-IA group, n = 507) and without pre-IA (non-pre-IA group, n = 653). Angiography and OCT findings were analyzed in patients with pre-intervention OCT and compared between groups of pre-IA (n = 219) and non-pre-IA (n = 269). RESULTS ST-segment elevation myocardial infarction (61% vs. 75%, p < 0.001) and cardiogenic shock (8% vs. 14%, p = 0.001) were less prevalent in pre-IA group. Peak creatine kinase-MB levels were lower in pre-IA group (median 83 IU/mL vs. 126 IU/mL, p < 0.001). In pre-intervention coronary angiography findings, initial TIMI flow grade 0/1 (43% vs. 56%, p = 0.019) and Rentrop collateral circulation 0/1 (69% vs. 79%, p = 0.018) were less frequently observed in pre-IA than in non-pre-IA patients. In post-thrombectomy OCT images, plaque rupture (39% vs. 56%, p = 0.003) and red thrombi (42% vs. 54%, p = 0.027) were also less frequently observed in pre-IA group. Kaplan-Meier estimate survival curves showed that cardiac death at 12-months was lower in pre-IA group than in non-pre-IA group (6.9% vs. 10.1%, p = 0.036). CONCLUSIONS Patients with pre-IA had less severe AMI on admission, smaller infarction size, and more favorable long-term survival, which may be caused by difference of lesion morphology between patients with and without pre-IA.
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Žaliaduonytė-Pekšienė D, Lesauskaitė V, Liutkevičienė R, Tamakauskas V, Kviesulaitis V, Šinkūnaitė-Maršalkienė G, Šimonytė S, Mačiulskytė S, Tamulevičiūtė-Prascienė E, Gustienė O, Tamošiūnas A, Žaliūnas R. Association of the genetic and traditional risk factors of ischaemic heart disease with STEMI and NSTEMI development. J Renin Angiotensin Aldosterone Syst 2017; 18:1470320317739987. [PMID: 29141503 PMCID: PMC5843915 DOI: 10.1177/1470320317739987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 10/06/2017] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION To evaluate the influence of traditional risk factors of ischaemic heart disease and genetic factors to predict different types of acute coronary syndromes. MATERIALS AND METHODS Five hundred and twenty-three patients with acute coronary syndromes (393 with ST elevation myocardial infarction (STEMI) and 130 with non-ST elevation myocardial infarction (NSTEMI)) comprised the study group. The control group consisted of 645 subjects free from symptoms of ischaemic heart disease and stroke. Genetic polymorphisms of MMP-2 (-735) C/T, MMP-2 (-1306) C/T, MMP-3 (-1171) 5A/6A, MMP-9 (-1562) C/T and ACE I/D were evaluated using polymerase chain reaction. RESULTS Patients with acute coronary syndromes more often had ID or II genotype than DD genotype of ACE ( P = 0.04) and 5A5A or 5A6A genotype than 6A6A genotype of MMP-3 ( P = 0.02) in comparison to the control group. The genotypes of other matrix metalloproteinase genes did not differ between the groups. 5A5A and 5A6A genotypes of MMP-3 (odds ratio (OR) 1.5; P = 0.021), II and ID genotypes of ACE (OR 1.7; P = 0.006) along with traditional ischaemic heart disease risk factors such as smoking (OR 4.9; P = 0.001), hypertension (OR 2.0; P = 0.001), diabetes mellitus (OR 2.9; P = 0.001) and dyslipidaemia (OR 2.1; P = 0.001) increased the risk of STEMI. However, the polymorphism of MMP-3 5A/6A and ACE I/D was not associated with the occurrence of NSTEMI. CONCLUSIONS Genetic polymorphisms of MMP-3 5A/6A and ACE I/D along with conventional ischaemic heart disease risk factors increase the risk of the occurrence of STEMI, while having no influence on the pathogenesis of NSTEMI.
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Affiliation(s)
| | - Vaiva Lesauskaitė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Rasa Liutkevičienė
- Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Vytenis Tamakauskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Vilius Kviesulaitis
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | | | - Sandrita Šimonytė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Simonita Mačiulskytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | | | - Olivija Gustienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Abdonas Tamošiūnas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Remigijus Žaliūnas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
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Bae YJ, Choi BS, Jung C, Yoon YH, Sunwoo L, Bae HJ, Kim JH. Differentiation of Deep Subcortical Infarction Using High-Resolution Vessel Wall MR Imaging of Middle Cerebral Artery. Korean J Radiol 2017; 18:964-972. [PMID: 29089829 PMCID: PMC5639162 DOI: 10.3348/kjr.2017.18.6.964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/16/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the utility of high-resolution vessel wall imaging (HR-VWI) of middle cerebral artery (MCA), and to compare HR-VWI findings between striatocapsular infarction (SC-I) and lenticulostriate infarction (LS-I). Materials and Methods This retrospective study was approved by the Institutional Review Board, and informed consent was waived. From July 2009 to February 2012, 145 consecutive patients with deep subcortical infarctions (SC-I, n = 81; LS-I, n = 64) who underwent HR-VWI were included in this study. The degree of MCA stenosis and the characteristics of MCA plaque (presence, eccentricity, location, extent, T2-high signal intensity [T2-HSI], and plaque enhancement) were analyzed, and compared between SC-I and LS-I, using Fisher's exact test. Results Stenosis was more severe in SC-I than in LS-I (p = 0.040). MCA plaque was more frequent in SC-I than in LS-I (p = 0.028), having larger plaque extent (p = 0.001), more T2-HSI (p = 0.001), and more plaque enhancement (p = 0.002). The eccentricity and location of the plaque showed no significant difference between the two groups. Conclusion Both SC-I and LS-I have similar HR-VWI findings of the MCA plaque, but SC-I had more frequent, larger plaques with greater T2-HSI and enhancement. This suggests that HR-VWI may have a promising role in assisting the differentiation of underlying pathophysiological mechanism between SC-I and LS-I.
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Affiliation(s)
- Yun Jung Bae
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yeon Hong Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Wieringa WG, Lexis CPH, Lipsic E, van der Werf HW, Burgerhof JGM, Hagens VE, Bartels GL, Broersen A, Schurer RA, Tan ES, van der Harst P, van den Heuvel AFM, Willems TP, Pundziute G. In vivo coronary lesion differentiation with computed tomography angiography and intravascular ultrasound as compared to optical coherence tomography. J Cardiovasc Comput Tomogr 2017; 11:111-118. [PMID: 28169175 DOI: 10.1016/j.jcct.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/20/2016] [Accepted: 01/14/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND In vitro studies have shown the feasibility of coronary lesion grading with computed tomography angiography (CTA), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) as compared to histology, whereas OCT had the highest discriminatory capacity. OBJECTIVE We investigated the ability of CTA and IVUS to differentiate between early and advanced coronary lesions in vivo, OCT serving as standard of reference. METHODS Multimodality imaging was prospectively performed in 30 NSTEMI patients. Plaque characteristics were assessed in 1083 cross-sections of 30 culprit lesions, co-registered among modalities. Absence of plaque, fibrous and fibrocalcific plaque on OCT were defined as early plaque, whereas lipid rich-plaque on OCT was defined as advanced plaque. Odds ratios adjusted for clustering were calculated to assess associations between plaque types on CTA and IVUS with early or advanced plaque. RESULTS Normal findings on CTA as well as on IVUS were associated with early plaque. Non-calcified, calcified plaques and the napkin ring sign on CTA were associated with advanced plaque. On IVUS, fatty and calcified plaques were associated with advanced plaque. CONCLUSIONS In vivo coronary plaque characteristics on CTA and IVUS are associated with plaque characteristics on OCT. Of note, normal findings on CTA and IVUS relate to early lesions on OCT. Nevertheless, multiple plaque features on CTA and IVUS are related to advanced plaques on OCT, which may make it difficult to use qualitative plaque assessment in clinical practice.
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Affiliation(s)
- Wouter G Wieringa
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Chris P H Lexis
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Erik Lipsic
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Hindrik W van der Werf
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Vincent E Hagens
- Ommelander Hospitals Group, Department of Cardiology, The Netherlands
| | - G Louis Bartels
- Martini Hospital, Department of Cardiology, Groningen, The Netherlands
| | - Alexander Broersen
- University of Leiden, Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden, The Netherlands
| | - Remco A Schurer
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Eng-Shiong Tan
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Ad F M van den Heuvel
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands
| | - Tineke P Willems
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Gabija Pundziute
- University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
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Afolabi A, Hu S, Wang C, Zhu Y, Mustafina I, Lin L, Zheng G, Zhe C, Jia H, Hou J, Yu B. Role of Optical Coherence Tomography in Diagnosis and Treatment of Patients with Acute Coronary Syndrome. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nishiguchi T, Tanaka A, Taruya A, Emori H, Ozaki Y, Orii M, Shiono Y, Shimamura K, Kameyama T, Yamano T, Yamaguchi T, Matsuo Y, Ino Y, Kubo T, Hozumi T, Hayashi Y, Akasaka T. Local Matrix Metalloproteinase 9 Level Determines Early Clinical Presentation of ST-Segment-Elevation Myocardial Infarction. Arterioscler Thromb Vasc Biol 2016; 36:2460-2467. [PMID: 27687605 DOI: 10.1161/atvbaha.116.308099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/13/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. APPROACH AND RESULTS This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively. We simultaneously investigated the culprit lesion morphologies using optical coherence tomography and inflammatory activities assessed by shedding matrix metalloproteinase 9 (MMP-9) and myeloperoxidase into the coronary circulation before and after stenting. Prevalence of plaque rupture, thin-cap fibroatheroma, and lipid arc or macrophage count was higher in patients with STEMI and non-STEMI than in those with stable angina pectoris. Red thrombus was frequently observed in STEMI compared with others. Local MMP-9 levels were significantly higher than systemic levels (systemic, 42.0 [27.9-73.2] ng/mL versus prestent local, 69.1 [32.2-152.3] ng/mL versus poststent local, 68.0 [35.6-133.3] ng/mL; P<0.01). Poststent local MMP-9 level was significantly elevated in patients with STEMI (STEMI, 109.9 [54.5-197.8] ng/mL versus non-STEMI: 52.9 [33.0-79.5] ng/mL; stable angina pectoris, 28.3 [14.2-40.0] ng/mL; P<0.01), whereas no difference was observed in the myeloperoxidase level. Poststent local MMP-9 and the presence of red thrombus are the independent determinants for STEMI in multivariate analysis. CONCLUSIONS Local MMP-9 level could determine the early clinical presentation in patients with MI. Local inflammatory activity for atherosclerosis needs increased attention.
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Affiliation(s)
- Tsuyoshi Nishiguchi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Atsushi Tanaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
| | - Akira Taruya
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Hiroki Emori
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yuichi Ozaki
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Makoto Orii
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yasutsugu Shiono
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Kunihiro Shimamura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takeyoshi Kameyama
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takashi Yamano
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Tomoyuki Yamaguchi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yoshiki Matsuo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yasushi Ino
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takashi Kubo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takeshi Hozumi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yasushi Hayashi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takashi Akasaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
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Kobayashi N, Takano M, Hata N, Kume N, Tsurumi M, Shirakabe A, Okazaki H, Shibuya J, Shiomura R, Nishigoori S, Seino Y, Shimizu W. Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study. Cardiology 2016; 135:56-65. [PMID: 27271099 DOI: 10.1159/000445994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The present study sought to clarify the relationship between matrix metalloproteinase-9 (MMP-9) levels and plaque morphology demonstrated by optical coherence tomography (OCT), and to examine their prognostic impacts in patients with acute coronary syndrome (ACS). METHODS MMP-9 levels were measured for patients with ACS (n = 249). Among 249 patients, 120 with evaluable OCT images were categorized into patients with ruptured plaques (n = 65) and those with nonruptured plaques (n = 55) on the basis of culprit lesion plaque morphology demonstrated by OCT. RESULTS MMP-9 levels on admission were significantly higher in the rupture group than in the nonrupture group (p = 0.029). Although creatine kinase-MB (CK-MB) on admission was comparable between the groups, peak CK-MB was higher in the rupture group than in the nonrupture group (p < 0.001). By receiver operating characteristic curve analysis, the optimal cut-off value of MMP-9 to detect ruptured plaques was 65.5 ng/ml (p = 0.029). There was a nonstatistically significant trend toward increased cardiac death at 2 years (5.9 vs. 1.0%, p = 0.059) in patients with high MMP-9 (≥65.5 ng/ml) compared to those with low MMP-9 (<65.5 ng/ml). CONCLUSIONS MMP-9 can differentiate ACS with ruptured plaques from nonruptured plaques, and MMP-9 may be a valuable predictor of long-term cardiac mortality in patients with ACS reflecting plaque rupture.
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Affiliation(s)
- Nobuaki Kobayashi
- Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
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Zahnd G, Schrauwen J, Karanasos A, Regar E, Niessen W, van Walsum T, Gijsen F. Fusion of fibrous cap thickness and wall shear stress to assess plaque vulnerability in coronary arteries: a pilot study. Int J Comput Assist Radiol Surg 2016; 11:1779-90. [PMID: 27236652 PMCID: PMC5034011 DOI: 10.1007/s11548-016-1422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/11/2016] [Indexed: 12/16/2022]
Abstract
Purpose Identification of rupture-prone plaques in coronary arteries is a major clinical challenge. Fibrous cap thickness and wall shear stress are two relevant image-based risk factors, but these two parameters are generally computed and analyzed separately. Accordingly, combining these two parameters can potentially improve the identification of at-risk regions. Therefore, the purpose of this study is to investigate the feasibility of the fusion of wall shear stress and fibrous cap thickness of coronary arteries in patient data. Methods Fourteen patients were included in this pilot study. Imaging of the coronary arteries was performed with optical coherence tomography and with angiography. Fibrous cap thickness was automatically quantified from optical coherence tomography pullbacks using a contour segmentation approach based on fast marching. Wall shear stress was computed by applying computational fluid dynamics on the 3D volume reconstructed from two angiograms. The two parameters then were co-registered using anatomical landmarks such as side branches. Results The two image modalities were successfully co-registered, with a mean (±SD) error corresponding to \documentclass[12pt]{minimal}
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\begin{document}$$8.6\,\pm \,6.7\,\%$$\end{document}8.6±6.7% of the length of the analyzed region. For all the analyzed participants, the average thinnest portion of each fibrous cap was \documentclass[12pt]{minimal}
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\begin{document}$$129\,\pm \,69\,\upmu \text {m}$$\end{document}129±69μm, and the average WSS value at the location of the fibrous cap was \documentclass[12pt]{minimal}
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\begin{document}$$1.46\,\pm \,1.16\,\text {Pa}$$\end{document}1.46±1.16Pa. A unique index was finally generated for each patient via the fusion of fibrous cap thickness and wall shear stress measurements, to translate all the measured parameters into a single risk map. Conclusion The introduced risk map integrates two complementary parameters and has potential to provide valuable information about plaque vulnerability.
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Affiliation(s)
- Guillaume Zahnd
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
| | - Jelle Schrauwen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Antonios Karanasos
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Wiro Niessen
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Frank Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
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22
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Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study. Int J Cardiol 2016; 209:139-41. [DOI: 10.1016/j.ijcard.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/20/2022]
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Zheng G, Li Y, Takayama T, Nishida T, Sudo M, Haruta H, Fukamachi D, Okubo K, Higuchi Y, Hiro T, Saito S, Hirayama A. The Spatial Distribution of Plaque Vulnerabilities in Patients with Acute Myocardial Infarction. PLoS One 2016; 11:e0152825. [PMID: 27031514 PMCID: PMC4816424 DOI: 10.1371/journal.pone.0152825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/03/2016] [Indexed: 11/28/2022] Open
Abstract
Objective Although the plaque characteristics have been recognized in patients with acute myocardial infarction (AMI), the plaque spatial distribution is not well clarified. Using color-mapping intravascular ultrasound (iMAP-IVUS), we examined culprit lesions to clarify plaque morphology, composition and spatial distribution of the sites of potential vulnerability. Methods Sixty-eight culprit lesions in 64 consecutive AMI patients who underwent angiography and IVUS examinations before intervention were analyzed. Plaque morphology and composition were quantified with iMAP-IVUS. The spatial distribution of the sites of potential vulnerability was assessed with longitudinal reconstruction of the consecutive IVUS images. The plaque characteristics were also compared between ruptured and non-ruptured lesions, and between totally occlusive (TO) and non-TO lesions. Results The sites with maximum necrotic area (maxNA), maximum plaque burden (maxPB) and most severely narrowed (minimal luminal area, MLA) were recognized vulnerability. In the majority of cases, maxNA sites were proximal to the maxPB sites, and MLA sites were distal to the maxNA and maxPB sites. Ruptures usually occurred close to maxNA sites and proximal to maxPB and MLA sites. The average distance from the site of rupture to the maxNA site was 0.33 ± 4.04 mm. Ruptured lesions showed significant vessel remodeling, greater plaque volume, and greater lipidic volume compared to those of non-ruptured lesions. Both the length and plaque burden (PB) of TO lesions were greater than those of non-TO lesions. Conclusions Instead of overlapping on maxPB sites, most maxNA sites are proximal to the maxPB sites and are the sites most likely to rupture. Plaque morphology and composition play critical roles in plaque rupture and coronary occlusion.
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Affiliation(s)
- Guian Zheng
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Department of Cardiology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Yuxin Li
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- * E-mail:
| | - Tadateru Takayama
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Toshihiko Nishida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Hironori Haruta
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Kimie Okubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Yoshiharu Higuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Takafumi Hiro
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Satoshi Saito
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Atsushi Hirayama
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
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Toutouzas K, Karanasos A, Tousoulis D. Optical Coherence Tomography For the Detection of the Vulnerable Plaque. Eur Cardiol 2016; 11:90-95. [PMID: 30310454 DOI: 10.15420/ecr.2016:29:2] [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: 01/07/2023] Open
Abstract
Morphological characteristics of the atheromatous plaque have been associated with the development of plaque rupture and the pathogenesis of acute coronary syndromes (ACS). Plaques with a specific morphological phenotype that are at high risk of causing ACS are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that enables detailed visualization of atheromatous plaques. Consequently, OCT is a valuable research tool for examining the role of morphological characteristics of atheromatous plaques in the progression of coronary artery disease and plaque destabilisation, which leads to the clinical manifestation of ACS. This article summarises the pathophysiological insights obtained by OCT imaging in the formation and rupture of the vulnerable plaque.
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Genetic Variants on Chromosome 1p13.3 Are Associated with Non-ST Elevation Myocardial Infarction and the Expression of DRAM2 in the Finnish Population. PLoS One 2015; 10:e0140576. [PMID: 26509668 PMCID: PMC4625034 DOI: 10.1371/journal.pone.0140576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/26/2015] [Indexed: 12/20/2022] Open
Abstract
Myocardial infarction (MI) is divided into either ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), differing in a number of clinical characteristics. We sought to identify genetic variants conferring risk to NSTEMI or STEMI by conducting a genome-wide association study (GWAS) of MI stratified into NSTEMI and STEMI in a consecutive sample of 1,579 acute MI cases with 1,576 controls. Subsequently, we followed the results in an independent population-based sample of 562 cases and 566 controls, a partially independent prospective cohort (N = 16,627 with 163 incident NSTEMI cases), and examined the effect of disease-associated variants on gene expression in 513 healthy participants. Genetic variants on chromosome 1p13.3 near the damage-regulated autophagy modulator 2 gene DRAM2 associated with NSTEMI (rs656843; odds ratio 1.57, P = 3.11 × 10−10) in the case-control analysis with a consistent but not statistically significant effect in the prospective cohort (rs656843; hazard ratio 1.13, P = 0.43). These variants were not associated with STEMI (rs656843; odds ratio, 1.11, P = 0.20; hazard ratio 0.97, P = 0.87), appearing to have a pronounced effect on NSTEMI risk. A majority of the variants at 1p13.3 associated with NSTEMI were also associated with the expression level of DRAM2 in blood leukocytes of healthy controls (top-ranked variant rs325927, P = 1.50 × 10−12). The results suggest that genetic factors may in part influence whether coronary artery disease results in NSTEMI rather than STEMI.
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26
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Iannaccone M, Quadri G, Taha S, D'Ascenzo F, Montefusco A, Omede' P, Jang IK, Niccoli G, Souteyrand G, Yundai C, Toutouzas K, Benedetto S, Barbero U, Annone U, Lonni E, Imori Y, Biondi-Zoccai G, Templin C, Moretti C, Luscher TF, Gaita F. Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis. Eur Heart J Cardiovasc Imaging 2015; 17:1128-37. [PMID: 26508517 DOI: 10.1093/ehjci/jev283] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023] Open
MESH Headings
- Acute Coronary Syndrome/diagnostic imaging
- Acute Coronary Syndrome/mortality
- Acute Coronary Syndrome/therapy
- Aged
- Angina, Stable/diagnostic imaging
- Angina, Stable/mortality
- Angina, Stable/therapy
- Angina, Unstable/diagnostic imaging
- Angina, Unstable/mortality
- Angina, Unstable/therapy
- Coronary Angiography/methods
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/epidemiology
- Coronary Artery Disease/pathology
- Female
- Humans
- Male
- Middle Aged
- Myocardial Infarction/diagnostic imaging
- Myocardial Infarction/mortality
- Myocardial Infarction/therapy
- Plaque, Atherosclerotic/diagnostic imaging
- Plaque, Atherosclerotic/epidemiology
- Plaque, Atherosclerotic/pathology
- Predictive Value of Tests
- Prevalence
- Prognosis
- Risk Assessment
- Rupture, Spontaneous/diagnostic imaging
- Rupture, Spontaneous/epidemiology
- Survival Analysis
- Tomography, Optical Coherence/methods
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Affiliation(s)
- Mario Iannaccone
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Quadri
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Salma Taha
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Montefusco
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Pierluigi Omede'
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Geraud Souteyrand
- Pole Cardiologie, Centre Hospitalier Universitaire de Clermont-Ferrant, Clermont-Ferrant, France
| | - Chen Yundai
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | | | - Sara Benedetto
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Umberto Barbero
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Umberto Annone
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Enrica Lonni
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | - Yoichi Imori
- Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan University Hospital, Zurich, Switzerland
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Claudio Moretti
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
| | | | - Fiorenzo Gaita
- Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy
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Toutouzas K, Benetos G, Karanasos A, Chatzizisis YS, Giannopoulos AA, Tousoulis D. Vulnerable plaque imaging: updates on new pathobiological mechanisms. Eur Heart J 2015; 36:3147-54. [DOI: 10.1093/eurheartj/ehv508] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/07/2015] [Indexed: 01/05/2023] Open
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Zahnd G, Karanasos A, van Soest G, Regar E, Niessen W, Gijsen F, van Walsum T. Quantification of fibrous cap thickness in intracoronary optical coherence tomography with a contour segmentation method based on dynamic programming. Int J Comput Assist Radiol Surg 2015; 10:1383-94. [PMID: 25740203 PMCID: PMC4563002 DOI: 10.1007/s11548-015-1164-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/13/2015] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Fibrous cap thickness is the most critical component of plaque stability. Therefore, in vivo quantification of cap thickness could yield valuable information for estimating the risk of plaque rupture. In the context of preoperative planning and perioperative decision making, intracoronary optical coherence tomography imaging can provide a very detailed characterization of the arterial wall structure. However, visual interpretation of the images is laborious, subject to variability, and therefore not always sufficiently reliable for immediate decision of treatment. METHODS A novel semiautomatic segmentation method to quantify coronary fibrous cap thickness in optical coherence tomography is introduced. To cope with the most challenging issue when estimating cap thickness (namely the diffuse appearance of the anatomical abluminal interface to be detected), the proposed method is based on a robust dynamic programming framework using a geometrical a priori. To determine the optimal parameter settings, a training phase was conducted on 10 patients. RESULTS Validated on a dataset of 179 images from 21 patients, the present framework could successfully extract the fibrous cap contours. When assessing minimal cap thickness, segmentation results from the proposed method were in good agreement with the reference tracings performed by a medical expert (mean absolute error and standard deviation of 22 ± 18 μm) and were similar to inter-observer reproducibility (21 ± 19 μm, R = .74), while being significantly faster and fully reproducible. CONCLUSION The proposed framework demonstrated promising performances and could potentially be used for online identification of high-risk plaques.
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Affiliation(s)
- Guillaume Zahnd
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands,
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Bouki KP, Sakkali E, Toutouzas K, Vlad D, Barmperis D, Phychari S, Riga M, Apostolou T, Stefanadis C. Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: An optical coherence tomography study. Catheter Cardiovasc Interv 2015; 86:237-46. [DOI: 10.1002/ccd.25855] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Eleni Sakkali
- Second Department of Cardiology; General Hospital of Nikea; Pireaus Greece
| | | | - Delia Vlad
- Second Department of Cardiology; General Hospital of Nikea; Pireaus Greece
| | | | - Stavroula Phychari
- Second Department of Cardiology; General Hospital of Nikea; Pireaus Greece
| | - Maria Riga
- First Department of Cardiology; University of Athens Medical School; Athens Greece
| | - Thomas Apostolou
- First Department of Cardiology; University of Athens Medical School; Athens Greece
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30
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Sinclair H, Bourantas C, Bagnall A, Mintz GS, Kunadian V. OCT for the Identification of Vulnerable Plaque in Acute Coronary Syndrome. JACC Cardiovasc Imaging 2015; 8:198-209. [DOI: 10.1016/j.jcmg.2014.12.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 12/22/2022]
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31
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Zivelonghi C, Ghione M, Kilickesmez K, Loureiro RE, Foin N, Lindsay A, de Silva R, Ribichini F, Vassanelli C, Di Mario C. Intracoronary optical coherence tomography: a review of clinical applications. J Cardiovasc Med (Hagerstown) 2015; 15:543-53. [PMID: 24922045 DOI: 10.2459/jcm.0000000000000032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Optical coherence tomography (OCT) is a light-based technology that provides very high spatial resolution images. OCT has been initially employed as a research tool to investigate plaque morphology and stent strut coverage. The introduction of frequency domain OCT allowing fast image acquisition during a prolonged contrast injection via the guiding catheter has made OCT applicable for guidance of coronary interventions. In this manuscript, the various applications of OCT are reviewed, from assessment of plaque vulnerability and severity to characteristics of unstable lesions and thrombus burden to stent optimization and evaluation of late results.
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Affiliation(s)
- Carlo Zivelonghi
- aCardiovascular Biomedical Research Unit, Royal Brompton Hospital bImperial College, London, UK cDepartment of Medicine, University of Verona, Verona, Italy
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Giannopoulos G, Pappas L, Synetos A, Hahalis G, Raisakis K, Papadimitriou C, Kossyvakis C, Alexopoulos D, Tousoulis D, Stefanadis C, Cleman MW, Deftereos S. Association of virtual histology characteristics of the culprit plaque with post-fibrinolysis flow restoration in ST-elevation myocardial infarction. Int J Cardiol 2014; 174:678-82. [PMID: 24809918 DOI: 10.1016/j.ijcard.2014.04.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Georgios Giannopoulos
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Hellenic Center for Disease Control and Prevention, Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Loukas Pappas
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | | | | | | | | | - Dimitrios Tousoulis
- 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Michael W Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Spyridon Deftereos
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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34
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Sanchez OD, Sakakura K, Otsuka F, Yahagi K, Virmani R, Joner M. Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology. Expert Rev Cardiovasc Ther 2014; 12:601-11. [PMID: 24738595 DOI: 10.1586/14779072.2014.902749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS) allowed the field to evaluate the principles of vascular anatomy, which is often underestimated by coronary angiography. Furthermore, IVUS image technologies were developed to obtain improved characterization of plaque composition. However, since spatial resolution of IVUS is insufficient to distinguish details of plaque morphology, a broad adoption of this technology in clinical practice was missing. Optical coherence tomography is a light-based imaging modality with higher spatial resolution compared to IVUS, which enables the assessment of vascular anatomy with great detail.
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35
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Takaoka N, Tsujita K, Kaikita K, Hokimoto S, Mizobe M, Nagano M, Horio E, Sato K, Nakayama N, Yoshimura H, Yamanaga K, Komura N, Kojima S, Tayama S, Nakamura S, Ogawa H. Comprehensive analysis of intravascular ultrasound and angiographic morphology of culprit lesions between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome. Int J Cardiol 2014; 171:423-30. [DOI: 10.1016/j.ijcard.2013.12.094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/26/2013] [Accepted: 12/21/2013] [Indexed: 11/28/2022]
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36
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Semi-automated Quantification of Fibrous Cap Thickness in Intracoronary Optical Coherence Tomography. INFORMATION PROCESSING IN COMPUTER-ASSISTED INTERVENTIONS 2014. [DOI: 10.1007/978-3-319-07521-1_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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37
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Legutko J, Jakala J, Mintz GS, Kaluza GL, Mrevlje B, Partyka L, Wizimirski M, Rzeszutko L, Richter A, Margolis P, Dudek D. Radiofrequency-intravascular ultrasound assessment of lesion coverage after angiography-guided emergent percutaneous coronary intervention in patients with non-ST elevation myocardial infarction. Am J Cardiol 2013; 112:1854-9. [PMID: 24063826 DOI: 10.1016/j.amjcard.2013.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
Using radiofrequency-intravascular ultrasound (VH-IVUS), we have previously demonstrated that in 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with optimal angiographic result, the stent does not fully cover the whole VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) related to the culprit lesion. Presently, we set out to extend these findings to 20 patients with non-STEMI with Thrombolysis In Myocardial Infarction flow 3 in the infarct-related artery before intervention who were then treated with angiography-guided direct stent implantation. The lesion was imaged with VH-IVUS before and after intervention, but the results were blinded to the operator. Plaque rupture site was identified in 8 lesions (40%), all proximal to the minimum lumen area (MLA) site. The maximum necrotic core site was found proximal to MLA in 18 lesions and at the MLA in 2 lesions. Although the plaque rupture site was fully covered with the stent in all lesions, an uncovered VH-TCFA was found in 7 lesions (35%), 4 in the proximal reference segment, 1 in the distal reference segment, and 2 in both the proximal and distal reference segments. In conclusion, in 35% of patients with non-STEMI undergoing angiography-guided emergent percutaneous coronary intervention, the stent does not fully cover a VH-TCFA related to the culprit lesion.
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Ghione M, Kýlýçkesmez K, Zivelonghi C, Estevez Loureiro R, Foin N, Mattesini A, Secco GG, Dall’Ara G, Rama-Merchan JC, de Silva R, Di Mario C. Intracoronary Optical Coherence Tomography: Experience and Indications for Clinical Use. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vergallo R, Yonetsu T, Kato K, Jia H, Abtahian F, Tian J, Hu S, McNulty I, Yu B, Biasucci LM, Crea F, Jang IK. Evaluation of culprit lesions by optical coherence tomography in patients with ST-elevation myocardial infarction. Int J Cardiol 2013; 168:1592-3. [DOI: 10.1016/j.ijcard.2013.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
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40
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Comparison of intravascular ultrasound and histological findings in culprit coronary plaques between ST-segment elevation and non-ST-segment elevation myocardial infarction. Am J Cardiol 2013; 112:68-72. [PMID: 23587281 DOI: 10.1016/j.amjcard.2013.02.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/22/2022]
Abstract
It remains uncertain whether the histology of culprit coronary plaques differs between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). We compared intravascular ultrasound (IVUS) and histologic findings in coronary culprit plaques among patients presenting with STEMI and NSTEMI. Atherectomy specimens were obtained from 96 patients, 70 with STEMI and 26 with NSTEMI, who underwent directional coronary atherectomy for de novo coronary artery lesions. IVUS examinations were performed before directional coronary atherectomy. IVUS and histologic data were analyzed. Clinical characteristics were largely similar between the 2 groups; however, normal antegrade flow before angioplasty was less frequently observed in patients with STEMI than those with NSTEMI. Plaque rupture was more common on the proximal side of the minimal lumen site. There were no differences in vessel area, lumen area, calcification, plaque burden, or remodelling index at the reference and culprit sites. However, the arc of the ruptured cavity was significantly greater in patients with STEMI than those with NSTEMI (69.4 ± 27.9° vs 51.8 ± 20.0°, respectively, p = 0.008). The proportion of atheroma, fibrocellular, and thrombus areas was not different between the 2 groups. Similarly, the relative areas immunopositive for CD31, smooth muscle α-actin, and CD68 were similar in the 2 groups. In conclusion, coronary culprit lesions in patients with STEMI show more severe plaque rupture with similar histologic features than those in patients with NSTEMI, supporting the idea that a large plaque rupture is more likely in STEMI patients.
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Navarro Valverde C, Núñez Gil I, Fernández Ortiz A. Síndrome coronario agudo y coronariografía sin lesiones significativas: ¿lo sabemos todo? Med Clin (Barc) 2013. [DOI: 10.1016/j.medcli.2012.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Current applications of optical coherence tomography for coronary intervention. Int J Cardiol 2013; 165:7-16. [DOI: 10.1016/j.ijcard.2012.02.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 01/30/2012] [Accepted: 02/04/2012] [Indexed: 11/17/2022]
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Karanasos A, Ligthart JMR, Witberg KT, Regar E. Calcified nodules: an underrated mechanism of coronary thrombosis? JACC Cardiovasc Imaging 2013; 5:1071-2. [PMID: 23058076 DOI: 10.1016/j.jcmg.2012.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/03/2012] [Accepted: 04/12/2012] [Indexed: 10/27/2022]
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Poon KKC, Incani A, Raffel OC, Walters DL, Jang IK. Optical coherence tomography: research applications, potential clinical utility and future directions. Interv Cardiol 2012. [DOI: 10.2217/ica.12.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Toutouzas K, Sfikakis PP, Karanasos A, Aggeli C, Felekos I, Kitas G, Zampeli E, Protogerou A, Stefanadis C. Myocardial ischaemia without obstructive coronary artery disease in rheumatoid arthritis: hypothesis-generating insights from a cross-sectional study. Rheumatology (Oxford) 2012. [PMID: 23185038 DOI: 10.1093/rheumatology/kes349] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE RA is associated with increased cardiovascular events, reportedly to equal diabetes mellitus (DM). The presence of myocardial ischaemia was assessed in asymptomatic high-risk RA patients and compared with patients with DM and a healthy control group. METHODS Eighteen consecutive non-diabetic RA patients without known cardiovascular disease who developed a new carotid atheromatic plaque during the last 3 years were matched 1:1 for traditional cardiovascular risk factors with asymptomatic type 2 DM patients and 1:2 with asymptomatic non-RA, non-DM control subjects. After dobutamine stress contrast echocardiography with wall-motion and perfusion evaluation, coronary angiography was performed in those with positive stress tests. RESULTS Ischaemia by echocardiography was found in 67% of RA patients; this was significantly higher than controls (31%, P = 0.019) but comparable to those with DM (78%, P = 0.71). Angiography performed in eight consenting RA patients was normal in four, revealed non-flow-limiting coronary atheromatic lesions in two and significant lesions in two patients. RA patients with ischaemia had CRP serum levels significantly higher by six-fold compared with those with normal stress echocardiography. CONCLUSION Asymptomatic RA patients may display myocardial ischaemia at similar levels to DM patients but with low prevalence of obstructive coronary artery disease. Microvascular abnormalities associated with increased inflammatory response may account for these findings. Their exact nature and significance require further evaluation.
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Affiliation(s)
- Konstantinos Toutouzas
- 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece.
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Karanasos A, Ligthart J, Witberg K, van Soest G, Bruining N, Regar E. Optical Coherence Tomography: Potential Clinical Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:206-220. [PMID: 22798978 PMCID: PMC3389242 DOI: 10.1007/s12410-012-9140-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular healing after stent implantation. This review will focus on the potential and advantages of OCT in the clinical practice of a catheterization laboratory.
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Affiliation(s)
- Antonios Karanasos
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Angiographic lesion severity and subsequent myocardial infarction. Am J Cardiol 2012; 110:167-72. [PMID: 22497675 DOI: 10.1016/j.amjcard.2012.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/03/2012] [Accepted: 03/03/2012] [Indexed: 12/31/2022]
Abstract
We sought to determine the angiographic severity of coronary lesions leading to ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) with a focus on determining the impact of interval from initial angiogram to subsequent clinical event. In the late 1980s angiographic data on lesion characteristics that culminated in STEMI and NSTEMI were obtained from angiograms obtained several months before MI. It is not clear whether the conclusions on lesion severity would be different if elapsed interval from baseline angiogram to clinical event was factored in the analysis. From 2003 through 2010, we identified 84 patients with NSTEMI and 41 patients with STEMI in vessels without previous intervention. These patients had ≥1 previous angiographic study at our center. Angiograms were reanalyzed with quantitative coronary angiography, and relevant clinical data were obtained from medical records. Similar to previous studies, 71% of patients with STEMI and 63% of patients with NSTEMI had <50% baseline stenosis at the culprit site when the interval from initial angiogram to MI was >3 months. Interestingly, lesions that led to STEMI ≤3 months after evaluation were more severe than those leading to STEMI in >3 months (59 ± 31% vs 36 ± 21%, p = 0.02) with 57% of lesions having >50% stenosis. Although most MIs occurred at sites that did not have significant obstruction when examined >3 months before MI, most baseline lesions showed significant luminal narrowing when examined ≤3 months before STEMI. In conclusion, high-grade coronary stenosis may be an important predictor of STEMI in subsequent months.
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Toutouzas K, Stathogiannis K, Synetos A, Karanasos A, Stefanadis C. Vulnerable Atherosclerotic Plaque: From the Basic Research Laboratory to the Clinic. Cardiology 2012; 123:248-53. [DOI: 10.1159/000345291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/01/2012] [Indexed: 11/19/2022]
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