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Kopriva K, Chen Z, Mates M, Holy F, Stekla B, Vesela M, Pudil J, Chval M, Wahle A, Sonka M, Kovarnik T. The accuracy of detailed analysis of optical coherence tomography in detection of plaque lipid content: dual-imaging study with optical coherence tomography and near-infrared spectroscopy. Acta Cardiol 2024; 79:206-214. [PMID: 38465606 DOI: 10.1080/00015385.2024.2324214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/17/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Lipid-rich plaque covered by a thin fibrous cap (FC) has been identified as a frequent morphological substrate for the development of acute coronary syndrome. Optical coherence tomography (OCT) permits the identification and measurement of the FC. Near-infrared spectroscopy (NIRS) has been approved for detection of coronary lipids. AIMS We aimed to assess the ability of detailed OCT analysis to identify coronary lipids, using NIRS as the reference method. METHODS In total, 40 patients with acute coronary syndrome underwent imaging of a non-culprit lesion by both NIRS and OCT. For each segment, the NIRS-derived 4 mm segment with maximal lipid core burden index (maxLCBI4mm) was assessed. OCT analysis was performed using a semi-automated method including measurement of the fibrous cap thickness (FCT) of all detected fibroatheromas. Subsequent quantitative volumetric evaluation furnished FCT, FC surface area (FC SA), lipid arc, and FC (fibrous cap) volume data. OCT features of lipid plaques were compared with maxLCBI4mm. Predictors of maxLCBI4mm >400 was assessed by using univariable and multivariable analysis. RESULTS OCT features (mean FCT, total FC SA, FC volume, maximal, mean, and total lipid arcs) strongly correlated with the maxLCBI4mm (p = 0.012 for the mean FCT, respectively p < 0.001 for all other aforementioned features). The strongest predictors of maxLCBI4mm >400 were the maximal (p = 0.002) and mean (p = 0.002) lipid arc, and total FC SA (p = 0.012). CONCLUSIONS We found a strong correlation between the OCT-derived features and NIRS findings. Detailed OCT analysis may be reliably used for detection of the presence of coronary lipids.
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Affiliation(s)
- Karel Kopriva
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Zhi Chen
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Martin Mates
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Frantisek Holy
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Barbora Stekla
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Michaela Vesela
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Pudil
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education, Charles University in Prague, Prague, Czech Republic
| | - Andreas Wahle
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Milan Sonka
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Tomas Kovarnik
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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2
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Hossain SS, Johnson MJ, Hughes TJR. A parametric study of the effect of 3D plaque shape on local hemodynamics and implications for plaque instability. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01834-6. [PMID: 38532042 DOI: 10.1007/s10237-024-01834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
The vast majority of heart attacks occur when vulnerable plaques rupture, releasing their lipid content into the blood stream leading to thrombus formation and blockage of a coronary artery. Detection of these unstable plaques before they rupture remains a challenge. Hemodynamic features including wall shear stress (WSS) and wall shear stress gradient (WSSG) near the vulnerable plaque and local inflammation are known to affect plaque instability. In this work, a computational workflow has been developed to enable a comprehensive parametric study detailing the effects of 3D plaque shape on local hemodynamics and their implications for plaque instability. Parameterized geometric 3D plaque models are created within a patient-specific coronary artery tree using a NURBS (non-uniform rational B-splines)-based vascular modeling pipeline. Realistic blood flow features are simulated by using a Navier-Stokes solver within an isogeometric finite-element analysis framework. Near wall hemodynamic quantities such as WSS and WSSG are quantified, and vascular distribution of an inflammatory marker (VCAM-1) is estimated. Results show that proximally skewed eccentric plaques have the most vulnerable combination of high WSS and high positive spatial WSSG, and the presence of multiple lesions increases risk of rupture. The computational tool developed in this work, in conjunction with clinical data, -could help identify surrogate markers of plaque instability, potentially leading to a noninvasive clinical procedure for the detection of vulnerable plaques before rupture.
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Affiliation(s)
- Shaolie S Hossain
- Molecular Cardiology Research Laboratories, The Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 E. 24th St, Austin, TX, 78712, USA.
| | - Michael J Johnson
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 E. 24th St, Austin, TX, 78712, USA
| | - Thomas J R Hughes
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 E. 24th St, Austin, TX, 78712, USA
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Baaten CCFMJ, Nagy M, Bergmeier W, Spronk HMH, van der Meijden PEJ. Platelet biology and function: plaque erosion vs. rupture. Eur Heart J 2024; 45:18-31. [PMID: 37940193 PMCID: PMC10757869 DOI: 10.1093/eurheartj/ehad720] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
The leading cause of heart disease in developed countries is coronary atherosclerosis, which is not simply a result of ageing but a chronic inflammatory process that can lead to acute clinical events upon atherosclerotic plaque rupture or erosion and arterial thrombus formation. The composition and location of atherosclerotic plaques determine the phenotype of the lesion and whether it is more likely to rupture or to erode. Although plaque rupture and erosion both initiate platelet activation on the exposed vascular surface, the contribution of platelets to thrombus formation differs between the two phenotypes. In this review, plaque phenotype is discussed in relation to thrombus composition, and an overview of important mediators (haemodynamics, matrix components, and soluble factors) in plaque-induced platelet activation is given. As thrombus formation on disrupted plaques does not necessarily result in complete vessel occlusion, plaque healing can occur. Therefore, the latest findings on plaque healing and the potential role of platelets in this process are summarized. Finally, the clinical need for more effective antithrombotic agents is highlighted.
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Affiliation(s)
- Constance C F M J Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
| | - Magdolna Nagy
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
| | - Wolfgang Bergmeier
- Department of Biochemistry and Biophysics, School of Medicine, University of North Caroline at Chapel Hill, Chapel Hill, NC, USA
- Blood Research Center, School of Medicine, University of North Caroline at Chapel Hill, Chapel Hill, NC, USA
| | - Henri M H Spronk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- Thrombosis Expertise Center, Heart+ Vascular Center, Maastricht University Medical Center+, P. Debeyelaan 25, Maastricht, the Netherlands
| | - Paola E J van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
- Thrombosis Expertise Center, Heart+ Vascular Center, Maastricht University Medical Center+, P. Debeyelaan 25, Maastricht, the Netherlands
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4
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Wu G, Zhu C, Wang H, Fu D, Lu X, Cao C, Zhang X, Zhu J, Huang L, Mossa-Basha M, Xia S. Co-existing intracranial and extracranial carotid atherosclerosis predicts large-artery atherosclerosis stroke recurrence: a single-center prospective study utilizing combined head-and-neck vessel wall imaging. Eur Radiol 2023; 33:6970-6980. [PMID: 37081300 PMCID: PMC10527495 DOI: 10.1007/s00330-023-09654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/15/2023] [Accepted: 03/09/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Intracranial and extracranial plaque features on high-resolution vessel wall imaging (HR-VWI) are associated with large-artery atherosclerosis (LAA) stroke recurrence. However, most studies have focused on a single vascular bed, and the prognostic value of combined intracranial and extracranial plaque features has yet to be studied. This study aimed to investigate the roles of plaque features, plaque number, and co-existing atherosclerosis in predicting stroke recurrence, utilizing combined head-and-neck HR-VWI. METHODS From September 2016 to March 2020, participants with acute LAA ischemic strokes were prospectively enrolled and underwent combined head-and-neck HR-VWI. The participants were followed for stroke recurrence for at least 12 months or until a subsequent event occurred. The imaging features at baseline, including conventional and histogram plaque features, plaque number, and co-existing atherosclerosis, were evaluated. Univariable Cox regression analysis and the least absolute shrinkage and selection operator (lasso) method were used for variable screening. Multivariable Cox regression analyses were used to determine the independent risk factors of stroke recurrence. RESULTS A total of 97 participants (59 ± 12 years, 63 men) were followed for a median of 30.9 months, and 21 participants experienced recurrent strokes. Multivariable Cox analysis identified co-existing intracranial high signal on T1-weighted fat-suppressed images (HST1) and extracranial carotid atherosclerosis (HR, 6.12; 95% CI, 2.52-14.82; p = 0.001) as an independent imaging predictor of stroke recurrence. CONCLUSION Co-existing intracranial HST1 and extracranial carotid atherosclerosis independently predicted LAA stroke recurrence. Combined head-and-neck HR-VWI is a promising technique for atherosclerosis imaging. CLINICAL RELEVANCE STATEMENT This prospective study using combined head-and-neck HR-VWI highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence. KEY POINTS • This study highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence. • This prospective study using combined head-and-neck HR-VWI found co-existing intracranial HST1 and extracranial carotid atherosclerosis to be independent predictors of stroke recurrence.
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Affiliation(s)
- Gemuer Wu
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, 325 9Th Ave, Seattle, WA, 98104, USA
| | - Huiying Wang
- The School of Medicine, Nankai University, 94 Weijin Road, Tianjin, 300071, China
| | - Dingwei Fu
- Department of Radiology, The Second Affiliated Hospital of Wannan Medical College, 10 Kangfu Road, Jinghu District, Wuhu, 241000, China
| | - Xiudi Lu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Chen Cao
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | | | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Lixiang Huang
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 325 9Th Ave, Seattle, WA, 98104, USA
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
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5
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Fernández-Alvarez V, Linares-Sánchez M, Suárez C, López F, Guntinas-Lichius O, Mäkitie AA, Bradley PJ, Ferlito A. Novel Imaging-Based Biomarkers for Identifying Carotid Plaque Vulnerability. Biomolecules 2023; 13:1236. [PMID: 37627301 PMCID: PMC10452902 DOI: 10.3390/biom13081236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Carotid artery disease has traditionally been assessed based on the degree of luminal narrowing. However, this approach, which solely relies on carotid stenosis, is currently being questioned with regard to modern risk stratification approaches. Recent guidelines have introduced the concept of the "vulnerable plaque," emphasizing specific features such as thin fibrous caps, large lipid cores, intraplaque hemorrhage, plaque rupture, macrophage infiltration, and neovascularization. In this context, imaging-based biomarkers have emerged as valuable tools for identifying higher-risk patients. Non-invasive imaging modalities and intravascular techniques, including ultrasound, computed tomography, magnetic resonance imaging, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy, have played pivotal roles in characterizing and detecting unstable carotid plaques. The aim of this review is to provide an overview of the evolving understanding of carotid artery disease and highlight the significance of imaging techniques in assessing plaque vulnerability and informing clinical decision-making.
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Affiliation(s)
- Verónica Fernández-Alvarez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Miriam Linares-Sánchez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Carlos Suárez
- Instituto de Investigacion Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (C.S.); (F.L.)
| | - Fernando López
- Instituto de Investigacion Sanitaria del Principado de Asturias, 33011 Oviedo, Spain; (C.S.); (F.L.)
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncologia del Principado de Asturias, University of Oviedo, CIBERONC, 33011 Oviedo, Spain
| | | | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029 Helsinki, Finland;
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Patrick J. Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK;
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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6
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Chen Q, Pan T, Wang YN, Schoepf UJ, Bidwell SL, Qiao H, Feng Y, Xu C, Xu H, Xie G, Gao X, Tao XW, Lu M, Xu PP, Zhong J, Wei Y, Yin X, Zhang J, Zhang LJ. A Coronary CT Angiography Radiomics Model to Identify Vulnerable Plaque and Predict Cardiovascular Events. Radiology 2023; 307:e221693. [PMID: 36786701 DOI: 10.1148/radiol.221693] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Background A noninvasive coronary CT angiography (CCTA)-based radiomics technique may facilitate the identification of vulnerable plaques and patients at risk for future adverse events. Purpose To assess whether a CCTA-based radiomic signature (RS) of vulnerable plaques defined with intravascular US was associated with increased risk for future major adverse cardiac events (MACE). Materials and Methods In a retrospective study, an RS of vulnerable plaques was developed and validated using intravascular US as the reference standard. The RS development data set included patients first undergoing CCTA and then intravascular US within 3 months between June 2013 and December 2020 at one tertiary hospital. The development set was randomly assigned to training and validation sets at a 7:3 ratio. Diagnostic performance was assessed internally and externally from three tertiary hospitals using the area under the curve (AUC). The prognostic value of the RS for predicting MACE was evaluated in a prospective cohort with suspected coronary artery disease between April 2018 and March 2019. Multivariable Cox regression analysis was used to evaluate the RS and conventional anatomic plaque features (eg, segment involvement score) for predicting MACE. Results The RS development data set included 419 lesions from 225 patients (mean age, 64 years ± 10 [SD]; 68 men), while the prognostic cohort included 1020 lesions from 708 patients (mean age, 62 years ± 11; 498 men). Sixteen radiomic features, including two shape features and 14 textural features, were selected to build the RS. The RS yielded a moderate to good AUC in the training, validation, internal, and external test sets (AUC = 0.81, 0.75, 0.80, and 0.77, respectively). A high RS (≥1.07) was independently associated with MACE over a median 3-year follow-up (hazard ratio, 2.01; P = .005). Conclusion A coronary CT angiography-derived radiomic signature of coronary plaque enabled the detection of vulnerable plaques that were associated with increased risk for future adverse cardiac outcomes. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by De Cecco and van Assen in this issue.
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Affiliation(s)
- Qian Chen
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Tao Pan
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Yi Ning Wang
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - U Joseph Schoepf
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Samuel L Bidwell
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Hongyan Qiao
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Yun Feng
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Cheng Xu
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Hui Xu
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Guanghui Xie
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Xiaofei Gao
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Xin-Wei Tao
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Mengjie Lu
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Peng Peng Xu
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Jian Zhong
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Yongyue Wei
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Xindao Yin
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Junjie Zhang
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
| | - Long Jiang Zhang
- From the Departments of Radiology (Q.C., H.X., G.X., X.Y.) and Cardiology (T.P., X.G., J. Zhang), Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing 210002, China (Q.C., U.J.S., P.P.X., J. Zhong, L.J.Z.); Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.N.W., C.X.); Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (U.J.S., S.L.B.); Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China (H.Q.); Department of Medical Imaging, Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China (Y.F.); Bayer Healthcare, Shanghai, China (X.W.T.); School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China (M.L.); and Department of Biostatistics, School of Public Health, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China (Y.W.)
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7
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Albadawi M, Abuouf Y, Elsagheer S, Sekiguchi H, Ookawara S, Ahmed M. Influence of Rigid-Elastic Artery Wall of Carotid and Coronary Stenosis on Hemodynamics. Bioengineering (Basel) 2022; 9:708. [PMID: 36421109 PMCID: PMC9687628 DOI: 10.3390/bioengineering9110708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/18/2023] Open
Abstract
Cardiovascular system abnormalities can result in serious health complications. By using the fluid-structure interaction (FSI) procedure, a comprehensive realistic approach can be employed to accurately investigate blood flow coupled with arterial wall response. The hemodynamics was investigated in both the coronary and carotid arteries based on the arterial wall response. The hemodynamics was estimated based on the numerical simulation of a comprehensive three-dimensional non-Newtonian blood flow model in elastic and rigid arteries. For stenotic right coronary artery (RCA), it was found that the maximum value of wall shear stress (WSS) for the FSI case is higher than the rigid wall. On the other hand, for the stenotic carotid artery (CA), it was found that the maximum value of WSS for the FSI case is lower than the rigid wall. Moreover, at the peak systole of the cardiac cycle (0.38 s), the maximum percentage of arterial wall deformation was found to be 1.9%. On the other hand, for the stenotic carotid artery, the maximum percentage of arterial wall deformation was found to be 0.46%. A comparison between FSI results and those obtained by rigid wall arteries is carried out. Findings indicate slight differences in results for large-diameter arteries such as the carotid artery. Accordingly, the rigid wall assumption is plausible in flow modeling for relatively large diameters such as the carotid artery. Additionally, the FSI approach is essential in flow modeling in small diameters.
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Affiliation(s)
- Muhamed Albadawi
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City 5221241, Egypt
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai 980-8577, Japan
- Engineering Mathematics and Physics Department, Faculty of Engineering, Alexandria University, Alexandria 5424041, Egypt
| | - Yasser Abuouf
- Mechanical Engineering Department, Faculty of Engineering, Alexandria University, Alexandria 5424041, Egypt
| | - Samir Elsagheer
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City 5221241, Egypt
- Faculty of Engineering, Aswan University, Aswan 81528, Egypt
| | - Hidetoshi Sekiguchi
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City 5221241, Egypt
- Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, Ookayama, Meguro-ku, Tokyo 152-8552, Japan
| | - Shinichi Ookawara
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City 5221241, Egypt
- Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, Ookayama, Meguro-ku, Tokyo 152-8552, Japan
| | - Mahmoud Ahmed
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City 5221241, Egypt
- Mechanical Engineering Department, Assiut University, Assiut 71516, Egypt
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8
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Cao Z, Li J, Fang Z, Feierkaiti Y, Zheng X, Jiang X. The factors influencing the efficiency of drug-coated balloons. Front Cardiovasc Med 2022; 9:947776. [PMCID: PMC9602405 DOI: 10.3389/fcvm.2022.947776] [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: 05/19/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device that delivers drugs to diseased vessels to decrease the rate of vascular stenosis. Recent clinical studies have demonstrated that DCBs tend to have both good safety and efficacy profiles, leading to extended application indications in the clinic, including in-stent restenosis (ISR) for metal stents such as drug-eluting stents (DESs), small vascular disease, bifurcation disease, large vascular disease, acute coronary syndrome (ACS), and high bleeding risk. However, some previous clinical data have suggested that DCBs performed less effectively than DESs. No studies or reviews have systematically discussed the improvement strategies for better DCB performance until now. Drug loss during the process of delivery to the target lesion and inefficient delivery of the coating drug to the diseased vascular wall are two key mechanisms that weaken the efficiency of DCBs. This review is the first to summarize the key influencing factors of DCB efficiency in terms of balloon structure and principles, and then it analyzes how these factors cause outcomes in practice based on current clinical trial studies of DCBs in the treatment of different types of lesions. We also provide some recommendations for improving DCBs to contribute to better DCB performance by improving the design of DCBs and combining other factors in clinical practice.
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Affiliation(s)
- Zheng Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Jun Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Zhao Fang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yushanjiang Feierkaiti
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiaoxin Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,*Correspondence: Xiaoxin Zheng,
| | - Xuejun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,Xuejun Jiang,
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9
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Potential of optical frequency domain imaging for differentiation between early and advanced coronary atherosclerosis. Int J Cardiovasc Imaging 2022; 38:2791-2799. [DOI: 10.1007/s10554-022-02600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/13/2022] [Indexed: 11/05/2022]
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10
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Munnur RK, Cheng K, Laggoune J, Talman A, Muthalaly R, Nerlekar N, Baey YW, Nogic J, Lin A, Cameron JD, Seneviratne S, Wong DTL. Quantitative plaque characterisation and association with acute coronary syndrome on medium to long term follow up: insights from computed tomography coronary angiography. Cardiovasc Diagn Ther 2022; 12:415-425. [PMID: 36033222 PMCID: PMC9412217 DOI: 10.21037/cdt-21-763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/25/2022] [Indexed: 11/09/2022]
Abstract
Background Computed tomography coronary angiography (CTCA) is an established imaging modality widely used for diagnosing coronary artery stenosis with expanding potential for comprehensive assessment of coronary artery disease (CAD). Lesion-based analyses of high-risk plaques (HRP) on CTCA may aid further in prognostication presenting with stable chest pain. We conduct qualitative and quantitative assessments to identify HRPs that are associated with acute coronary syndrome (ACS) on a medium to long term follow-up. Methods Retrospective cohort study of patients who underwent CTCA for suspected CAD. Obstructive stenosis (OS) is defined as ≥50% and the presence of HRP and its constituents: positive-remodelling (PR), low-attenuation-plaque (LAP; <56 HU), very-low-attenuation-plaque (vLAP; <30 HU) and spotty-calcification (SC) were recorded. A cross-sectional quantitative analysis of HRP was performed at the site of minimum-luminal-area (MLA). The primary endpoint was fatal or non-fatal ACS on follow-up. Results A total of 1,257 patients were included (mean age 61±14 years old and 51% male) with a median follow-up of 7.24 years (interquartile range 5.5 to 7.7 years). The occurrence of ACS was significantly higher in HRP (+) patients compared to HRP (−) patients and patients with no plaques (20.5% vs. 1.6% vs. 0.4%, log-rank test P<0.001). ACS was more frequent in HRP (+)/OS (+) patients (20.7%) compared to HRP (+)/OS (−) patients (8.6%), HRP (−)/OS (+) patients (1.8%) and HRP (−)/OS (−) patients (1.0%). OS, cross-sectional plaque area (PA) and the presence of vLAP identified those HRP lesions that were more likely to cause future ACS. Cross-sectional LAP area (<56 HU) in HRP lesions added incremental prognostic value to OS in predicting ACS (P=0.008). Conclusions The presence of OS and the LAP area at the site of MLA identify the HRP lesions that have the greatest association with development of future ACS.
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Affiliation(s)
- Ravi K Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jordan Laggoune
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Talman
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Rahul Muthalaly
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Yi-Wei Baey
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Jason Nogic
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Andrew Lin
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia.,South Australian Health Medical Research Institute (SAHMRI), Adelaide, Australia
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11
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van den Hoogen IJ, Stuijfzand WJ, Gianni U, van Rosendael AR, Bax AM, Lu Y, Tantawy SW, Hollenberg EJ, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Gonçalves PDA, Hadamitzky M, Kim YJ, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines TC, Lee SE, Al'Aref SJ, Baskaran L, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Berman DS, Chang HJ, Narula J, Min JK, Bax JJ, Lin FY, Shaw LJ. Early versus late acute coronary syndrome risk patterns of coronary atherosclerotic plaque. Eur Heart J Cardiovasc Imaging 2022; 23:1314-1323. [PMID: 35904766 DOI: 10.1093/ehjci/jeac114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The temporal instability of coronary atherosclerotic plaque preceding an incident acute coronary syndrome (ACS) is not well defined. We sought to examine differences in the volume and composition of coronary atherosclerosis between patients experiencing an early (≤90 days) versus late ACS (>90 days) after baseline coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicenter study, we enrolled patients who underwent a clinically indicated baseline CCTA and experienced ACS during follow-up. Separate core laboratories performed blinded adjudication of ACS events and quantification of CCTA including compositional plaque volumes by Hounsfield units (HU): calcified plaque >350 HU, fibrous plaque 131-350 HU, fibrofatty plaque 31-130 HU and necrotic core <30 HU. In 234 patients (mean age 62 ± 12 years, 36% women), early and late ACS occurred in 129 and 105 patients after a mean of 395 ± 622 days, respectively. Patients with early ACS had a greater maximal diameter stenosis and maximal cross-sectional plaque burden as compared to patients with late ACS (P < 0.05). Larger total, fibrous, fibrofatty, and necrotic core volumes were observed in the early ACS group (P < 0.05). Findings for total, fibrous, fibrofatty, and necrotic core volumes were reproduced in an external validation cohort (P < 0.05). CONCLUSIONS Volumetric differences in composition of coronary atherosclerosis exist between ACS patients according to their timing antecedent to the acute event. These data support that a large burden of non-calcified plaque on CCTA is strongly associated with near-term plaque instability and ACS risk.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wijnand J Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - A Maxim Bax
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Sara W Tantawy
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Faculty of Medicine, Department of Radiology, Ain Shams University, Cairo, Egypt
| | - Emma J Hollenberg
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | - Fabian Plank
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Todd C Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Lohendran Baskaran
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiovascular Medicine, National Heart Centre, Singapore
| | - Ibrahim Danad
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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12
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Shishikura D, Octavia Y, Hayat U, Thondapu V, Barlis P. Atherogenesis and Inflammation. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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13
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Svoboda N, Voldřich R, Mandys V, Hrbáč T, Kešnerová P, Roubec M, Školoudík D, Netuka D. Histological analysis of carotid plaques: The predictors of stroke risk. J Stroke Cerebrovasc Dis 2022; 31:106262. [DOI: 10.1016/j.jstrokecerebrovasdis.2021.106262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
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14
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Wu G, Wang H, Zhao C, Cao C, Chai C, Huang L, Guo Y, Gong Z, Tirschwell D, Zhu C, Xia S. Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging. AJNR Am J Neuroradiol 2022; 43:207-215. [PMID: 35058299 PMCID: PMC8985671 DOI: 10.3174/ajnr.a7402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and stroke recurrence. MATERIALS AND METHODS Patients with ischemic stroke due to intracranial atherosclerosis were retrospectively collected and categorized into first-time and recurrent-stroke groups. Patients underwent high-resolution vessel wall imaging and DSC-PWI. Intracranial plaque number, culprit plaque features (such as plaque volume/burden, degree of stenosis, enhancement ratio), and perfusion deficit variables were recorded. Logistic regression analyses were performed to determine the independent factors associated with recurrent stroke. RESULTS One hundred seventy-five patients (mean age, 59 [SD, 12] years; 115 men) were included. Compared with the first-time stroke group (n = 100), the recurrent-stroke group (n = 75) had a larger culprit volume (P = .006) and showed more intracranial plaques (P < .001) and more enhanced plaques (P = .003). After we adjusted for other factors, culprit plaque volume (OR, 1.16 per 10-mm3 increase; 95% CI, 1.03-1.30; P = .015) and total plaque number (OR, 1.31; 95% CI, 1.13-1.52; P < .001) were independently associated with recurrent stroke. Combining these factors increased the area under the curve to 0.71. CONCLUSIONS Large culprit plaque and more intracranial plaques were independently associated with recurrent stroke. Performing whole-brain vessel wall imaging may help identify patients with a higher risk of recurrent stroke.
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Affiliation(s)
- G. Wu
- From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China
| | - H. Wang
- From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China
| | - C. Zhao
- Department of Radiology (C. Zhao), First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - C. Cao
- Department of Radiology (C. Cao), Tianjin Huanhu Hospital, Tianjin, China
| | - C. Chai
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - L. Huang
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - Y. Guo
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - Z. Gong
- Neurology (Z.G.), Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | | | - C. Zhu
- Radiology (C. Zhu), University of Washington, Seattle, Washington
| | - S. Xia
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
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15
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Wu Y, Li F, Wang Y, Hu T, Gao H. Standard-Dose Atorvastatin Treatment in Patients With Symptomatic Middle Cerebral Artery Atherosclerotic Stenosis: A Vessel Wall Magnetic Resonance Imaging Study. Front Neurol 2021; 12:693397. [PMID: 34956036 PMCID: PMC8693378 DOI: 10.3389/fneur.2021.693397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose: Ischemic stroke can be caused by atherosclerotic lesions of the middle cerebral artery (MCA). Some studies have described the effects of statin treatment on carotid artery plaques, but little is known about the effects of statin treatment on MCA plaques. The purpose of this study was to validate the efficacy of standard-dose atorvastatin (20 mg/day) in patients with symptomatic MCA atherosclerotic stenosis (SMAS) in northern China. Materials and Methods: This study is a prospective, single-arm, single-center, 12-month follow-up observational study monitoring imaging, and clinical outcomes of standard-dose atorvastatin treatment among patients with SMAS. The primary outcomes were changes in vessel wall magnetic resonance imaging (VWMRI) and serum lipid profiles before and after (1, 3, 6, and 12 months) statin treatment. Results: A total of 46 patients were recruited for this study, and 24 patients completed the follow-up. During the follow-up period, serum non-high-density lipoprotein cholesterol concentrations gradually decreased in the patients. Fourteen patients (54.33%) had a reversal of MCA plaques and 10 patients (41.67%) had no significant progression of MCA plaques and remained stable at the follow-up endpoint. At the 12 months follow-up time-point, the treatment did not reverse vascular remodeling or change the shape and distribution of plaques. Altered serum low-density lipoprotein cholesterol (LDL-C) concentrations in patients were strongly associated with plaque reversal. Conclusion: Vessel wall magnetic resonance imaging could accurately characterize changes in MCA plaques after lipid-lowering therapy. Standard-dose atorvastatin treatment could stabilize and reverse plaques in northern Chinese patients with SMAS.
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Affiliation(s)
- Yejun Wu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Fangbing Li
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yilin Wang
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Tianxiang Hu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Honghua Gao
- Department of Neurology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
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16
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Song J, Kouidri S, Bakir F. Review on the numerical investigations of mass transfer from drug eluting stent. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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The Role of Angiotensin Antagonism in Coronary Plaque Regression: Insights from the Glagovian Model. Int J Vasc Med 2021; 2021:8887248. [PMID: 33880191 PMCID: PMC8046567 DOI: 10.1155/2021/8887248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/21/2021] [Indexed: 11/17/2022] Open
Abstract
The benefit of antagonizing the effect of the renin angiotensin aldosterone system (RAAS), notably by the use of angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II type 1 receptor blocker (ARB) for coronary artery disease (CAD), has been demonstrated in multiple studies, which may be attributed to their ability to inhibit the deleterious effect of RAAS to the cardiovascular system. It is well known that angiotensin II (Ang II) plays a vital role in atheromatous plaque formation and progression through multiple pathways, including inflammatory and arterial remodeling aspects. Significant coronary atheromatous plaque regression has been previously demonstrated in various studies using statin agents. Similar results have been reported in different studies using angiotensin inhibitor agents, notably ARB agents. Analysis from various trials utilizing ARB showed a significant plaque regression using olmesartan and telmisartan as evaluated by IVUS studies. In contrary, the use of ACEi did not demonstrated significant plaque regression, which may be attributed to the heavy plaque calcification in respective studies. On this review, we aim to present the basic mechanism on the role of RAAS in plaque modulation and its arterial remodeling aspect, which is then integrated with the clinical evidence based on the available intravascular ultrasonography (IVUS) studies on coronary arteries.
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18
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Pan J, Cai Y, Wang L, Maehara A, Mintz GS, Tang D, Li Z. A prediction tool for plaque progression based on patient-specific multi-physical modeling. PLoS Comput Biol 2021; 17:e1008344. [PMID: 33780445 PMCID: PMC8057612 DOI: 10.1371/journal.pcbi.1008344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/20/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
Atherosclerotic plaque rupture is responsible for a majority of acute vascular syndromes and this study aims to develop a prediction tool for plaque progression and rupture. Based on the follow-up coronary intravascular ultrasound imaging data, we performed patient-specific multi-physical modeling study on four patients to obtain the evolutional processes of the microenvironment during plaque progression. Four main pathophysiological processes, i.e., lipid deposition, inflammatory response, migration and proliferation of smooth muscle cells (SMCs), and neovascularization were coupled based on the interactions demonstrated by experimental and clinical observations. A scoring table integrating the dynamic microenvironmental indicators with the classical risk index was proposed to differentiate their progression to stable and unstable plaques. The heterogeneity of plaque microenvironment for each patient was demonstrated by the growth curves of the main microenvironmental factors. The possible plaque developments were predicted by incorporating the systematic index with microenvironmental indicators. Five microenvironmental factors (LDL, ox-LDL, MCP-1, SMC, and foam cell) showed significant differences between stable and unstable group (p < 0.01). The inflammatory microenvironments (monocyte and macrophage) had negative correlations with the necrotic core (NC) expansion in the stable group, while very strong positive correlations in unstable group. The inflammatory microenvironment is strongly correlated to the NC expansion in unstable plaques, suggesting that the inflammatory factors may play an important role in the formation of a vulnerable plaque. This prediction tool will improve our understanding of the mechanism of plaque progression and provide a new strategy for early detection and prediction of high-risk plaques. Besides the traditional systematic factors, the influences of the local microenvironmental factors on atherosclerotic plaque progression have been demonstrated. Mathematical and computational modeling is an important tool to investigate the complex interplay between plaque progression and the microenvironment, and provides a potential way toward the prediction of plaque vulnerability according to the comprehensive evaluation of both morphological and/or biochemical factors in tissue level with microenvironmental factors in cellular level. We performed patient-specific multi-physical modeling study on four patients to obtain the evolutional processes of the microenvironment during plaque progression and predicted the possible plaque developments. A scoring table integrating the dynamic microenvironmental indicators with the classical risk index was proposed to differentiate their progression to stable and unstable plaques. Based on patient-specific imaging data, the mathematical model will provide a novel method to predict the changes of plaque microenvironment and improve ability to access the personal therapeutic strategy for atherosclerotic plaque.
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Affiliation(s)
- Jichao Pan
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing Jiangsu, China
| | - Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing Jiangsu, China
| | - Liang Wang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing Jiangsu, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, New York, New York, United States of America
| | - Gary S Mintz
- The Cardiovascular Research Foundation, New York, New York, United States of America
| | - Dalin Tang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing Jiangsu, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Massachusetts, United States of America
| | - Zhiyong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing Jiangsu, China
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
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19
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Li S, Song X, Hu Q, Zhao J, Du H, Yan Y, Wang G, Chen X, Wang Q. Association of Plaque Features with Infarct Patterns in Patients with Acutely Symptomatic Middle Cerebral Artery Atherosclerotic Disease. J Stroke Cerebrovasc Dis 2021; 30:105724. [PMID: 33714918 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105724] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Understanding the stroke mechanism of middle cerebral artery (MCA) atherosclerosis is important for stroke triage and future trial design. The aim of this study was to characterize intrinsic MCA plaque and acute cerebral infarct in vivo by using high-resolution black-blood (BB) and diffusion-weighted magnetic resonance (MR) imaging and to investigate the relationship between plaque features and infarct patterns. METHODS A single-center retrospective study was conducted at a tertiary referral center between March 2017 and August 2019. Patients consecutively admitted for acute ischemic stroke with MCA stenosis underwent diffusion-weighted and BB MR imaging. Plaque features and infarct patterns were assessed. The association between plaque features and infarct patterns (binary variable: single/multiple) was evaluated using a multivariate logistic regression model. RESULTS Of 49 patients with MCA atherosclerotic stenosis, diffusion-weighted MR imaging showed that 28 patients (57%) had multiple acute cerebral infarcts and 21 patients had single acute cerebral infarcts. In contrast to single infarct, multiple infarcts were associated with greater plaque burden (81.9±7.24 versus 71.3±13.7; P=0.012). A multivariate logistic regression model adjusted for 7 potential confounders confirmed a statistically significant positive association between plaque burden and multiple acute infarcts (adjusted R2 =0.432, P< 0.001). The rate of plaque surface irregularity was significantly greater in patients with multiple infarcts than those with single infarct (71% versus 43%, P=0.044). For single acute penetrating artery infarct, patients with infarct size > 2cm had greater plaque burden compared with patients with infarct size < 2cm (75.3±13.4 versus 63.4±10.9; P = 0.016). CONCLUSIONS Increased plaque burden, plaque surface irregularity in patients with MCA stenosis is associated with its likelihood to have caused an artery-to-artery embolism that produces multiple cerebral infarcts, especially along the border zone region, and increased plaque burden may promote subcortical single infarct size by occluding penetrating arteries. Our results provide important insight into stroke mechanism of MCA atherosclerosis.
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Affiliation(s)
- Shuang Li
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China
| | - Xiaoyan Song
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China.
| | - Qimin Hu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China
| | - Jinglong Zhao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China
| | - Heng Du
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China
| | - Yufeng Yan
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China
| | - Guodong Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region of the People's Republic of China, China.
| | - Qiaoshu Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Shanghai 201620, China.
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20
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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21
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Malaiapan Y, Leung M, White AJ. The role of intravascular ultrasound in percutaneous coronary intervention of complex coronary lesions. Cardiovasc Diagn Ther 2020; 10:1371-1388. [PMID: 33224763 DOI: 10.21037/cdt-20-189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intravascular ultrasound (IVUS) is a catheter-based coronary imaging technique. It utilises the emission & subsequent detection of reflected high frequency (30-60 MHz) sound waves to create high resolution, cross-sectional images of the coronary artery. IVUS has been the cornerstone of intracoronary imaging for more than two decades. When compared to the invasive coronary angiogram which studies only the silhouette of the contrast-filled artery lumen, IVUS also crucially images the vessel wall. Because of this capability, IVUS has greatly facilitated understanding of the coronary atherosclerosis process. Such insights from IVUS reveal how commonly and extensively plain angiography underestimates the true extent of coronary plaque, the characteristics of plaques prone to rupture and cause acute coronary syndromes (lipid rich, thin cap atheroma), and a realisation of the widespread occurrence of vessel remodelling in response to atherosclerosis. Similarly, IVUS has historically provided salutary mechanistic insights that have guided many of the incremental advances in the techniques of percutaneous coronary intervention (PCI). Examples include mechanisms of in-stent restenosis, and the importance of high-pressure post-dilatation of stents to ensure adequate stent apposition and thereby reduce the occurrence of stent thrombosis. IVUS also greatly facilitates the choice of correct diameter and length of stent to implant. Overall, a compelling body of evidence indicates that use of intravascular ultrasound in PCI helps to achieve optimal technical results and to mitigate the risk of adverse cardiac events. In this review, the role of intravascular ultrasound as an adjunct to PCI in complex coronary lesions is explored. The complex coronary situations discussed are the left main stem, ostial stenoses, bifurcation stenoses, thrombotic lesions, the chronically occluded coronary artery, and calcified coronary artery disease. By thorough review of the available evidence, we establish that the advantages of IVUS guidance are particularly evident in each of these complex CAD subsets. In particular, some consider the use of IVUS to be almost mandatory in left main PCI. A comparison with other intracoronary imaging techniques is also explored.
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Affiliation(s)
- Yuvaraj Malaiapan
- Monash Heart, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Michael Leung
- Monash Heart, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Anthony J White
- Monash Heart, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
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22
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Montarello NJ, Nelson AJ, Verjans J, Nicholls SJ, Psaltis PJ. The role of intracoronary imaging in translational research. Cardiovasc Diagn Ther 2020; 10:1480-1507. [PMID: 33224769 DOI: 10.21037/cdt-20-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This has helped further our appreciation of the natural history of coronary artery disease (CAD) and the risk for major adverse cardiovascular events (MACE), evaluate the responsiveness to conventional and experimental therapeutic interventions, and assist in guiding percutaneous coronary intervention (PCI). Here we review the use of different imaging modalities for these purposes and the lessons they have provided thus far.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J Nelson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Duke Clinical Research Institute, Durham, NC, USA
| | - Johan Verjans
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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23
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Yamaya S, Morino Y, Taguchi Y, Ninomiya R, Ishida M, Fusazaki T, Itoh T, Kimura T. Comparison of Archival Angiographic Findings in Patients Later Developing Acute Coronary Syndrome or Stable Angina. Int Heart J 2020; 61:454-462. [DOI: 10.1536/ihj.19-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shohei Yamaya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yuya Taguchi
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Ryo Ninomiya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Takumi Kimura
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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24
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Systematic Scoring Balloon Lesion Preparation for Drug-Coated Balloon Angioplasty in Clinical Routine: Results of the PASSWORD Observational Study. Adv Ther 2020; 37:2210-2223. [PMID: 32274746 PMCID: PMC7467461 DOI: 10.1007/s12325-020-01320-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Indexed: 01/21/2023]
Abstract
Introduction Scoring balloon angioplasty (SBA) for lumen gain prior to stent implantations or drug-coated balloon angioplasty (DCB) is considered an essential interventional tool for lesion preparation. Recent evidence indicates that SBA may play a pivotal role in enhancing the angiographic and clinical outcomes of DCB angioplasty. Methods We studied the systematic use of SBA with a low profile, non-slip element device prior to DCB angioplasty in an unselected, non-randomized patient population. This prospective, all-comers study enrolled patients with de novo lesions as well as in-stent restenotic lesions in bare metal stents (BMS-ISR) and drug-eluting stents (DES-ISR). The primary endpoint was the target lesion failure (TLF) rate at 9 months (ClinicalTrials.gov Identifier NCT02554292). Results A total of 481 patients (496 lesions) were recruited to treat de novo lesions (78.4%, 377), BMS-ISR (4.0%, 19), and DES-ISR (17.6%, 85). Overall risk factors were acute coronary syndrome (ACS, 20.6%, 99), diabetes mellitus (46.8%, 225), and atrial fibrillation (8.5%, 41). Average lesion lengths were 16.7 ± 10.4 mm in the de novo group, and 20.1 ± 8.9 mm (BMS-ISR) and 16.2 ± 9.8 mm (DES-ISR) in the ISR groups. Scoring balloon diameters were 2.43 ± 0.41 mm (de novo), 2.71 ± 0.31 mm (BMS-ISR), and 2.92 ± 0.42 mm (DES-ISR) whereas DCB diameters were 2.60 ± 0.39 mm (de novo), 3.00 ± 0.35 mm (BMS-ISR), and 3.10 ± 0.43 mm (DES-ISR), respectively. The overall accumulated TLF rate of 3.0% (14/463) was driven by significantly higher target lesion revascularization rates in the BMS-ISR (5.3%, 1/19) and the DES-ISR group (6.0%, 5/84). In de novo lesions, the TLF rate was 1.1% (4/360) without differences between calcified and non-calcified lesions (p = 0.158) and small vs. large reference vessel diameters with a cutoff value of 3.0 mm (p = 0.901). Conclusions The routine use of a non-slip element scoring balloon catheter to prepare lesions suitable for drug-coated balloon angioplasty is associated with high procedural success rates and low TLF rates in de novo lesions.
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Abstract
Atherosclerosis is a chronic inflammatory vascular disease and the predominant cause of heart attack and ischemic stroke. Despite the well-known sexual dimorphism in the incidence and complications of atherosclerosis, there are relatively limited data in the clinical and preclinical literature to rigorously address mechanisms underlying sex as a biological variable in atherosclerosis. In multiple histological and imaging studies, overall plaque burden and markers of inflammation appear to be greater in men than women and are predictive of cardiovascular events. However, while younger women are relatively protected from cardiovascular disease, by the seventh decade, the incidence of myocardial infarction in women ultimately surpasses that of men, suggesting an interaction between sex and age. Most preclinical studies in animal atherosclerosis models do not examine both sexes, and even in those that do, well-powered direct statistical comparisons for sex as an independent variable remain rare. This article reviews the available data. Overall, male animals appear to have more inflamed yet smaller plaques compared to female animals. Plaque inflammation is often used as a surrogate end point for plaque vulnerability in animals. The available data support the notion that rather than plaque size, plaque inflammation may be more relevant in assessing sex-specific mechanisms since the findings correlate with the sex difference in ischemic events and mortality and thus may be more reflective of the human condition. Overall, the number of preclinical studies directly comparing plaque inflammation between the sexes is extremely limited relative to the vast literature exploring atherosclerosis mechanisms. Failure to include both sexes and to address age in mechanistic atherosclerosis studies are missed opportunities to uncover underlying sex-specific mechanisms. Understanding the mechanisms driving sex as a biological variable in atherosclerotic disease is critical to future precision medicine strategies to mitigate what is still the leading cause of death of men and women worldwide.
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Affiliation(s)
- Joshua J Man
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (J.J.M., I.Z.J.).,Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA (J.J.M.)
| | - Joshua A Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (J.A.B.)
| | - Iris Z Jaffe
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (J.J.M., I.Z.J.)
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Abstract
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed toward more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high-quality imaging studies, both invasive and noninvasive, which promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events. We discuss the role of VP imaging in managing atherosclerotic vascular disease.
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Shishikura D, Kataoka Y, Di Giovanni G, Takata K, Scherer DJ, Andrews J, Psaltis PJ, Puri R, Wolski K, Nissen SE, Nicholls SJ. Progression of ultrasound plaque attenuation and low echogenicity associates with major adverse cardiovascular events. Eur Heart J 2020; 41:2965-2973. [DOI: 10.1093/eurheartj/ehaa173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/05/2019] [Accepted: 03/04/2020] [Indexed: 02/02/2023] Open
Abstract
Abstract
Aims
Intravascular ultrasound (IVUS) imaging can visualize vulnerable plaque features including attenuation (AP) and echolucency (ELP). While IVUS-derived vulnerable plaque features associate with microvascular obstruction during percutaneous coronary intervention, the relationship between these plaque features and clinical outcomes has not been established. This analysis aimed to evaluate the association of AP/ELP with cardiovascular events.
Methods and results
Serial IVUS imaging was reviewed in 1497 patients, followed for 18–24 months, with coronary artery disease from two clinical trials. Attenuated plaque and ELP were identified to measure each characteristics (AP arc, ELP area, and lengths), which permitted calculation of an AP index (API) and ELP volume. Attenuated plaque/ELP progression was defined as patients with any increase of API or ELP volume on serial imaging. The major cardiovascular events (MACEs) were defined as death, myocardial infarction, stroke, and coronary revascularization. AP or ELP was identified in 282 patients (18.8%) at baseline and 160 (10.7%) patients demonstrated an increase in AP or ELP at follow-up. The incidence of MACE was higher in patients with baseline AP/ELP than those without (8.2% vs. 3.9%, P = 0.002). Patients with AP/ELP progression were more likely to be acute coronary syndrome (41.9 vs. 33.2%, P = 0.03) and have greater baseline percent atheroma volume (40.0% vs. 35.8%, P < 0.001) than those without. On multivariable analysis, AP/ELP progression was more strongly associated with MACE [baseline AP/ELP: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.05–2.97, AP/ELP progression: HR 2.19, 95% CI 1.24–3.86].
Conclusion
Attenuation/ELP progression was associated with a higher prevalence of cardiovascular events, supporting a potential role for the identification of high-risk vulnerable plaques in patients with coronary artery disease.
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Affiliation(s)
- Daisuke Shishikura
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Yu Kataoka
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Giuseppe Di Giovanni
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Kohei Takata
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Daniel J Scherer
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Jordan Andrews
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Peter J Psaltis
- Heart Health Them, South Australian Health & Medical Research Institute, University of Adelaide, North Terrace, Adelaide, SA 5001, Australia
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Centre for Clinical Research, Euclid Avenue, Cleveland, OH 44195, USA
| | - Kathy Wolski
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Centre for Clinical Research, Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Centre for Clinical Research, Euclid Avenue, Cleveland, OH 44195, USA
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, 246 Clayton Rd, Clayton, Victoria 3168, Australia
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Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
With coronary artery disease (CAD) projected to remain the leading cause of global mortality, prevention strategies seem to be the only effective approach able to reduce the burden and improve mortality and morbidity. At this moment, diagnostic strategies focus mainly on symptomatic patients, ignoring the occurrence of major cardiovascular events as the only manifestation of CAD. As two thirds of fatal myocardial infarction are resulting from plaque rupture, an approach based on the “vulnerable plaque” concept is mandatory in order to improve patient diagnosis, treatment, and, by default, prognosis. Given that the main studies focus on a plaque-centered approach, this is a prospective observational study that will perform a complex assessment of the features that characterize unstable coronary lesions, in terms of both local assessment via specific coronary computed tomography angiography markers of coronary plaque vulnerability and systemic approach based on serological markers of systemic inflammation in patients proved to be “vulnerable” by developing acute cardiovascular events.
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29
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Timóteo AT, Mota Carmo M, Soares C, Cruz Ferreira R. Is metabolic syndrome a prognostic marker in patients at high cardiovascular risk? A long-term cohort study. Rev Port Cardiol 2019; 38:325-332. [PMID: 31221487 DOI: 10.1016/j.repc.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Obese patients are at higher cardiovascular risk in primary prevention. In secondary prevention, an obesity paradox has been reported. We analyzed a cohort of individuals from a previous cross-sectional study on the impact of metabolic syndrome (MS) on coronary artery disease (CAD), aiming to assess the occurrence of cardiovascular events in a long follow-up. METHODS We analyzed 296 individuals in a mean follow-up of 6.9±2.2 years. Subjects were divided into four groups according to the presence of MS or CAD (defined as ≥70% coronary stenosis). RESULTS The study population had a mean age of 65±9 years at the beginning of the study; 59.5% were male, 55.7% had MS and 41.6% had CAD. During follow-up 10.1% of the population suffered all-cause death, 3.7% cardiovascular death, 14.2% cardiovascular readmission and 22.0% the composite outcome (mortality, acute coronary syndrome, coronary revascularization, stroke/transient ischemic attack or heart failure admission). There were no significant differences in any type of mortality. Patients with CAD had more readmissions and composite outcomes (log-rank p<0.001 and p=0.001, respectively), but there was no difference according to the presence of MS. Only CAD was an independent predictor of cardiovascular admission (HR 3.21, 95% CI 1.66-6.21) and composite outcomes (HR 2.41, 95% CI 1.44-4.02). CONCLUSIONS In patients with high cardiovascular risk or established CAD, the presence of MS is not associated with cerebral or cardiac events in long-term follow-up.
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Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Lisboa, Portugal.
| | - Miguel Mota Carmo
- Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Lisboa, Portugal
| | - Cristina Soares
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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Seo J, Kim GS, Lee HY, Byun YS, Jung IH, Rhee KJ, Kim BO. Prevalence and Clinical Outcomes of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Concurrent Coronary and Carotid Angiography. Yonsei Med J 2019; 60:542-546. [PMID: 31124337 PMCID: PMC6536396 DOI: 10.3349/ymj.2019.60.6.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The prevalence and clinical outcomes of asymptomatic carotid artery stenosis (CAS) in patients with coronary artery disease (CAD) have not been thoroughly studied. We examined the prevalence and predictors of asymptomatic CAS detected by carotid angiography and determined the impact of concomitant CAS on prognosis in patients undergoing coronary angiography (CAG) due to CAD. MATERIALS AND METHODS Between January 2013 and July 2015, 395 patients who underwent carotid digital subtraction angiography to screen for CAS during CAG were analyzed. The presence of CAS was defined as angiographically significant stenosis (≥50%). Major adverse cardiac and cerebrovascular event (MACCE) rates were compared between patients with and without CAS. MACCEs included a composite of cardiac death, cerebrovascular death, acute myocardial infarction, and stroke. RESULTS Of the 395 patients, 101 (25.5%) patients had significant CAS. The independent predictors of CAS were age, male sex, hypertension, diabetes, and multi-vessel disease. In patients with CAD, the presence of CAS was as an independent predictor for MACCEs after adjusting for confounding factors (hazard ratio 2.47, 95% confidence interval 1.16-5.24, p=0.018). CONCLUSION Asymptomatic CAS was documented in up to 25% of patients with CAD. The presence of CAS in patients with CAD was associated with a higher rate of MACCEs. Therefore, detection of CAS by carotid angiography during CAG may be important for risk stratification for CAD patients, particularly those with multi-vessel disease.
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Affiliation(s)
- Jongkwon Seo
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Gwang Sil Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kun Joo Rhee
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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31
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Syaifudin A, Ariatedja JB, Kaelani Y, Takeda R, Sasaki K. Vulnerability analysis on the interaction between Asymmetric stent and arterial layer. Biomed Mater Eng 2019; 30:309-322. [PMID: 31127751 DOI: 10.3233/bme-191054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The utilization of Asymmetric stent for recovering atherosclerotic diseases, particularly non-symmetric obstruction, is a quite challenging breakthrough treatment. In terms of eccentric plaque, the non-uniform stiffness of arterial layer causes the increasingly complex issues of vulnerability. This study investigated the vulnerability of the interaction between the Asymmetric stent and the surrounding arterial layer using structural transient dynamic analysis in ANSYS. Four combinations of stent deployment, i.e. the Sinusoidal stent expanded by the offset balloon, the Sinusoidal stent expanded by the ordinary cylindrical balloon, the Asymmetric stent expanded by the offset balloon, and the Asymmetric stent expanded by the ordinary cylindrical balloon, are generated for this comparative study. Multilayer material properties from recent in vitro experiments are adopted for the surrounding arterial layer, such as a fibrous cap, lipid core, diseased-healthy intima, and diseased-healthy media. In order to address plaque vulnerability, the Cauchy stresses and Hencky strains are used for stress measure because of convenience in comparison with the uniaxial/biaxial tension test data. The location-specific threshold value from the diseased human carotid artery is adopted for rupture criteria. The simulation indicated that as regards the eccentric plaque, the plaque vulnerability is caused by the plaque shape and components rather than caused by the geometrical structure of the stent or balloon expansion method. Nevertheless, the non-symmetric inflation of balloon, which leads against the plaque, contributed to an increase in the vulnerability of fibrous cap of fibroatheroma plaque.
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Affiliation(s)
- Achmad Syaifudin
- Department of Mechanical Engineering, Faculty of Industrial Technology, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Julendra B Ariatedja
- Department of Mechanical Engineering, Faculty of Industrial Technology, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Yusuf Kaelani
- Department of Mechanical Engineering, Faculty of Industrial Technology, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Ryo Takeda
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Katsuhiko Sasaki
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Japan
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32
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Johnson KW, Glicksberg BS, Shameer K, Vengrenyuk Y, Krittanawong C, Russak AJ, Sharma SK, Narula JN, Dudley JT, Kini AS. A transcriptomic model to predict increase in fibrous cap thickness in response to high-dose statin treatment: Validation by serial intracoronary OCT imaging. EBioMedicine 2019; 44:41-49. [PMID: 31126891 PMCID: PMC6607084 DOI: 10.1016/j.ebiom.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 02/04/2023] Open
Abstract
Background Fibrous cap thickness (FCT), best measured by intravascular optical coherence tomography (OCT), is the most important determinant of plaque rupture in the coronary arteries. Statin treatment increases FCT and thus reduces the likelihood of acute coronary events. However, substantial statin-related FCT increase occurs in only a subset of patients. Currently, there are no methods to predict which patients will benefit. We use transcriptomic data from a clinical trial of rosuvastatin to predict if a patient's FCT will increase in response to statin therapy. Methods FCT was measured using OCT in 69 patients at (1) baseline and (2) after 8–10 weeks of 40 mg rosuvastatin. Peripheral blood mononuclear cells were assayed via microarray. We constructed machine learning models with baseline gene expression data to predict change in FCT. Finally, we ascertained the biological functions of the most predictive transcriptomic markers. Findings Machine learning models were able to predict FCT responders using baseline gene expression with high fidelity (Classification AUC = 0.969 and 0.972). The first model (elastic net) using 73 genes had an accuracy of 92.8%, sensitivity of 94.1%, and specificity of 91.4%. The second model (KTSP) using 18 genes has an accuracy of 95.7%, sensitivity of 94.3%, and specificity of 97.1%. We found 58 enriched gene ontology terms, including many involved with immune cell function and cholesterol biometabolism. Interpretation In this pilot study, transcriptomic models could predict if FCT increased following 8–10 weeks of rosuvastatin. These findings may have significance for therapy selection and could supplement invasive imaging modalities.
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Affiliation(s)
- Kipp W Johnson
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, United States of America; Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Benjamin S Glicksberg
- Bakar Computational Health Sciences Institute, The University of California, San Francisco, San Francisco, CA, United States of America
| | - Khader Shameer
- Advanced Analytics Center, AstraZeneca, Gaithersburg, MD, United States of America
| | - Yuliya Vengrenyuk
- Mount Sinai Heart, Mount Sinai Health System, New York, NY, United States of America
| | - Chayakrit Krittanawong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Adam J Russak
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, United States of America; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Samin K Sharma
- Mount Sinai Heart, Mount Sinai Health System, New York, NY, United States of America
| | - Jagat N Narula
- Mount Sinai Heart, Mount Sinai Health System, New York, NY, United States of America
| | - Joel T Dudley
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, United States of America; Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Annapoorna S Kini
- Mount Sinai Heart, Mount Sinai Health System, New York, NY, United States of America.
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Cao L, Guo Y, Zhu Z. Study of the Inflammatory Mechanisms in Hyperhomocysteinemia on Large-Artery Atherosclerosis Based on Hypersensitive C-Reactive Protein-A Study from Southern China. J Stroke Cerebrovasc Dis 2019; 28:1816-1823. [PMID: 31080137 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To study the inflammatory mechanism of hyperhomocysteinemia on large-artery atherosclerosis based on hypersensitive C-reactive protein in patients. METHODS In all, 153 inpatients and 1357 physical examinees were selected. The levels of homocysteine were compared between the carotid/intracranial artery stenosis group and the nonstenosis group, between the carotid artery unstable plaque group and the nonplaque group, and between the intima-media thickness (IMT) greater than or equal to 1 group and the normal IMT group. The hypersensitive C-reactive protein levels were compared between the lacunar infarction (LI) group and the nonstroke control group and between the unstable plaque group and the nonplaque group. RESULTS Homocysteine level was significantly higher in the carotid/intracranial artery stenosis group than in the nonstenosis group, in the LI group than in the inpatient nonstroke group, and in the IMT greater than or equal to 1 group than in the normal IMT group. The hypersensitive C-reactive protein level was significantly higher in the LI group than in the nonstroke group and in the unstable plaque group than in the nonplaque group. CONCLUSIONS Hyperhomocysteinemia may aggravate the development of IMT, carotid atherosclerotic plaque instability, and carotid/intracranial artery stenosis by increasing inflammation, ultimately leading to the occurrence of LI. Hyperhomocysteinemia-induced inflammation mechanism warrants further study.
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Affiliation(s)
- Liming Cao
- Department of neurology, The First Affiliated Hospital of Jinan University, Guang zhou, China; Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen City, China.
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, Shenzhen City, China
| | - Zhishan Zhu
- Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen City, China
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Coronary Plaque Geometry and Thoracic Fat Distribution in Patients with Acute Chest Pain – a CT Angiography Study. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of our study was to investigate the correlation between volumes of thoracic fat distributed in different compartments and the geometry of vulnerable coronary plaques assessed by coronary computed tomography angiography (CCTA), in patients with acute chest pain.
Methods: This was a non-randomized, observational, single-center study, including 50 patients who presented in the emergency department with acute chest pain who underwent 128-slice single-source CCTA. Plaque geometry was evaluated in transversal and longitudinal planes, and the assessment of adipose tissue was performed using the Syngo.via Frontier (Siemens AG, Healthcare Sector, Forchheim, Germany) research platform.
Results: Eccentric plaques presented a significantly higher incidence of spotty calcification (40% vs. 22%, p = 0.018), whereas positive remodeling, volume of low attenuation plaque, and incidence of napkin-ring sign were not significantly different between the study groups or in ascending versus descending plaques. The volume of pericoronary fat around the plaque was significantly larger near eccentric lesions (707.68 ± 454.08 mm3 vs. 483.25 ± 306.98 mm3, p = 0.046) and descendent plaques (778.26 ± 479.37 mm3 vs. 473.60 ± 285.27 mm3, p = 0.016). Compared to ascending lesions, descendent ones presented a significantly larger volume of thoracic fat (1,599.25 ± 589.12 mL vs. 1,240.71 ± 291.50 mL), while there was no significant correlation between thoracic fat and cross-sectional eccentricity.
Conclusions: The phenotype of plaque distribution and geometry seems to be associated with a higher vulnerability of coronary lesions and may be influenced by the local accumulation of inflammatory mediators released by the pericoronary epicardial adipose tissue.
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Is metabolic syndrome a prognostic marker in patients at high cardiovascular risk? A long-term cohort study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Quantitative score of the vessel morphology in middle cerebral artery atherosclerosis. J Neurol Sci 2019; 399:111-117. [PMID: 30798108 DOI: 10.1016/j.jns.2019.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aimed to quantitatively assess the vessel morphology of middle cerebral artery (MCA) atherosclerosis and explore its value in discriminating plaque types. METHODS Patients were selected from a high-resolution magnetic resonance imaging (HRMRI) study from January 2007 to December 2015. One hundred and three patients with acute cerebral infarcts due to MCA stenosis (>50%) and eighty-nine patients with asymptomatic MCA stenosis (>50%) were included. Quantitative measurements of MCA morphology, including lumen area, outer-wall and wall area at stenotic site and reference site, stenotic degree, plaque length, remodeling index and plaque eccentricity, were performed on HRMRI with observers blinded to clinical presentations. Firth's penalized logistic regression analysis was used to construct a symptomatic plaque score (SPS) model. Then, the HRMRI data of 39 patients prospectively enrolled from January 2016 to January 2017 were used to validate the SPS model. RESULTS The HRMRI data of 103 patients with symptomatic MCA stenosis and 89 patients with asymptomatic MCA stenosis in the construction cohort were analyzed. Four main factors were found to be associated with symptomatic plaques: stenotic lumen area ≥ 2.28 mm2, stenotic wall area ≥ 8.88 mm2, plaque length and presence of an eccentric plaque. Summation of each logistic regression coefficient multiplying the corresponding score produced the SPS with an area under curve (AUC) of 0.890 on receiver operating characteristics analysis. Validation of the score of 39 plaques (19 symptomatic and 20 asymptomatic) revealed an AUC of 0.862, confirming the continued diagnostic ability. When the data were pooled in all 235 plaques, the optimal cutoff score of discriminating symptomatic and asymptomatic plaques was 2.79 (SPS ≥ 2.79 indicating a symptomatic plaque) with AUC = 0.886, sensitivity 81.1% and specificity 80.5%. CONCLUSIONS The quantitative analysis of MCA morphology can independently and accurately discriminate plaque types, suggesting its close association with the underlying pathophysiology. Further prospective studies are required to verify whether the SPS model is clinically valuable in monitoring plaque progression and assessing the vulnerability.
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Ratiu M, Chitu M, Benedek I, Benedek T, Kovacs I, Rat N, Rezus C. Impact of coronary plaque geometry on plaque vulnerability and its association with the risk of future cardiovascular events in patients with chest pain undergoing coronary computed tomographic angiography-the GEOMETRY study: Protocol for a prospective clinical trial. Medicine (Baltimore) 2018; 97:e13498. [PMID: 30544446 PMCID: PMC6310548 DOI: 10.1097/md.0000000000013498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Coronary computed tomography angiography (CCTA) has emerged as a valuable noninvasive imaging tool for assessing atheromatous plaque morphology and composition, and several CCTA features have been validated as reliable indicators of the plaque-associated risk. However, the role of lesion geometry as a CCTA feature of plaque vulnerability has not been investigated so far. MATERIAL AND METHODS Here we present the study protocol of the GEOMETRY trial, a prospective, single center, cohort study in which we aim to investigate the relationship between plaque geometry (as expressed by cross-sectional and longitudinal plaque eccentricity) and the risk for major adverse cardiac events (MACE) during 2 years of follow-up, in order to validate plaque eccentricity as a new CCTA marker of coronary plaque vulnerability. One thousand patients with suspected coronary artery disease (CAD) and pretest probability of CAD between 15% and 85%, who undergo CCTA and in whom CCTA identifies the presence of at least 1 significant coronary plaque (producing a luminal narrowing of at least 50%) will be enrolled in the study. Based on the results of complex image post-processing and plaque analysis, patients will be divided into 2 groups: group 1-patients in whom CCTA analysis identifies only non-eccentric coronary plaque; and group 2-patients in whom CCTA analysis reveals the presence of at least 1 eccentric significant coronary plaque producing a significant luminal narrowing. Study outcomes will consist in the rate of major cardiovascular events and the rate of plaque progression during follow-up.The study is funded by the Romanian Ministry of European Funds, the Romanian Government and the European Union, as part of the research grant number 103544/2016 - PlaqueIMAGE (contract number 26/01.09.2016). CONCLUSION In conclusion, GEOMETRY will be the first CCTA-based study that will investigate the impact of geometric distribution of coronary atheromatous plaque on the future risk of cardiovascular events and on the rate of plaque progression, introducing and validating a new potential feature of plaque vulnerability represented by plaque geometry.
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Affiliation(s)
- Mihaela Ratiu
- Department of Radiology
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Monica Chitu
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Imre Benedek
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Theodora Benedek
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Istvan Kovacs
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Nora Rat
- Department of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Ciprian Rezus
- Department of Medical Clinic III - Internal Medicine, University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania
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Yamashita K, Yamamoto MH, Igawa W, Ono M, Kido T, Ebara S, Okabe T, Saito S, Amemiya K, Isomura N, Araki H, Ochiai M. Association of Epicardial Adipose Tissue Volume and Total Coronary Plaque Burden in Patients with Coronary Artery Disease. Int Heart J 2018; 59:1219-1226. [PMID: 30369579 DOI: 10.1536/ihj.17-709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The relationship between epicardial adipose tissue volume (EATV) and plaque vulnerability in non-culprit coronary lesions is not clearly understood.Fifty-four consecutive patients/158 lesions with suspected coronary artery disease underwent computed tomography (CT) and 40 MHz intravascular ultrasound imaging (iMap-IVUS) in cardiac catheterization. Cross-sectional CT slices were semiautomatically traced from base to apex of the heart. Using a 3D workstation, EATV was measured as the sum of fat areas (-190 to -30 Hounsfield units [HU]). All coronary vessels were imaged using iMap-IVUS before stenting to analyze coronary plaques as fibrotic, lipidic, necrotic, or calcified tissue.Mean EATV was 73.7 ± 24.6 (range: 30.2 to 131.8) mL. Patients were divided into two groups by mean EATV (group H: n = 27, EATV ≥ 73.7 mL; group L: n = 27, EATV < 73.7 mL). Total luminal volume, total vessel volume, and total plaque volume were significantly larger in group H. Fibrotic plaque and lipidic plaque volumes were also significantly larger in group H. There was a significant negative correlation between EATV and fibrous tissue (r = -0.31, P = 0.02) and a significant positive correlation between EATV and necrotic tissue (r = 0.37, P = 0.007). EATV was related to plaque with vulnerability in the right coronary artery (RCA) (r = 0.57, P = 0.04) and the left anterior descending artery (LAD) (r = 0.53, P = 0.02). In conclusion, increased EATV was associated with the total coronary plaque burden and composition, particularly in the RCA and LAD.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Myong Hwa Yamamoto
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital.,Cardiovascular Research Foundation.,Columbia University Medical Center
| | - Wataru Igawa
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Morio Ono
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Takehiko Kido
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Seitarou Ebara
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Toshitaka Okabe
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Shigeo Saito
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Kisaki Amemiya
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Naoei Isomura
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Hiroshi Araki
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
| | - Masahiko Ochiai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital
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Xie X, Li Y, Xie S. Computation of hemodynamics in eccentric coronary stenosis: A morphological parametric study. Technol Health Care 2018; 26:229-238. [PMID: 29660973 DOI: 10.3233/thc-160529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Flow recirculation occurs in eccentric coronary stenosis, which can lead to adverse outcome. The complex local geodesic patterns of eccentric stenosis are critical factors in determining the flow characteristics in post-stenotic flow. OBJECTIVE The main objective of this study is to relate the relationship between the detailed morphological parameters in eccentric coronary stenosis and the post-stenotic flow characteristics. METHODS Several idealized eccentric coronary stenosis models with variable morphological parameters are created to conduct a series of computational fluid dynamics analysis. The impact of four specific lesion morphological parameters, eccentricity index (EI), diameter stenosis (DS), stenosis length (SL) and shape of lesion, are investigated. RESULTS When EI is small (< 0.33), the length of recirculation zones would increase as EI increase; while when EI is large (> 0.33), it would decreased as EI increase; Larger magnitude of retrograde flow occurs in models with smaller EIs. Both the recirculation zone length and maximum shear rate increase significantly as DS increases. Increase of SL will lead to increase of recirculation zone length. Higher maximum shear rate and larger recirculation zone are observed in models with sharper stenosis shape. CONCLUSIONS Except DS, the detailed geometry patterns (EI, SL and shape of the stenosis) also have great impact on post-stenotic flow behaviors in eccentric coronary stenosis.
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The effect of plaque eccentricity on blood hemodynamics and drug release in a stented artery. Med Eng Phys 2018; 60:47-60. [DOI: 10.1016/j.medengphy.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022]
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Chang HJ, Lin FY, Lee SE, Andreini D, Bax J, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, Hadamitzky M, Kim YJ, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Raff GL, van Rosendael AR, Villines TC, Weirich HG, Al'Aref SJ, Baskaran L, Cho I, Danad I, Han D, Heo R, Lee JH, Rivzi A, Stuijfzand WJ, Gransar H, Lu Y, Sung JM, Park HB, Berman DS, Budoff MJ, Samady H, Shaw LJ, Stone PH, Virmani R, Narula J, Min JK. Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. J Am Coll Cardiol 2018; 71:2511-2522. [PMID: 29852975 PMCID: PMC6020028 DOI: 10.1016/j.jacc.2018.02.079] [Citation(s) in RCA: 288] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. OBJECTIVES The purpose of this study was to identify atherosclerotic features associated with precursors of ACS. METHODS We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 ± 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (≥50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs). RESULTS We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm3 fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm3 necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP. CONCLUSIONS Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden.
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Affiliation(s)
- Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edoardo Conte
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Fabian Plank
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan
| | - Alexander R van Rosendael
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Center, Bethesda, Maryland
| | - Harald G Weirich
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Subhi J Al'Aref
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Lohendran Baskaran
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Chung-Ang University Hospital, Seoul, South Korea
| | - Ibrahim Danad
- VU University Medical Center, Amsterdam, the Netherlands
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Ran Heo
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Asim Rivzi
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Wijnand J Stuijfzand
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Heidi Gransar
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Yao Lu
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Bok Park
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter H Stone
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.
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Spacek M, Zemanek D, Hutyra M, Sluka M, Taborsky M. Vulnerable atherosclerotic plaque - a review of current concepts and advanced imaging. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:10-17. [DOI: 10.5507/bp.2018.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/06/2018] [Indexed: 01/31/2023] Open
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Syaifudin A, Takeda R, Sasaki K. Development of asymmetric stent for treatment of eccentric plaque. Biomed Mater Eng 2018; 29:299-317. [PMID: 29578470 DOI: 10.3233/bme-181737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The selection of stent and balloon type is decisive in the stenting process. In the treatment of an eccentric plaque obstruction, a symmetric expansion from stent dilatation generates nonuniform stress distribution, which may aggravate fibrous cap prone to rupture. This paper developed a new stent design to treat eccentric plaque using structural transient dynamic analysis in ANSYS. A non-symmetric structural geometry of stent is generated to obtain reasonable stress distribution safe for the arterial layer surrounding the stent. To derive the novel structural geometry, a Sinusoidal stent type is modified by varying struts length and width, adding bridges, and varying curvature width of struts. An end ring of stent struts was also modified to eliminate dogboning phenomenon and to reduce the Ectropion angle. Two balloon types were used to deploy the stent, an ordinary cylindrical and offset balloon. Positive modification results were used to construct the final non-symmetric stent design, called an Asymmetric stent. Analyses of the deformation characteristics, changes in surface roughness and induced stresses within intact arterial layer were subsequently examined. Interaction between the stent and vessel wall was implemented by means of changes in surface roughness and stress distribution analyses. The Palmaz and the Sinusoidal stent were used for a comparative study. This study indicated that the Asymmetric stent types reduced the central radial recoiling and the dogboning phenomenon. In terms of changes in surface roughness and induced stresses, the Asymmetric stent has a comparable effect with that of the Sinusoidal stent. In addition, it could enhance the distribution of surface roughening as expanded by an offset balloon.
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Affiliation(s)
- Achmad Syaifudin
- Department of Mechanical Engineering, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Ryo Takeda
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Katsuhiko Sasaki
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Japan
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Parviz Y, Shlofmitz E, Fall KN, Konigstein M, Maehara A, Jeremias A, Shlofmitz RA, Mintz GS, Ali ZA. Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography. Br Med Bull 2018; 125:79-90. [PMID: 29360941 DOI: 10.1093/bmb/ldx049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/15/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Intracoronary imaging is an important tool for guiding decision making in the cardiac catheterization laboratory. SOURCES OF DATA We have reviewed the latest available evidence in the field to highlight the various potential benefits of intravascular imaging. AREAS OF AGREEMENT Coronary angiography has been considered the gold standard test to appropriately diagnose and manage patients with coronary artery disease, but it has the inherent limitation of being a 2-dimensional x-ray lumenogram of a complex 3-dimensional vascular structure. AREAS OF CONTROVERSY There is well-established inter- and intra-observer variability in reporting coronary angiograms leading to potential variability in various management strategies. Intracoronary imaging improves the diagnostic accuracy while optimizing the results of an intervention. Utilization of intracoronary imaging modalities in routine practice however remains low worldwide. Increased costs, resources, time and expertise have been cited as explanations for low incorporation of these techniques. GROWING POINTS Intracoronary imaging supplements and enhances an operator's decision-making ability based on detailed and objective lesion assessment rather than a subjective visual estimation. The benefits of intravascular imaging are becoming more profound as the complexity of cases suitable for revascularization increases. AREAS TIMELY FOR DEVELOPING RESEARCH While the clinical benefits of intravascular ultrasound have been well validated, optical coherence tomography in comparison is a newer technology, with robust clinical trials assessing its clinical benefit are underway.
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Affiliation(s)
- Yasir Parviz
- Division of Cardiology, Columbia UniversityMedical Center, New York, NY, USA
| | - Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Khady N Fall
- Division of Cardiology, Columbia UniversityMedical Center, New York, NY, USA
| | | | - Akiko Maehara
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY, USA.,St. Francis Hospital, Roslyn, NY, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A Ali
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
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45
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Tan HW, Chen X, Maingard J, Barras CD, Logan C, Thijs V, Kok HK, Lee MJ, Chandra RV, Brooks M, Asadi H. Intracranial Vessel Wall Imaging with Magnetic Resonance Imaging: Current Techniques and Applications. World Neurosurg 2018; 112:186-198. [PMID: 29360586 DOI: 10.1016/j.wneu.2018.01.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
Abstract
Vessel wall magnetic resonance imaging (VW-MRI) is a modern imaging technique with expanding applications in the characterization of intracranial vessel wall pathology. VW-MRI provides added diagnostic capacity compared with conventional luminal imaging methods. This review explores the principles of VW-MRI and typical imaging features of various vessel wall pathologies, such as atherosclerosis, dissection, and vasculitis. Radiologists should be familiar with this important imaging technique, given its increasing use and future relevance to everyday practice.
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Affiliation(s)
- Haur Wey Tan
- Department of Radiology, Austin Hospital, Melbourne, Australia.
| | - Xiao Chen
- Department of Radiology, Austin Hospital, Melbourne, Australia
| | - Julian Maingard
- Department of Radiology, Austin Hospital, Melbourne, Australia; Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Christen D Barras
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Interventional Radiology Service, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Imaging, Monash University, Melbourne, Victoria, Australia
| | - Mark Brooks
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Radiology, Interventional Neuroradiology Service, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
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46
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[Contribution of intracoronary imaging in acute coronary syndrome]. Ann Cardiol Angeiol (Paris) 2017; 66:405-410. [PMID: 29106830 DOI: 10.1016/j.ancard.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in the world, although it has considerably decreased through technical and pharmacological advances. The physiopathological approach of the ACS has progressed considerably in recent years thanks to the anatomopathological work and the data of the endocoronary imaging, in particular of the endovascular ultrasound (IVUS). Plaque rupture is the most common cause of ACS, however OCT (optical coherence tomography) studies have shown that surface plaque erosion was more common than thought. The use of OCT in the ACS may prove to be a valuable diagnostic aid: study of the culpable lesion, spontaneous coronary dissection or intramural spontaneous hematoma, stent thrombosis; from a therapeutic point of view: reduction of the risk of stent malapposition, additional technique, delayed stenting, implantation of a bioresorbable stent, medical treatment of ACS without stenting. Endocoronary imaging, especially OCT, will of course never be systematic as treatment of ACS, but providing excellent value for both diagnosis and treatment, it must be an integral part of the therapeutic arsenal available in cathlab.
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47
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Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet 2017; 390:793-809. [PMID: 28831995 DOI: 10.1016/s0140-6736(17)31957-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging-intravascular ultrasound and more recently optical coherence tomography-provide a tomographical or cross-sectional image of the coronary arteries. These techniques are clinically useful to answer questions such as whether the stenosis is clinically relevant; the identification of the culprit lesion; or whether the plaque (or patient) is at high risk of future adverse events. They can also be used to optimise stent implantation to minimise stent-related adverse events, provide answers to the likelihood of distal embolisation or peri-procedural myocardial infarction during stent implantation, and provide reasons for stent thrombosis or restenosis. This review considers the usefulness of intravascular imaging in day-to-day practice.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA.
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48
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Sex-related differences in serum matrix metalloproteinase-9 screening non-calcified and mixed coronary atherosclerotic plaques in outpatients with chest pain. Heart Vessels 2017; 32:1424-1431. [PMID: 28726114 DOI: 10.1007/s00380-017-1014-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study is to evaluate the clinical feasibility of serum matrix metalloproteinase-9 (MMP-9) for screening plaque composition as assessed by coronary computed tomography angiography (CCTA) in outpatients with chest pain,and the effects of sex on this feasibility. Eight hundred and sixty-two consecutive outpatients with chest pain were divided into three groups according to the results of CCTA: non-plaque (NP, n = 474), calcified plaques (CPs, n = 179), non-calcified and mixed plaques (NCPs and MPs, n = 209). We found that serum MMP-9 levels were significantly higher in patients with NCPs and MPs compared to those with either NP or CPs, especially in women (649.7 ± 279.8 vs. 485.7 ± 231.6 ng/mL or 515.7 ± 274.5 ng/mL, P < 0.001). MMP-9 showed better identification of NCPs and MPs than other related factors and was an independent predictor for NCPs and MPs both in women and men. The receiver operating characteristic analysis indicated a substantial superiority in women with area under the curve of 0.75 (95% CI 0.69-0.82, P < 0.01), compared with men of 0.59 (95% CI 0.53-0.65, z = 3.71, P < 0.01). The diagnostic tests revealed a moderate risk of the presence of NCPs and MPs with MMP-9 ≥531.6 ng/mL in female patients.
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49
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Hays AG, Iantorno M, Schär M, Mukherjee M, Stuber M, Gerstenblith G, Weiss RG. Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease. J Cardiovasc Magn Reson 2017; 19:51. [PMID: 28679397 PMCID: PMC5499038 DOI: 10.1186/s12968-017-0358-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 04/11/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Coronary endothelial function (CEF) in patients with coronary artery disease (CAD) varies among coronary segments in a given patient. Because both coronary vessel wall eccentricity and coronary endothelial dysfunction are predictors of adverse outcomes, we hypothesized that local coronary endothelial dysfunction is associated with local coronary artery eccentricity. METHODS We used 3 T coronary CMR to measure CEF as changes in coronary cross-sectional area (CSA) and coronary blood flow (CBF) during isometric handgrip exercise (IHE), a known endothelial-dependent stressor, in 29 patients with known CAD and 16 healthy subjects. Black-blood MRI quantified mean coronary wall thickness (CWT) and coronary eccentricity index (EI) and CEF was determined in the same segments. RESULTS IHE-induced changes in CSA and CBF in healthy subjects (10.6 ± 6.6% and 38.3 ± 29%, respectively) were greater than in CAD patients 1.3 ± 7.7% and 6.5 ± 19.6%, respectively, p < 0.001 vs. healthy for both measures), as expected. Mean CWT and EI in healthy subjects (1.1 ± 0.3 mm 1.9 ± 0.5, respectively) were less than those in CAD patients (1.6 ± 0.4 mm, p < 0.0001; and 2.6 ± 0.6, p = 0.006 vs. healthy). In CAD patients, we observed a significant inverse relationship between stress-induced %CSA change and both EI (r = -0.60, p = 0.0002), and CWT (r = -0.54, p = 0.001). Coronary EI was independently and significantly related to %CSA change with IHE even after controlling for mean CWT (adjusted r = -0.69, p = 0.0001). For every unit increase in EI, coronary CSA during IHE is expected to change by -6.7 ± 9.4% (95% confidence interval: -10.3 to -3.0, p = 0.001). CONCLUSION There is a significant inverse and independent relationship between coronary endothelial macrovascular function and the degree of local coronary wall eccentricity in CAD patients. Thus anatomic and physiologic indicators of high-risk coronary vascular pathology are closely related. The noninvasive identification of coronary eccentricity and its relationship with underlying coronary endothelial function, a marker of vascular health, may be useful in identifying high-risk patients and culprit lesions.
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Affiliation(s)
- Allison G. Hays
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287 USA
| | - Micaela Iantorno
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287 USA
| | - Michael Schär
- Department of Radiology, Division of Magnetic Resonance Research, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Monica Mukherjee
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287 USA
| | - Matthias Stuber
- Department of Radiology, Division of Magnetic Resonance Research, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287 USA
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Center for Biomedical Imaging (CIBM), University of Lausanne, Lausanne, Switzerland
| | - Gary Gerstenblith
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287 USA
| | - Robert G. Weiss
- Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287 USA
- Department of Radiology, Division of Magnetic Resonance Research, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287 USA
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50
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Ming JE, Abrams RE, Bartlett DW, Tao M, Nguyen T, Surks H, Kudrycki K, Kadambi A, Friedrich CM, Djebli N, Goebel B, Koszycki A, Varshnaya M, Elassal J, Banerjee P, Sasiela WJ, Reed MJ, Barrett JS, Azer K. A Quantitative Systems Pharmacology Platform to Investigate the Impact of Alirocumab and Cholesterol-Lowering Therapies on Lipid Profiles and Plaque Characteristics. GENE REGULATION AND SYSTEMS BIOLOGY 2017; 11:1177625017710941. [PMID: 28804243 PMCID: PMC5484552 DOI: 10.1177/1177625017710941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/17/2017] [Indexed: 12/20/2022]
Abstract
Reduction in low-density lipoprotein cholesterol (LDL-C) is associated with decreased risk for cardiovascular disease. Alirocumab, an antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), significantly reduces LDL-C. Here, we report development of a quantitative systems pharmacology (QSP) model integrating peripheral and liver cholesterol metabolism, as well as PCSK9 function, to examine the mechanisms of action of alirocumab and other lipid-lowering therapies, including statins. The model predicts changes in LDL-C and other lipids that are consistent with effects observed in clinical trials of single or combined treatments of alirocumab and other treatments. An exploratory model to examine the effects of lipid levels on plaque dynamics was also developed. The QSP platform, on further development and qualification, may support dose optimization and clinical trial design for PCSK9 inhibitors and lipid-modulating drugs. It may also improve our understanding of factors affecting therapeutic responses in different phenotypes of dyslipidemia and cardiovascular disease.
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Affiliation(s)
- Jeffrey E Ming
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Ruth E Abrams
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | | | - Mengdi Tao
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Tu Nguyen
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Howard Surks
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | | | | | | | - Nassim Djebli
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Britta Goebel
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Alex Koszycki
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Meera Varshnaya
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | | | | | | | | | - Jeffrey S Barrett
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Karim Azer
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
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