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Cai K, Jiang H, Zou Y, Song C, Cao K, Chen S, Wu Y, Zhang Z, Geng D, Zhang N, Liu B, Sun G, Tang M, Li Z, Zhang Y, Sun Y, Zhang Y. Programmed death of cardiomyocytes in cardiovascular disease and new therapeutic approaches. Pharmacol Res 2024; 206:107281. [PMID: 38942341 DOI: 10.1016/j.phrs.2024.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
Cardiovascular diseases (CVDs) have a complex pathogenesis and pose a major threat to human health. Cardiomyocytes have a low regenerative capacity, and their death is a key factor in the morbidity and mortality of many CVDs. Cardiomyocyte death can be regulated by specific signaling pathways known as programmed cell death (PCD), including apoptosis, necroptosis, autophagy, pyroptosis, and ferroptosis, etc. Abnormalities in PCD can lead to the development of a variety of cardiovascular diseases, and there are also molecular-level interconnections between different PCD pathways under the same cardiovascular disease model. Currently, the link between programmed cell death in cardiomyocytes and cardiovascular disease is not fully understood. This review describes the molecular mechanisms of programmed death and the impact of cardiomyocyte death on cardiovascular disease development. Emphasis is placed on a summary of drugs and potential therapeutic approaches that can be used to treat cardiovascular disease by targeting and blocking programmed cell death in cardiomyocytes.
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Affiliation(s)
- Kexin Cai
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Haoyue Jiang
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Yuanming Zou
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Chunyu Song
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Kexin Cao
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Shuxian Chen
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Yanjiao Wu
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Zhaobo Zhang
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Danxi Geng
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China
| | - Naijin Zhang
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China; Institute of health sciences, China medical university, 77 Puhe Road, Shenbei New District, Shenyang, Liaoning 110001, People's Republic of China; Key Laboratory of Reproductive and Genetic Medicine (China Medical University), National Health Commission, 77 Puhe Road, Shenbei New District, Shenyang, Liaoning 110001, People's Republic of China
| | - Bo Liu
- The first hospital of China Medical University, Department of cardiac surgery, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China.
| | - Guozhe Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China.
| | - Man Tang
- Department of clinical pharmacology, College of Pharmacy, China medical university, 77 Puhe Road, Shenbei New District, Shenyang, Liaoning 110001, People's Republic of China.
| | - Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China.
| | - Yixiao Zhang
- Department of Urology Surgery, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, People's Republic of China.
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China; Institute of health sciences, China medical university, 77 Puhe Road, Shenbei New District, Shenyang, Liaoning 110001, People's Republic of China; Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, 77 Puhe Road, Shenbei New District, Shenyang, Liaoning 110001, People's Republic of China.
| | - Ying Zhang
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning 110001, People's Republic of China; Institute of health sciences, China medical university, 77 Puhe Road, Shenbei New District, Shenyang, Liaoning 110001, People's Republic of China.
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Kim DA, Ku DN. Material strengths of shear-induced platelet aggregation clots and coagulation clots. Sci Rep 2024; 14:11460. [PMID: 38769378 PMCID: PMC11106319 DOI: 10.1038/s41598-024-62165-1] [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: 09/18/2023] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
Arterial occlusion by thrombosis is the immediate cause of some strokes, heart attacks, and peripheral artery disease. Most prior studies assume that coagulation creates the thrombus. However, a contradiction arises as whole blood (WB) clots from coagulation are too weak to stop arterial blood pressures (> 150 mmHg). We measure the material mechanical properties of elasticity and ultimate strength for Shear-Induced Platelet Aggregation (SIPA) type clots, that form under stenotic arterial hemodynamics in comparison with coagulation clots. The ultimate strength of SIPA clots averaged 4.6 ± 1.3 kPa, while WB coagulation clots had a strength of 0.63 ± 0.3 kPa (p < 0.05). The elastic modulus of SIPA clots was 3.8 ± 1.5 kPa at 1 Hz and 0.5 mm displacement, or 2.8 times higher than WB coagulation clots (1.3 ± 1.2 kPa, p < 0.0001). This study shows that the SIPA thrombi, formed quickly under high shear hemodynamics, is seven-fold stronger and three-fold stiffer compared to WB coagulation clots. A force balance calculation shows a SIPA clot has the strength to resist arterial pressure with a short length of less than 2 mm, consistent with coronary pathology.
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Affiliation(s)
- Dongjune A Kim
- Georgia Institute of Technology, G.W. Woodruff School of Mechanical Engineering, 315 Ferst Drive NW, IBB 2307, Atlanta, GA, 30332, USA
| | - David N Ku
- Georgia Institute of Technology, G.W. Woodruff School of Mechanical Engineering, 315 Ferst Drive NW, IBB 2307, Atlanta, GA, 30332, USA.
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Borovac JA. Percutaneous coronary intervention for non-obstructive vulnerable plaques. Lancet 2024; 403:1724-1725. [PMID: 38604207 DOI: 10.1016/s0140-6736(24)00488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Josip Andelo Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, Split 21000, Croatia; Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia.
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Manubolu VS, Ichikawa K, Budoff MJ. Innovations in cardiac computed tomography: Imaging in coronary artery disease. Prog Cardiovasc Dis 2024; 84:51-59. [PMID: 38754532 DOI: 10.1016/j.pcad.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool in the non-invasive evaluation of coronary artery disease (CAD). Recent advancements in imaging techniques, quantitative plaque assessment methods, assessment of coronary physiology, and perivascular coronary inflammation have propelled CCTA to the forefront of CAD management, enabling precise risk stratification, disease monitoring, and evaluation of treatment response. However, challenges persist, including the need for cardiovascular outcomes data for therapy modifications based on CCTA findings and the lack of standardized quantitative plaque assessment techniques to establish universal guidelines for treatment strategies. This review explores the current utilization of CCTA in clinical practice, highlighting its clinical impact and discussing challenges and opportunities for future development. By addressing these nuances, CCTA holds promise for revolutionizing coronary imaging and improving CAD management in the years to come. Ultimately, the goal is to provide precise risk stratification, optimize medical therapy, and improve cardiovascular outcomes while ensuring cost-effectiveness for healthcare systems.
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Li D, Zhao X, Xiao Q, Yang R, Li Z, Xie Y, Mao X, Li X, Hu W, Deng Y. Evaluation of left ventricular flow field changes after stress in patients with nonobstructive coronary artery disease using ultrasonic flow vector imaging. Front Cardiovasc Med 2024; 11:1340289. [PMID: 38576423 PMCID: PMC10991677 DOI: 10.3389/fcvm.2024.1340289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
Purpose Vector flow mapping and treadmill exercise stress echocardiography were used to evaluate and explore changes in the left ventricular (LV) flow field of patients with nonobstructive coronary artery disease. Methods Overall, 34 patients with nonobstructive (<50%) left anterior descending coronary artery stenosis (case group) and 36 patients with no coronary artery stenosis (control group) were included. Apical four-, three-, and two-chamber echocardiographic images were collected at rest and during early recovery from treadmill exercise. LV flow field, vortex area, and circulation (cir) changes were recorded in different phases: isovolumetric systole (S1), rapid ejection (S2), slow ejection (S3), isovolumetric diastole (D1), rapid filling (D2), slow filling (D3), and atrial systole (D4). Intra- and inter-group differences were compared before and after exercise loading. Results The control and case groups demonstrated regular trends of eddy current formation and dissipation at rest and under stress. Compared with the control group, the case group had irregular streamline distributions. Abnormal vortices formed in the S1 and D3 apical segments and D1 left ventricular middle segment in the resting group. Compared with the control group, the resting group had decreased left ventricular S1 vortex areas and increased S3 vortex areas. The post-stress D1 and D3 vortex areas and D1 and D2 cir increased. Compared with at rest, after stress, the control group had decreased S1, S3, D2, and D3 vortex areas; increased S2, D1, D3, and D4 cir; and decreased D2 cir. After stress, the case group had decreased S3 and D2 vortex areas, increased D1 vortex areas, and increased S2, D1, D3, and D4 cir (P all < 0.001). Logistic regression and ROC curve analyses show that increased D1 vortex area after stress is an independent risk factor for stenosis in nonobstructive stenosis of coronary arteries (OR: 1.007, 95% CI: 1.005-1.010, P < 0.05). A D1 vortex area cutoff value of 82.26 had an AUC, sensitivity, and specificity of 0.67, 0.655, and 0.726, respectively. Conclusion The resting left ventricular flow field changed in patients with nonobstructive left anterior descending coronary artery stenosis. Both groups had more disordered left ventricular blood flow after stress. The increased D1 vortex area after stress is an independent risk factor for mild coronary stenosis and may contribute to the assessment of nonobstructive coronary stenosis. VFM combined with treadmill stress is useful in evaluating left ventricular flow field changes in patients with nonobstructive coronary artery disease, which is valuable in the early evaluation of coronary heart disease.
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Affiliation(s)
- Dongmei Li
- School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Xin Zhao
- Department of Ultrasound Medicine, School of Medicine, Chengdu Second People’s Hospital, Chengdu, China
| | - Qiuyu Xiao
- School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Rui Yang
- School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Zizhuo Li
- School of Medicine, Chengdu Medical College, Chengdu, China
| | - Yuanyuan Xie
- School of Medicine, Chengdu Medical College, Chengdu, China
| | - Xinyue Mao
- School of Medicine, North Sichuan Medical College, Nanchong, China
| | - Xi Li
- School of Medicine, North Sichuan Medical College, Nanchong, China
| | - Wenhan Hu
- School of Medicine, North Sichuan Medical College, Nanchong, China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Cardiac Function, Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People’s Hospital Sichuan Provincial Key Laboratory of Ultrasonic Cardiac Electrophysiology and Biomechanics Sichuan Clinical Medical Research Center for Cardiovascular Disease National Clinical Medical Research Center for Cardiovascular Diseases Branch Center, Chengdu, China
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Rotzinger DC, Magnin V, van der Wal AC, Grabherr S, Qanadli SD, Michaud K. Coronary CT angiography for the assessment of atherosclerotic plaque inflammation: postmortem proof of concept with histological validation. Eur Radiol 2024; 34:1755-1763. [PMID: 37658143 PMCID: PMC10873449 DOI: 10.1007/s00330-023-10169-2] [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: 05/01/2023] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES To evaluate the diagnostic utility of multiphase postmortem CT angiography (PMCTA) to detect plaque enhancement as a surrogate marker of inflammation, using fatal coronary plaques obtained from autopsies following sudden cardiac death. METHODS In this retrospective study, we included 35 cases (12 women, 34%; median [IQR] age, 52 [11] years), with autopsy-proven coronary thrombosis, histological examination, and multiphase PMCTA. Two radiologists blinded towards histological findings assessed PMCTA for plaque enhancement of the culprit lesion in consensus. Two forensic pathologists determined the culprit lesion and assessed histological samples in consensus. Cases with concomitant vasa vasorum density increase and intraplaque and periadventital inflammation were considered positive for plaque inflammation. Finally, we correlated radiology and pathology findings. RESULTS All 35 cases had histological evidence of atherosclerotic plaque disruption and thrombosis; 30 (85.7%) had plaque inflammation. Plaque enhancement at multiphase PMCTA was reported in 21 (60%) and resulted in a PPV of 95.2% (77.3-99.2%) and an NPV of 28.6% (17-43.9%). Median histological ratings indicated higher intraplaque inflammation (p = .024) and vasa vasorum density (p = .032) in plaques with enhancement. We found no evidence of a difference in adventitial inflammation between CT-negative and CT-positive plaques (p = .211). CONCLUSIONS Plaque enhancement was found in 2/3 of fatal atherothrombotic occlusions at coronary postmortem CT angiography. Furthermore, plaque enhancement correlated with histopathological plaque inflammation and increased vasa vasorum density. Plaque enhancement on multiphase CT angiography could potentially serve as a noninvasive marker of inflammation in high-risk populations. CLINICAL RELEVANCE STATEMENT Phenotyping coronary plaque more comprehensively is one of the principal challenges cardiac imaging is facing. Translating our ex vivo findings of CT-based plaque inflammation assessment into clinical studies might help pave the way in defining high-risk plaque better. KEY POINTS • Most thrombosed coronary plaques leading to fatality in our series had histological signs of inflammation. • Multiphase postmortem CT angiography can provide a noninvasive interrogation of plaque inflammation through contrast enhancement. • Atherosclerotic plaque enhancement at multiphase postmortem CT angiography correlated with histopathological signs of plaque inflammation and could potentially serve as an imaging biological marker of plaque vulnerability.
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Affiliation(s)
- David C Rotzinger
- Division of Cardiothoracic and Vascular Imaging, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Virginie Magnin
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de La Vulliette 4, Lausanne, Switzerland
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Allard C van der Wal
- Department of Pathology, Amsterdam University Medical Centers (AUMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Silke Grabherr
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de La Vulliette 4, Lausanne, Switzerland
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Salah D Qanadli
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Riviera-Chablais Hospital (HRC), 1847, Rennaz, Switzerland
| | - Katarzyna Michaud
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de La Vulliette 4, Lausanne, Switzerland
- University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Roguin A, Kobo O, Meisel SR, Darawsha Z, Odeh M, Frimerman A, Amsalem N, Abu Fanne R. Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram-Insights from a Retrospective Study. J Clin Med 2024; 13:870. [PMID: 38337564 PMCID: PMC10855996 DOI: 10.3390/jcm13030870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Introduction: A significant proportion of patients undergoing coronary angiography (CAG) have normal (NCA) or non-obstructive coronary artery disease (NOCAD). This study retrospectively tested the incidence of re-catheterization, and long-term outcomes of this population in patients aged over 50 years. (2) Methods: We identified all patients above 50 years of age with NOCAD who underwent their first CAG at our center between January 2008 and December 2019. Patients were evaluated for their baseline characteristics, risk factors profile, and indication for CAG. Patients undergoing repeat CAG after the index procedure were assessed for the above, including the primary preventive pharmacotherapy prescribed. (3) Results: A total of 1939 patients were reported to have NOCAD. Of these, 1756 (90%) patients (62% males, median age 66 (56-75) years) had no repeat angiography (group 1). Repeat angiography was performed in 10%: 136 (7%) proved futile (median time for repeat angiography 5 (3-8) years) (group 3), and 47 (3%) ended with angioplasty (median time for repeat angiography 4 (3-6) years) (group 2). Male gender, BMI above 30 (23% vs. 13%), hypertension (68% vs. 57%), diabetes (28% vs. 17%) and smoking (36% vs. 19%) were significantly higher in the interventional group. Regression analysis showed both paroxysmal atrial fibrillation and hyperlipidemia were significantly associated with repeat CAG. The indication for the first CAG was mainly symptoms related. In the interventional repeat angiography (n = 47) the incidence of troponin positive cases increased from 8.2% before intervention to 57.5%, 50% being ST elevation cases. The symptoms-related cases went from 36.7% to 18.4%. Intriguingly, 85% of the interventional group were not prescribed statin and/or aspirin on a regular basis, and/or did not adhere to treatment. (4) Conclusions: NOCAD is a frequent occurrence. The threshold for repeat angiography must be higher, better reserved to troponin positive cases. Moreover, patients must be handled according to their risk profile, not being mistakenly reassured by a snapshot benign coronary angiography.
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Affiliation(s)
- Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
| | - Simha-Ron Meisel
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
| | - Ziad Darawsha
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
| | - Mahmood Odeh
- Emergency Department, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel;
| | - Aharon Frimerman
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
| | - Naama Amsalem
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
| | - Rami Abu Fanne
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel; (A.R.); (O.K.); (S.-R.M.); (Z.D.); (A.F.); (N.A.)
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Los J, Mensink FB, Mohammadnia N, Opstal TSJ, Damman P, Volleberg RHJA, Peeters DAM, van Royen N, Garcia-Garcia HM, Cornel JH, El Messaoudi S, van Geuns RJM. Invasive coronary imaging of inflammation to further characterize high-risk lesions: what options do we have? Front Cardiovasc Med 2024; 11:1352025. [PMID: 38370159 PMCID: PMC10871865 DOI: 10.3389/fcvm.2024.1352025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Coronary atherosclerosis remains a leading cause of morbidity and mortality worldwide. The underlying pathophysiology includes a complex interplay of endothelial dysfunction, lipid accumulation and inflammatory pathways. Multiple structural and inflammatory features of the atherosclerotic lesions have become targets to identify high-risk lesions. Various intracoronary imaging devices have been developed to assess the morphological, biocompositional and molecular profile of the intracoronary atheromata. These techniques guide interventional and therapeutical management and allow the identification and stratification of atherosclerotic lesions. We sought to provide an overview of the inflammatory pathobiology of atherosclerosis, distinct high-risk plaque features and the ability to visualize this process with contemporary intracoronary imaging techniques.
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Affiliation(s)
- Jonathan Los
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frans B. Mensink
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Tjerk S. J. Opstal
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Denise A. M. Peeters
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jan H. Cornel
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
- Dutch Network for Cardiovascular Research (WCN), Utrecht, Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
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Moody JB, Poitrasson-Rivière A, Renaud JM, Hagio T, Al-Mallah MH, Weinberg RL, Ficaro EP, Murthy VL. Integrated myocardial flow reserve (iMFR) assessment: diffuse atherosclerosis and microvascular dysfunction are more strongly associated with mortality than focally impaired perfusion. Eur J Nucl Med Mol Imaging 2023; 51:123-135. [PMID: 37787848 DOI: 10.1007/s00259-023-06448-1] [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: 07/16/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND AIMS Although treatment of ischemia-causing epicardial stenoses may improve symptoms of ischemia, current evidence does not suggest that revascularization improves survival. Conventional myocardial ischemia imaging does not uniquely identify diffuse atherosclerosis, microvascular dysfunction, or nonobstructive epicardial stenoses. We sought to evaluate the prognostic value of integrated myocardial flow reserve (iMFR), a novel noninvasive approach to distinguish the perfusion impact of focal atherosclerosis from diffuse coronary disease. METHODS This study analyzed a large single-center registry of consecutive patients clinically referred for rest-stress myocardial perfusion positron emission tomography. Cox proportional hazards modeling was used to assess the association of two previously reported and two novel perfusion measures with mortality risk: global stress myocardial blood flow (MBF); global myocardial flow reserve (MFR); and two metrics derived from iMFR analysis: the extents of focal and diffusely impaired perfusion. RESULTS In total, 6867 patients were included with a median follow-up of 3.4 years [1st-3rd quartiles, 1.9-5.0] and 1444 deaths (21%). Although all evaluated perfusion measures were independently associated with death, diffusely impaired perfusion extent (hazard ratio 2.65, 95%C.I. [2.37-2.97]) and global MFR (HR 2.29, 95%C.I. [2.08-2.52]) were consistently stronger predictors than stress MBF (HR 1.62, 95%C.I. [1.46-1.79]). Focally impaired perfusion extent (HR 1.09, 95%C.I. [1.03-1.16]) was only moderately related to mortality. Diffusely impaired perfusion extent remained a significant independent predictor of death when combined with global MFR (p < 0.0001), providing improved risk stratification (overall net reclassification improvement 0.246, 95%C.I. [0.183-0.310]). CONCLUSIONS The extent of diffusely impaired perfusion is a strong independent and additive marker of mortality risk beyond traditional risk factors, standard perfusion imaging, and global MFR, while focally impaired perfusion is only moderately related to mortality.
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Affiliation(s)
| | | | | | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Richard L Weinberg
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edward P Ficaro
- INVIA, LLC, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Jung J, Lee SN, Her SH, Yoo KD, Moon KW, Moon D, Jang WY. Long-Term Clinical Impact of Patients with Multi-Vessel Non-Obstructive Coronary Artery Disease. Life (Basel) 2023; 13:2119. [PMID: 38004259 PMCID: PMC10671936 DOI: 10.3390/life13112119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Non-obstructive coronary artery disease (CAD) is a disease commonly diagnosed in patients undergoing coronary angiography. However, little is known regarding the long-term clinical impact of multi-vessel non-obstructive CAD. Therefore, the object of this study was to investigate the long-term clinical impact of multi-vessel non-obstructive CAD. METHOD A total of 2083 patients without revascularization history and obstructive CAD were enrolled between January 2010 and December 2015. They were classified into four groups according to number of vessels involved in non-obstructive CAD (25% ≤ luminal stenosis < 70%): zero, one, two, or three diseased vessels (DVs). We monitored the patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiac death, stroke, and myocardial infarction (MI). RESULT The occurrence of MACCEs increased as the number of non-obstructive DVs increased, and was especially high in patients with three DVs. After adjustment, patients with three DVs still showed significantly poorer clinical outcomes of MACCEs, stroke, and MI compared those with zero DVs. CONCLUSION Multi-vessel non-obstructive CAD, especially in patients with non-obstructive three DVs, is strongly associated with poor long-term clinical outcomes. This finding suggests that more intensive treatment may be required in this subset of patients.
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Affiliation(s)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (J.J.); (S.-H.H.); (K.-D.Y.); (K.-W.M.); (D.M.); (W.-Y.J.)
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11
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Ambrose JA, Sharma AV. Identifying and Treating Vulnerable Atherosclerotic Plaques. Am J Cardiol 2023; 205:214-222. [PMID: 37611413 DOI: 10.1016/j.amjcard.2023.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
Acute coronary syndromes and, in particular, ST-elevation myocardial infarction are usually caused by coronary thrombosis in which the thrombus develops either on a disrupted plaque (usually a thin-capped fibroatheroma) or an eroded atherosclerotic plaque. These thrombus-prone plaques are vulnerable or high-risk. Although, traditionally, cardiologists have concentrated on treating significant coronary obstruction, there has been great interest over the last 2 decades in possibly preventing the thrombotic causes of myocardial infarction/sudden coronary death by mostly identifying and stabilizing these asymptomatic vulnerable or high-risk plaques, which, at least on invasive angiography, are mostly nonobstructive. Computed tomographic angiography and intravascular imaging during invasive coronary angiography have now been shown to identify a majority of these vulnerable or high-risk plaques before symptoms, thus opening up new preventive strategies. In conclusion, this article discusses the identification and management of these thrombus-prone lesions and patients with these lesions either with noninvasive techniques and systemic therapies or possibly through a new and bold interventional paradigm.
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Affiliation(s)
- John A Ambrose
- Division of Cardiology, Department of Medicine, UCSF Fresno Medical Education Program, Fresno, California.
| | - Avinash V Sharma
- Division of Cardiology, Department of Medicine, UCSF Fresno Medical Education Program, Fresno, California
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12
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Chen Q, Xie G, Tang CX, Yang L, Xu P, Gao X, Lu M, Fu Y, Huo Y, Zheng S, Tao X, Xu H, Yin X, Zhang LJ. Development and Validation of CCTA-based Radiomics Signature for Predicting Coronary Plaques With Rapid Progression. Circ Cardiovasc Imaging 2023; 16:e015340. [PMID: 37725670 DOI: 10.1161/circimaging.123.015340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Rapid plaque progression (RPP) is associated with a higher risk of acute coronary syndromes compared with gradual plaque progression. We aimed to develop and validate a coronary computed tomography angiography (CCTA)-based radiomics signature (RS) of plaques for predicting RPP. METHODS A total of 214 patients who underwent serial CCTA examinations from 2 tertiary hospitals (development group, 137 patients with 164 lesions; validation group, 77 patients with 101 lesions) were retrospectively enrolled. Conventional CCTA-defined morphological parameters (eg, high-risk plaque characteristics and plaque burden) and radiomics features of plaques were analyzed. RPP was defined as an annual progression of plaque burden ≥1.0% on lesion-level at follow-up CCTA. RS was built to predict RPP using XGBoost method. RESULTS RS significantly outperformed morphological parameters for predicting RPP in both the development group (area under the receiver operating characteristic curve, 0.82 versus 0.74; P=0.04) and validation group (area under the receiver operating characteristic curve, 0.81 versus 0.69; P=0.04). Multivariable analysis identified RS (odds ratio, 2.35 [95% CI, 1.32-4.46]; P=0.005) as an independent predictor of subsequent RPP in the validation group after adjustment of morphological confounders. Unlike unchanged RS in the non-RPP group, RS increased significantly in the RPP group at follow-up in the whole dataset (P<0.001). CONCLUSIONS The proposed CCTA-based RS had a better discriminative value to identify plaques at risk of rapid progression compared with conventional morphological plaque parameters. These data suggest the promising utility of radiomics for predicting RPP in a low-risk group on CCTA.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Affiliated Jinling Hospital (Q.C., C.X.T., L.Y., P.X., L.J.Z.), Nanjing Medical University, China
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Guanghui Xie
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Chun Xiang Tang
- Department of Radiology, Affiliated Jinling Hospital (Q.C., C.X.T., L.Y., P.X., L.J.Z.), Nanjing Medical University, China
| | - Liu Yang
- Department of Radiology, Affiliated Jinling Hospital (Q.C., C.X.T., L.Y., P.X., L.J.Z.), Nanjing Medical University, China
| | - Pengpeng Xu
- Department of Radiology, Affiliated Jinling Hospital (Q.C., C.X.T., L.Y., P.X., L.J.Z.), Nanjing Medical University, China
| | - Xiaofei Gao
- Department of Cardiology, Nanjing First Hospital (X.G.), Nanjing Medical University, China
| | - Mengjie Lu
- School of Public Health, Shanghai JiaoTong University School of Medicine, China (M.L.)
| | - Yunlei Fu
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Yingsong Huo
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Shaoqing Zheng
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Xinwei Tao
- Bayer Healthcare, Shanghai, China (X.T.)
| | - Hui Xu
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital (Q.C., G.X., Y.F., Y.H., S.Z., H.X., X.Y.), Nanjing Medical University, China
| | - Long Jiang Zhang
- Department of Radiology, Affiliated Jinling Hospital (Q.C., C.X.T., L.Y., P.X., L.J.Z.), Nanjing Medical University, China
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Betageri O, Ashraf H, Hafeez A, Kerensky R, Huber TS, Massoomi M. An Unusual Cause of Coronary Occlusion During an Abdominal Aortic Aneurysm Repair: Reperfusion With Diagnostic Angiography Only. Cureus 2023; 15:e39610. [PMID: 37388602 PMCID: PMC10306248 DOI: 10.7759/cureus.39610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
We present a unique case of a type I peri-operative myocardial infarction during an extensive abdominal aortic aneurysm repair occurring due to the occlusion of a severe stable ostial plaque stenosis by a small overlying thrombus. During coronary angiography, the thrombus was dislodged by the diagnostic catheter which restored normal flow without stent placement. We demonstrate a care approach that was carefully arrived upon through multidisciplinary management with vascular surgery and anesthesiology colleagues.
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Affiliation(s)
- Omkar Betageri
- Cardiology, Maine Medical Center - Tufts University, Portland, USA
| | - Hassan Ashraf
- Cardiology, University of Texas at Houston, Houston, USA
| | - Adam Hafeez
- Cardiology, University of Florida College of Medicine, Gainesville, USA
| | - Richard Kerensky
- Cardiology, University of Florida College of Medicine, Gainesville, USA
| | - Thomas S Huber
- Vascular Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Michael Massoomi
- Cardiology, University of Florida College of Medicine, Gainesville, USA
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14
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Weintraub WS, Mancini GBJ, Boden WE. Percutaneous coronary intervention from COURAGE to ISCHEMIA and beyond. Int J Cardiol 2023; 373:39-43. [PMID: 36427605 DOI: 10.1016/j.ijcard.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
Multiple randomized clinical trials and observational studies in patients with chronic coronary artery disease have evaluated whether revascularization, in particular PCI, can reduce the incidence of future cardiovascular events and relieve angina. Perhaps the two most widely quoted trials are COURAGE and ISCHEMIA. In both trials revascularization did not reduce the incidence of cardiovascular death or non-fatal events. In both, revascularization did relieve angina, particularly in patients with severe pain. From the time of COURAGE to ISCHEMIA there were also multiple developments. In particular improved stent technology with second and third generation drug eluting stents in ISCHEMIA compared to bare metal stents in COURAGE. There was also the development of new methods to evaluate ischemia, in particular the potential surrogate fractional flow reserve. This period also saw improvement and maturation of coronary computed tomography angiography to assess coronary anatomy non-invasively. There was also greater emphasis on more intensive, guideline directed medical therapy to treat dyslipidemia and hypertension. There has also been greater recognition that not all angina is due to epicardial obstructive disease. Microvascular disease and coronary spasm are responsible for much of the symptom burden of ischemia. These data have led to a paradigm shift toward a more nuanced approach to treating stable ischemic heart disease, with less need for revascularization except in cases of particularly severe anatomic disease or unremitting symptoms while on optimal medial therapy. In recognition of the importance of disparities in cardiovascular health, it is crucial to implement preventive strategies with optimal medical therapy in the community.
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Affiliation(s)
- William S Weintraub
- MedStar Health Research Institute and Georgetown University, Washington, DC, USA.
| | - G B John Mancini
- Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William E Boden
- VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
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15
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Gaudino M, Di Franco A, Spadaccio C, Rahouma M, Robinson NB, Demetres M, Fremes S, Doenst T. Difference in spontaneous myocardial infarction and mortality in percutaneous versus surgical revascularization trials: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2023; 165:662-669.e14. [PMID: 34045061 PMCID: PMC8802340 DOI: 10.1016/j.jtcvs.2021.04.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/16/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES It has been hypothesized that the survival benefit of coronary artery bypass (CABG) compared with percutaneous interventions (PCI) may be associated with the reduction in spontaneous myocardial infarction (SMI) achieved by surgery. This, however, has not been formally investigated. The present meta-analysis aims to evaluate the association between the difference in SMI and in survival in PCI versus CABG randomized controlled trials (RCTs). METHODS A systematic search was performed to identify all RCTs comparing PCI with CABG for the treatment of coronary artery disease and reporting SMI outcomes. Generic inverse variance method was used to pool outcomes as natural logarithms of the incident rate ratios across studies. Subgroup analysis and interaction test were used to compare the difference of the primary outcome among trials that did and did not report a significant reduction in SMI- in the patients treated by CABG. Primary outcome was all-cause mortality; secondary outcome was SMI. RESULTS Twenty RCTs were included in the meta-analysis. A statistically significant difference in SMI in favor of CABG was found in 7 of the included trials (35%). Overall, PCI was associated with significantly greater all-cause mortality (incident rate ratio, 1.13; 95% confidence interval, 1.01-1.28). At subgroup analysis, a significant difference in survival in favor of CABG was seen only in trials that reported a significant reduction in SMI in the surgical arm (P for interaction 0.02). CONCLUSIONS In the published PCI versus CABG trials, the reduction in all-cause mortality in the surgical arm is associated with the protective effect of CABG against SMI.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, USA
| | - Stephen Fremes
- Schulich Heart Centre, Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University of Jena, Jena, Germany
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16
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Stone PH, Libby P, Boden WE. Fundamental Pathobiology of Coronary Atherosclerosis and Clinical Implications for Chronic Ischemic Heart Disease Management-The Plaque Hypothesis: A Narrative Review. JAMA Cardiol 2023; 8:192-201. [PMID: 36515941 PMCID: PMC11016334 DOI: 10.1001/jamacardio.2022.3926] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Recent clinical and imaging studies underscore that major adverse cardiac events (MACE) outcomes are associated not solely with severe coronary obstructions (ischemia hypothesis or stenosis hypothesis), but with the plaque burden along the entire coronary tree. New research clarifies the pathobiologic mechanisms responsible for plaque development/progression/destabilization leading to MACE (plaque hypothesis), but the translation of these insights to clinical management strategies has lagged. This narrative review elaborates the plaque hypothesis and explicates the current understanding of underlying pathobiologic mechanisms, the provocative destabilizing influences, the diagnostic and therapeutic implications, and their actionable clinical management approaches to optimize the management of patients with chronic coronary disease. Observations Clinical trials of management strategies for patients with chronic coronary artery disease demonstrate that while MACE rate increases progressively with the anatomic extent of coronary disease, revascularization of the ischemia-producing obstruction does not forestall MACE. Most severely obstructive coronary lesions often remain quiescent and seldom destabilize to cause a MACE. Coronary lesions that later provoke acute myocardial infarction often do not narrow the lumen critically. Invasive and noninvasive imaging can identify the plaque anatomic characteristics (plaque burden, plaque topography, lipid content) and local hemodynamic/biomechanical characteristics (endothelial shear stress, plaque structural stress, axial plaque stress) that can indicate the propensity of individual plaques to provoke a MACE. Conclusions and Relevance The pathobiologic construct concerning the culprit region of a plaque most likely to cause a MACE (plaque hypothesis), which incorporates multiple convergent plaque features, informs the evolution of a new management strategy capable of identifying the high-risk portion of plaque wherever it is located along the course of the coronary artery. Ongoing investigations of high-risk plaque features, coupled with technical advances to enable prognostic characterization in real time and at the point of care, will soon enable evaluation of the entire length of the atheromatous coronary artery and broaden the target(s) of our therapeutic intervention to include all regions of the plaque (both flow limiting and nonflow limiting).
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Affiliation(s)
- Peter H Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - William E Boden
- VA Boston Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, and Boston University School of Medicine, Boston, Massachusetts
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17
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Ansheles AA. [The Revival of the "Ischemic" Approach in the Assessment of Ischemic Heart Disease: Analysis of Major World Research]. KARDIOLOGIIA 2023; 63:60-67. [PMID: 36749203 DOI: 10.18087/cardio.2023.1.n1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 02/08/2023]
Abstract
This analytical review focuses on large international studies on diagnostics of ischemic heart disease and addresses the role of radionuclide methods in evaluating myocardial perfusion and transient ischemia. Based on the reviewed data, the authors proposed a comprehensive instrumental approach to selecting a tactics for the management of patients with suspected or documented ischemic heart disease and for evaluating their prognosis.
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Affiliation(s)
- A A Ansheles
- Chazov National Medical Research Center of Cardiology, Moscow
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18
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Assessment of indices of conjunctival microvascular function in patients with and without obstructive coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:26-33. [PMID: 36707373 DOI: 10.1016/j.carrev.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atherosclerotic heart disease often remains asymptomatic until presentation with a major adverse cardiovascular event. Primary preventive therapies improve outcomes, but conventional screening often misattributes risk. Vascular imaging can be utilised to detect atherosclerosis, but often involves ionising radiation. The conjunctiva is a readily accessible vascular network allowing non-invasive hemodynamic evaluation. AIM To compare conjunctival microcirculatory function in patients with and without obstructive coronary artery disease. METHODS We compared the conjunctival microcirculation of myocardial infarction patients (MI-cohort) to controls with no obstructive coronary artery disease (NO-CAD cohort). Conjunctival imaging was performed using a smartphone and slit-lamp biomicroscope combination. Microvascular indices of axial (Va) and cross-sectional (Vcs) velocity; blood flow rate (Q); and wall shear rate (WSR) were compared in all conjunctival vessels between 5 and 45 μm in diameter. RESULTS A total of 127 patients were recruited (66 MI vs 61 NO-CAD) and 3602 conjunctival vessels analysed (2414 MI vs 1188 NO-CAD). Mean Va, Vcs and Q were significantly lower in the MI vs NO-CAD cohort (Va 0.50 ± 0.17 mm/s vs 0.55 ± 0.15 mm/s, p < 0.001; Vcs 0.35 ± 0.12 mm/s vs 0.38 ± 0.10 mm/s, p < 0.001; Q 154 ± 116 pl/s vs 198 ± 130 pl/s, p < 0.001). To correct for differences in mean vessel diameter, WSR was compared in 10-36 μm vessels (3268/3602 vessels) and was lower in the MI-cohort (134 ± 64 s-1 vs 140 ± 63 s-1, p = 0.002). CONCLUSIONS Conjunctival microcirculatory alterations can be observed in patients with obstructive coronary artery disease. The conjunctival microvasculature merits further evaluation in cardiovascular risk screening.
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Patil P, Doshi G. Deciphering the Role of Pyroptosis Impact on Cardiovascular Diseases. Curr Drug Targets 2023; 24:1166-1183. [PMID: 38164730 DOI: 10.2174/0113894501267496231102114410] [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: 07/28/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Pyroptosis has become a noteworthy area of focus in recent years due to its association with inflammatory diseases. Pyroptosis is a type of programmed cell death accompanied by an inflammatory response, and the discovery of the gasdermin family has expanded the study of pyroptosis. The primary characteristics of pyroptosis include cell expansion, membrane penetration, and the ejection of cell contents. In healthy physiology, pyroptosis is an essential part of the host's defence against pathogen infection. Excessive Pyroptosis, however, can lead to unchecked and persistent inflammatory responses, including the emergence of inflammatory diseases. More precisely, gasdermin family members have a role in the creation of membrane holes during pyroptosis, which leads to cell lysis. It is also related to how pro-inflammatory intracellular substances, including IL-1, IL-18, and High mobility group box 1 (HMGB1), are used. Two different signalling pathways, one of which is regulated by caspase-1 and the other by caspase-4/5/11, are the primary causes of pyroptosis. Cardiovascular diseases are often associated with cell death and acute or chronic inflammation, making this area of research particularly relevant. In this review, we first systematically summarize recent findings related to Pyroptosis, exploring its characteristics and the signalling pathway mechanisms, as well as various treatment strategies based on its modulation that has emerged from the studies. Some of these strategies are currently undergoing clinical trials. Additionally, the article elaborates on the scientific evidence indicating the role of Pyroptosis in various cardiovascular diseases. As a whole, this should shed insight into future paths and present innovative ideas for employing Pyroptosis as a strong disease-fighting weapon.
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Affiliation(s)
- Poonam Patil
- Department of Pharmacology, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, VLM Road, Vile Parle (w), Mumbai, 400056, India
| | - Gaurav Doshi
- Department of Pharmacology, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, VLM Road, Vile Parle (w), Mumbai, 400056, India
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Limpijankit T, Jongjirasiri S, Meemook K, Unwanatham N, Thakkinstian A, Laothamatas J. Predictive values of coronary artery calcium and arterial stiffness for long-term cardiovascular events in patients with stable coronary artery disease. Clin Cardiol 2022; 46:171-183. [PMID: 36448219 PMCID: PMC9933115 DOI: 10.1002/clc.23955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subclinical atherosclerosis detected by increased coronary artery calcium (CAC) or arterial stiffness as reflected by cardio-ankle vascular index (CAVI) has been associated with major adverse cardiovascular events (MACEs). However, comparative data from these two assessments in the same population are still limited. METHODS From 2005 to 2013, patients with stable coronary artery disease (CAD), both asymptomatic and symptomatic who underwent both coronary computed tomography and CAVI were enrolled and followed for occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke) until December 2019. A cause-specific hazard model was applied to assess the associations of CAC score, and CAVI with long-term MACEs. RESULTS A total of 8687 patients participated. Of them, CAC scores were 0, 1-99, 100-399, and ≥400 in 49.7%, 31.9%, 12.3%, and 6.1%, respectively. Arterial stiffness (CAVI ≥ 9.0) was associated with the magnitude of CAC in 23.8%, 36.3%, 44.5%, and 56.2%, respectively. During an average of 9.9 ± 2.4 years follow-up, MACEs occurred in 8.0% (95% CI: 7.4%, 8.6%) of subjects. After adjusting for covariables, CAC scores of 100-399 and ≥400, and CAVIs of ≥9.0 were found to independently predict the occurrence of MACEs with the hazard ratios (95% CI) of 1.70 (1.13, 1.98), 1.87 (1.33, 2.63), and 1.27 (1.06, 1.52), respectively. Other risk predictors were hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), aspirin, and statin therapy. CONCLUSIONS A CAC score ≥100 or a CAVI ≥ 9.0 predicts the long-term occurrence of MACEs in both asymptomatic and symptomatic patients with stable CAD. These two noninvasive tests can be used as screening tools to guide treatment for the prevention of future CV events.
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Affiliation(s)
- Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Sutipong Jongjirasiri
- Department of Radiology, Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Krissada Meemook
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Nattawut Unwanatham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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The MRI enhancement ratio and plaque steepness may be more accurate for predicting recurrent ischemic cerebrovascular events in patients with intracranial atherosclerosis. Eur Radiol 2022; 32:7004-7013. [PMID: 35771249 DOI: 10.1007/s00330-022-08893-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the complementary value of high-resolution multi-contrast MRI (hrMRI) in identifying symptomatic patients with intracranial atherosclerosis (ICAS) who are likely to experience recurrent ischemic cerebrovascular events. METHODS In this retrospective cohort study, eighty patients with acute ischemic events attributed to ICAS who underwent hrMRI examination between January 2015 and January 2019 were included. Median follow-up for all patients was 30 months (range: 1 to 52 months) and recurrent ischemic cerebrovascular events were recorded. Cox regression analysis and time-dependent ROC were performed to quantify the association between the plaque characteristics and recurrent events. RESULTS During the follow-up, 14 patients experienced recurrent ischemic cerebrovascular events. Young males and those with diabetes and poor medication persistence were more likely to experience recurrent events. ICAS in patients with recurrence had significantly higher enhancement ratio and steepness which is defined as the ratio between the plaque height and length than those without (p < 0.001 and p = 0.015, respectively). After adjustment of clinical factors, enhancement ratio (HR, 13.13 [95% CI, 3.58-48.20], p < 0.001) and plaque steepness (HR, 110.27 [95% CI, 4.75-2560.91], p = 0.003) were independent imaging biomarkers associated with recurrent events. Time-dependent ROC indicated that integrated high enhancement ratio and steepness into clinical risk factors improved discrimination power with the ROC increased from 0.79 to 0.94 (p = 0.008). CONCLUSIONS The enhancement ratio and plaque steepness improved the accuracy over traditional clinical risk factors in predicting recurrent ischemic cerebrovascular events for patients with ICAS. KEY POINTS • High-resolution magnetic resonance imaging helps clinicians to evaluate high-risk Intracranial plaque. • The higher enhancement ratio and plaque steepness (= height/length) were the primary biomarkers associated with future ischemic cerebrovascular events. • High-resolution magnetic resonance imaging combined with clinical characteristics showed a higher accuracy for the prediction of recurrent events in patients with intracranial atherosclerosis.
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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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Tian X, Wang X, Shi Z, Yu C, Li M, Chen L, Jia Q, Liang G. Tumor Necrosis Factor-Stimulated Gene-6-A New Serum Identification Marker to Identify Severe and Symptomatic Carotid Artery Stenosis. Pathol Res Pract 2022; 232:153838. [DOI: 10.1016/j.prp.2022.153838] [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: 01/23/2022] [Revised: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
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Single-Cell Analysis Uncovers Osteoblast Factor Growth Differentiation Factor 10 as Mediator of Vascular Smooth Muscle Cell Phenotypic Modulation Associated with Plaque Rupture in Human Carotid Artery Disease. Int J Mol Sci 2022; 23:ijms23031796. [PMID: 35163719 PMCID: PMC8836240 DOI: 10.3390/ijms23031796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Vascular smooth muscle cells (VSMCs) undergo a complex phenotypic switch in response to atherosclerosis environmental triggers, contributing to atherosclerosis disease progression. However, the complex heterogeneity of VSMCs and how VSMC dedifferentiation affects human carotid artery disease (CAD) risk has not been clearly established. (2) Method: A single-cell RNA sequencing analysis of CD45− cells derived from the atherosclerotic aorta of Apolipoprotein E-deficient (Apoe−/−) mice on a normal cholesterol diet (NCD) or a high cholesterol diet (HCD), respecting the site-specific predisposition to atherosclerosis was performed. Growth Differentiation Factor 10 (GDF10) role in VSMCs phenotypic switch was investigated via flow cytometry, immunofluorescence in human atherosclerotic plaques. (3) Results: scRNAseq analysis revealed the transcriptomic profile of seven clusters, five of which showed disease-relevant gene signature of VSMC macrophagic calcific phenotype, VSMC mesenchymal chondrogenic phenotype, VSMC inflammatory and fibro-phenotype and VSMC inflammatory phenotype. Osteoblast factor GDF10 involved in ossification and osteoblast differentiation emerged as a hallmark of VSMCs undergoing phenotypic switch. Under hypercholesteremia, GDF10 triggered VSMC osteogenic switch in vitro. The abundance of GDF10 expressing osteogenic-like VSMCs cells was linked to the occurrence of carotid artery disease (CAD) events. (4) Conclusions: Taken together, these results provide evidence about GDF10-mediated VSMC osteogenic switch, with a likely detrimental role in atherosclerotic plaque stability.
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Ajoolabady A, Bi Y, McClements DJ, Lip GYH, Richardson DR, Reiter RJ, Klionsky DJ, Ren J. Melatonin-based therapeutics for atherosclerotic lesions and beyond: Focusing on macrophage mitophagy. Pharmacol Res 2022; 176:106072. [PMID: 35007709 DOI: 10.1016/j.phrs.2022.106072] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/11/2022]
Abstract
Atherosclerosis refers to a unique form of chronic proinflammatory anomaly of the vasculature, presented as rupture-prone or occlusive lesions in arteries. In advanced stages, atherosclerosis leads to the onset and development of multiple cardiovascular diseases with lethal consequences. Inflammatory cytokines in atherosclerotic lesions contribute to the exacerbation of atherosclerosis. Pharmacotherapies targeting dyslipidemia, hypercholesterolemia, and neutralizing inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-17, and IL-12/23) have displayed proven promises although contradictory results. Moreover, adjuvants such as melatonin, a pluripotent agent with proven anti-inflammatory, anti-oxidative and neuroprotective properties, also display potentials in alleviating cytokine secretion in macrophages through mitophagy activation. Here, we share our perspectives on this concept and present melatonin-based therapeutics as a means to modulate mitophagy in macrophages and, thereby, ameliorate atherosclerosis.
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Affiliation(s)
- Amir Ajoolabady
- University of Wyoming College of Health Sciences, Laramie, WY 82071, USA; Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yaguang Bi
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - David J McClements
- Department of Food Science, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Gregory Y H Lip
- University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Des R Richardson
- Molecular Pharmacology and Pathology Program, Department of Pathology and Bosch Institute, University of Sydney, Sydney, New South Wales 2006, Australia; Department of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Centre for Cancer Cell Biology and Drug Discovery, Griffith Institute for Drug Discovery, Griffith University, Nathan, Brisbane, Queensland 4111, Australia
| | - Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA.
| | - Daniel J Klionsky
- Life Sciences Institute and Departments of Molecular, Cellular and Developmental Biology and Biological Chemistry, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Jun Ren
- University of Wyoming College of Health Sciences, Laramie, WY 82071, USA; Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195 USA.
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Nakanishi R, Osawa K, Kurata A, Miyoshi T. Role of coronary computed tomography angiography (CTA) post the ISCHEMIA trial: Precision prevention based on coronary CTA-derived coronary atherosclerosis. J Cardiol 2021; 79:572-580. [PMID: 34974937 DOI: 10.1016/j.jjcc.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/10/2021] [Indexed: 12/28/2022]
Abstract
The International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial has been recently published and suggested the importance of the selection of patients at high risk for future cardiovascular disease events and the enhancing optimal medical therapy. In the ISCHEMIA trial, coronary computed tomography angiography (CTA) was performed in most of the patients to exclude high-risk patients and those without obstructive coronary artery disease (CAD) who should not be randomized. Coronary CTA has been widely used as a non-invasive diagnostic modality to assess patients with suspected CAD. Currently, the international guidelines allow use of coronary CTA as a class I recommendation for patients with chest pain. Besides, in the numerous multicenter trials, the emerging role of coronary CTA has proven that it could soon become the standard for monitoring CAD and identifying patients at high risk of future cardiovascular events. In this review article, we summarize the current evidence on coronary CTA and the potential role of coronary CTA after the ISCHEMIA trial for patients with CAD. Risk assessment using detailed CAD data obtained non-invasively and prevention of future cardiovascular events through improved medical care will become increasingly essential for the precision treatment and prevention of CAD in patients.
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Affiliation(s)
- Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
| | - Kazuhiro Osawa
- Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Akira Kurata
- Department of Cardiology, Shikoku Cancer Center, Ehime, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Dzaye O, Razavi AC, Blaha MJ, Mortensen MB. Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management. Curr Opin Cardiol 2021; 36:769-775. [PMID: 34620792 PMCID: PMC8547346 DOI: 10.1097/hco.0000000000000911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a summary of recent literature on the relative impact of luminal stenosis versus atherosclerotic plaque burden in atherosclerotic cardiovascular disease (ASCVD) risk stratification and management. RECENT FINDINGS Recent results from both randomized controlled clinical trials as well as observational cohort studies have demonstrated that ASCVD risk is mediated mainly by the extent of atherosclerotic disease burden rather than by the presence of coronary stenosis or inducible ischemia. Although patients with obstructive CAD are generally at higher risk for ASCVD events than patients with nonobstructive CAD, this is driven by a higher plaque burden in those with obstructive CAD. Accordingly, the ASCVD risk for a given plaque burden is similar in patients with and without obstructive CAD. Accompanying these observations are randomized controlled trial data, which show that optimization of medical therapy instead of early revascularization is most important for improving prognosis in patients with stable obstructive CAD. SUMMARY Emerging evidence shows that atherosclerotic plaque burden, and not stenosis per se, is the main driver of ASCVD risk in patients with CAD. This information challenges the current paradigm of selecting patients for intensive secondary prevention measures based primarily on the presence of obstructive CAD.
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Affiliation(s)
- Omar Dzaye
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alexander C. Razavi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Martin Bødtker Mortensen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction. Sci Rep 2021; 11:21403. [PMID: 34725407 PMCID: PMC8560938 DOI: 10.1038/s41598-021-00832-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
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Mitchell JD, Cehic DA, Morgia M, Bergom C, Toohey J, Guerrero PA, Ferencik M, Kikuchi R, Carver JR, Zaha VG, Alvarez-Cardona JA, Szmit S, Daniele AJ, Lopez-Mattei J, Zhang L, Herrmann J, Nohria A, Lenihan DJ, Dent SF. Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the International Cardio-Oncology Society. JACC: CARDIOONCOLOGY 2021; 3:360-380. [PMID: 34604797 PMCID: PMC8463721 DOI: 10.1016/j.jaccao.2021.06.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 01/09/2023]
Abstract
Radiation therapy is a cornerstone of cancer therapy, with >50% of patients undergoing therapeutic radiation. As a result of widespread use and improved survival, there is increasing focus on the potential long-term effects of ionizing radiation, especially cardiovascular toxicity. Radiation therapy can lead to atherosclerosis of the vasculature as well as valvular, myocardial, and pericardial dysfunction. We present a consensus statement from the International Cardio-Oncology Society based on general principles of radiotherapy delivery and cardiovascular risk assessment and risk mitigation in this population. Anatomical-based recommendations for cardiovascular management and follow-up are provided, and a priority is given to the early detection of atherosclerotic vascular disease on imaging to help guide preventive therapy. Unique management considerations in radiation-induced cardiovascular disease are also discussed. Recommendations are based on the most current literature and represent a unanimous consensus by the multidisciplinary expert panel. Radiation therapy leads to short- and long-term cardiovascular adverse effects of the vasculature and the heart, including valvular, myocardial, and pericardial disease. Computed tomography scans conducted for radiation planning or cancer staging provide an available opportunity to detect asymptomatic atherosclerosis and direct preventive therapies. Additional practical screening recommendations for cardiovascular disease based on anatomical exposure are provided. There are unique considerations in the management of radiation-induced cardiovascular disease; contemporary percutaneous treatment is often preferred over surgical options.
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Key Words
- CABG, coronary artery bypass graft
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CTCA, computed tomography coronary angiography
- CV, cardiovascular
- DIBH, deep inspiratory breath hold
- HF, heart failure
- HL, Hodgkin lymphoma
- HNC, head and neck cancer
- HR, hazard ratio
- LIMA, left internal mammary artery
- MRI, magnetic resonance imaging
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- OR, odds ratio
- PAD, peripheral arterial disease
- RT, radiation therapy
- SAVR, surgical aortic valve replacement
- SVC, superior vena cava
- TAVR, transcatheter aortic valve replacement
- TTE, transthoracic echocardiogram
- aHR, adjusted hazard ratio
- cancer
- cardiovascular disease
- imaging
- prevention
- radiation therapy
- screening
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Affiliation(s)
- Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
- Address for correspondence: Dr Joshua D. Mitchell, Cardio-Oncology Center of Excellence, Washington University in St Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110-1093, USA. @joshmitchellmd@Dr_Daniel_Cehic@carmenbergom@ICOSociety
| | | | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Carmen Bergom
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joanne Toohey
- Department of Radiation Oncology, GenesisCare, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Robin Kikuchi
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Joseph R. Carver
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vlad G. Zaha
- Cardiology Division, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health and Hospital System, Dallas, Texas, USA
| | - Jose A. Alvarez-Cardona
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | | | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lili Zhang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jörg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Anju Nohria
- Cardio-Oncology Program, Dana Farber Cancer Institute/Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Daniel J. Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan F. Dent
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Coronary Angiography Print: An Automated Accurate Hidden Biometric Method Based on Filtered Local Binary Pattern Using Coronary Angiography Images. J Pers Med 2021; 11:jpm11101000. [PMID: 34683139 PMCID: PMC8538583 DOI: 10.3390/jpm11101000] [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: 08/15/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background and purpose: Biometrics is a commonly studied research issue for both biomedical engineering and forensics sciences. Besides, the purpose of hidden biometrics is to discover hidden biometrics features. This work aims to demonstrate the biometric identification ability of coronary angiography images. Material and method: A new coronary angiography images database was collected to develop an automatic identification model. The used database was collected from 51 subjects and contains 2156 images. The developed model has to preprocess; feature generation using local binary pattern; feature selection with neighborhood component analysis; and classification phases. In the preprocessing phase; image rotations; median filter; Gaussian filter; and speckle noise addition functions have been used to generate filtered images. A multileveled extractor is presented using local binary pattern and maximum pooling together. The generated features are fed to neighborhood component analysis and the selected features are classified using k nearest neighbor classifier. Results: The presented angiography image identification method attained 99.86% classification accuracy on the collected database. Conclusions: The obtained findings demonstrate that the angiography images can be utilized as biometric identification. Moreover, we discover a new hidden biometric feature using coronary angiography images and name of this hidden biometric is coronary angiography print.
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Velagapudi P, Altin SE, Schneider MD, Alasnag M. Sex Differences in Intracoronary Imaging and Functional Evaluation of Coronary Arteries. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09557-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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De Filippo O, Di Franco A, Boretto P, Bruno F, Cusenza V, Desalvo P, Demetres M, Saglietto A, Franchin L, Piroli F, Marengo G, Elia E, Falk V, Conrotto F, Doenst T, Rinaldi M, De Ferrari GM, D'Ascenzo F, Gaudino M. Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01238-1. [PMID: 34538641 DOI: 10.1016/j.jtcvs.2021.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Comparative data after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs distal) are scant. The aim of this meta-analysis was to investigate outcomes after PCI or CABG for ULMCA disease according to lesion site. METHODS Randomized controlled trials (RCTs) and adjusted observational studies that compared PCI versus CABG in patients with ULMCA disease and reported outcomes according to lesion site were systematically identified. Major adverse cardiovascular events (MACE; a composite of all-cause death, myocardial infarction, stroke, and repeat revascularization) and all-cause death were the co-primary end points. Individual components of MACE were secondary end points. Sensitivity analysis including RCTs only were performed for each outcome. RESULTS Nine studies (3 RCTs, 6 adjusted observational), encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or distal ULMCA, respectively) were included. At the 5-year follow-up, there were no significant differences between CABG and PCI for MACE, death, or any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10 [95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95% CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The benefit of CABG for MACE and revascularization was confirmed in the analysis limited to RCTs, whereas the benefit for mortality was not. CONCLUSIONS Among patients with distal ULMCA disease, CABG is associated with lower incidence of MACE and revascularization compared with PCI, whereas no differences in outcomes were observed for ostial/shaft ULMCA disease.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Paolo Boretto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Vincenzo Cusenza
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Paolo Desalvo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences, Translational Cardiovascular Technologies, ETH Zurich, Zurich, Switzerland
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Prati F, Arbustini E, Alfonso F. Potential of an Approach Based on the Identification and Treatment of Vulnerable Coronary Plaques. JACC Cardiovasc Interv 2021; 14:468-473. [PMID: 33602444 DOI: 10.1016/j.jcin.2020.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/01/2022]
Abstract
In this viewpoint paper, the authors are tackling criticism to the limits of invasive imaging modalities for identification and treatment of vulnerable plaques. They believe in the clinical usefulness of invasive imaging modalities for identification of vulnerable plaques, and are suggesting an explanation for the suboptimal results of past studies, that failed to demonstrate a correlation between interventional treatment of vulnerable plaques, and reduction of hard clinical endpoints. Vulnerability studies have been based, so far, on the detection and measurement of plaques lipid content, because of its ease. However, the search for lipid "lakes" as a single common causal feature of acute coronary syndromes does not seem sufficient to identify patients at risk of adverse events. New imaging studies provided the rationale for improving clinical outcomes, adopting a more comprehensive assessment of target plaque morphology. There is little rationale in pursuing a functional assessment of coronary lesions to predict myocardial infarction. Recent studies are further confirming this hypothesis, suggesting that the clinical benefit of the fractional flow reserve-guided strategy is simply due to a significant reduction in the rate of repeated revascularizations, with no significant differences in the incidence of hard endpoints. There is a need to develop new randomized studies, requiring a feasible number of patients, to test the superiority of an approach based on vulnerable plaque sealing and treatment.
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Affiliation(s)
- Francesco Prati
- Centro per la Lotta Contro L'Infarto-CLI Foundation, Rome, Italy; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Madrid, Spain
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34
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Kim YK, Jang CW, Kwon SH, Kim JH, Lerman A, Bae J. Ten-year clinical outcomes in patients with intermediate coronary stenosis according to the combined culprit lesion. Clin Cardiol 2021; 44:1161-1168. [PMID: 34133033 PMCID: PMC8364722 DOI: 10.1002/clc.23668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We assessed the long-term clinical outcomes of an intermediate lesion (IL) according to the presence of a combined culprit lesion (CCL). HYPOTHESIS Long-term clinical outcomes of IL may be affected by the presence of a CCL. METHODS Angiographic findings (n = 1096) and medical chart were reviewed. Patients with IL were divided into two groups: IL without CCL group (n = 383, 64.5%) and IL with CCL group (n = 211, 35.5%). RESULTS The major adverse cardiovascular events (MACE) in the IL with CCL group were significantly higher than those in the IL without CCL group (death: 12.3% vs. 7.0%, myocardial infarction: 3.3%vs. 0.5%, stroke: 6.6% vs. 2.6%, and revascularization [RVSC]: 25.1% vs. 7.6%) during a mean follow up period of 118.4 ± 5.5 months. IL related RVSC rate in the IL with CCL group was higher than that in the IL without CCL group (5.7% vs. 2.1%, p = 0.020). RVSC rate related to IL in total subjects was lower than that related to stented lesion (3.4% vs. 6.4%). The important predictors of total MACE in total subjects were the presence of CCL, IL percent diameter stenosis, hypertension, history of percutaneous coronary intervention, blood glucose and ejection fraction. The predictors of IL related RVSC were IL percent diameter stenosis and IL located in the right coronary artery. CONCLUSION 10-year clinical outcomes of an IL (especially IL without CCL) were better than those of stented lesions. This study suggests that the IL can be safely followed up in sites that do not have ability to assess functional study.
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Affiliation(s)
- Yong Kyun Kim
- Division of Cardiology, Department of Internal MedicineKonyang University HospitalDaejeonSouth Korea
| | - Chae Won Jang
- Division of Cardiology, Department of Internal MedicineKonyang University HospitalDaejeonSouth Korea
| | - Soon Ho Kwon
- Division of Cardiology, Department of Internal MedicineKonyang University HospitalDaejeonSouth Korea
| | - Jae Hoon Kim
- Division of Cardiology, Department of Internal MedicineKonyang University HospitalDaejeonSouth Korea
| | - Amir Lerman
- Department of Cardiovascular DiseaseMayo ClinicRochesterMinnesotaUSA
| | - Jang‐Ho Bae
- Division of Cardiology, Department of Internal MedicineKonyang University HospitalDaejeonSouth Korea
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35
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Babunashvili A, Pancholy S, Babunashvili T, Prokhorov A. Thrombus aspiration without stenting in a patient with anterior STEMI: Regression and healing of an unstable plaque assessed by OCT at 24 months of follow-up. Clin Case Rep 2021; 9:e04549. [PMID: 34429984 PMCID: PMC8364997 DOI: 10.1002/ccr3.4549] [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: 01/25/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022] Open
Abstract
In selected cases, when STEMI caused by mild or moderate degree lesion with a large concomitant thrombus, additional OCT-guided PCI strategy after thrombus removal allows us to defer stenting with the follow-up natural healing of the vessel wall.
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Affiliation(s)
| | - Samir Pancholy
- Geisinger Commonwealth School of MedicineThe Wright Center for Graduate Medical EducationScrantonPAUSA
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36
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Patients with Non-Obstructive Coronary Artery Disease Require Strict Control of All Cardiovascular Risk Factors: Results from the Polish Local Population Medical Records. J Clin Med 2021; 10:jcm10122704. [PMID: 34207396 PMCID: PMC8233810 DOI: 10.3390/jcm10122704] [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: 05/04/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of the project was to compare patients treated with percutaneous transluminal coronary angioplasty (PTCA), who also had undergone PTCA in the past, with a group of people who had had no angiographic stenosis in the lumen of the coronary arteries in the past, and who also required PTCA during index hospitalization. The secondary aim was to compare the obtained data with the characteristics of a group of people who had undergone angiography twice and for whom no significant stenosis had been found in their coronary arteries. The study used registry data concerning 3085 people who had undergone at least two invasive procedures. Acute coronary syndrome (ACS) was significantly more often observed (Non-ST-segment elevation myocardial infarction (NSTEMI) OR 2.76 [1.91–3.99] and ST-segment elevation myocardial infarction (STEMI) OR 2.35 [1.85–2.99]) in patients with no significant coronary stenosis in the past (who required coronary angioplasty at the time of the study), compared to patients who had already had PTCA. They also demonstrated more frequent occurrence of ‘multivessel disease’. This was probably most likely caused by inadequate control of cardiovascular risk factors, as determined by higher total cholesterol levels ([mg/dL] 193.7 ± 44.4 vs. 178.2 ± 43.7) and LDL (123.4 ± 36.2 vs. 117.7 ± 36.2). On the other hand, patients in whom no significant stenosis was found in two consecutive angiographies were more likely to be burdened with chronic obstructive pulmonary disease, atrial fibrillation and chronic kidney disease.
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37
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Huang R, DeMarco JK, Ota H, Macedo TA, Abdelmoneim SS, Huston J, Pellikka PA, Mulvagh SL. Prognostic Value of Intraplaque Neovascularization Detected by Carotid Contrast-Enhanced Ultrasound in Patients Undergoing Stress Echocardiography. J Am Soc Echocardiogr 2021; 34:614-624. [DOI: 10.1016/j.echo.2020.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
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38
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Morais TC, Assunção-Jr AN, Dantas RN, da Silva CFG, de Paula CB, Torres RA, Magalhães TA, Nomura CH, de Ávila LFR, Parga JR. Diagnostic Performance of a Machine Learning-Based CT-Derived FFR in Detecting Flow-Limiting Stenosis. Arq Bras Cardiol 2021; 116:1091-1098. [PMID: 34133592 PMCID: PMC8288523 DOI: 10.36660/abc.20190329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 02/11/2020] [Accepted: 03/16/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The non-invasive quantification of the fractional flow reserve (FFRCT) using a more recent version of an artificial intelligence-based software and latest generation CT scanner (384 slices) may show high performance to detect coronary ischemia. OBJECTIVES To evaluate the diagnostic performance of FFRCT for the detection of significant coronary artery disease (CAD) in contrast to invasive FFR (iFFR) using previous generation CT scanners (128 and 256- detector rows). METHODS Retrospective study with patients referred to coronary artery CT angiography (CTA) and catheterization (iFFR) procedures. Siemens Somatom Definition Flash (256-detector rows) and AS+ (128-detector rows) CT scanners were used to acquire the images. The FFRCT and the minimal lumen area (MLA) were evaluated using a dedicated software (cFFR version 3.0.0, Siemens Healthineers, Forchheim, Germany). Obstructive CAD was defined as CTA lumen reduction ≥ 50%, and flow-limiting stenosis as iFFR ≤0.8. All reported P values are two-tailed, and when <0.05, they were considered statistically significant. RESULTS Ninety-three consecutive patients (152 vessels) were included. There was good agreement between FFRCT and iFFR, with minimal FFRCT overestimation (bias: -0.02; limits of agreement:0.14-0.09). Different CT scanners did not modify the association between FFRCT and FFRi (p for interaction=0.73). The performance of FFRCT was significantly superior compared to the visual classification of coronary stenosis (AUC 0.93vs.0.61, p<0.001) and to MLA (AUC 0.93vs.0.75, p<0.001), reducing the number of false-positive cases. The optimal cut-off point for FFRCT using a Youden index was 0.85 (87% Sensitivity, 86% Specificity, 73% PPV, 94% NPV), with a reduction of false-positives. CONCLUSION Machine learning-based FFRCT using previous generation CT scanners (128 and 256-detector rows) shows good diagnostic performance for the detection of CAD, and can be used to reduce the number of invasive procedures.
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Affiliation(s)
- Thamara Carvalho Morais
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
| | - Antonildes Nascimento Assunção-Jr
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
| | - Roberto Nery Dantas
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
| | | | | | - Roberto Almeida Torres
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
| | - Tiago Augusto Magalhães
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
- Complexo Hospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrasil Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR) - Cardiovascular CT/MR, Curitiba , PR - Brasil
| | - César Higa Nomura
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
| | - Luiz Francisco Rodrigues de Ávila
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
| | - José Rodrigues Parga
- Hospital Sírio-libanêsSão PauloSPBrasil Hospital Sírio-libanês , São Paulo , SP - Brasil
- Universidade de São PauloFaculdade de MedicinaDepartamento de Imagem CardiovascularSão PauloSPBrasil Universidade de São Paulo Faculdade de Medicina - CDI - InCor/HCFMUSP - Departamento de Imagem Cardiovascular , São Paulo , SP - Brasil
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39
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Nishida T, Hiro T, Takayama T, Sudo M, Haruta H, Fukamachi D, Hirayama A, Okumura Y. Clinical significance of microvessels detected by in vivo optical coherence tomography within human atherosclerotic coronary arterial intima: a study with multimodality intravascular imagings. Heart Vessels 2021; 36:756-765. [PMID: 33403471 DOI: 10.1007/s00380-020-01756-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
The significance of microvessels within atherosclerotic plaques is not yet fully clarified. Associated with plaque vulnerability. The aim of this study is to examine tissue characteristics of plaque with microvessels detected by optical coherence tomography (OCT) by use of a commercially available color-coded intravascular ultrasound (IVUS) and coronary angioscopy (CAS). The subjects examined comprised of 44 patients with stable angina pectoris who underwent percutaneous coronary intervention. Microvessels were defined as a tiny tubule with a diameter of 50-300 µm detected over three or more frames in OCT. We compared the total volume of microvessels with tissue component such as fibrotic, lipidic, necrotic, and calcified volume and the number of yellow plaque. In IVUS analysis, % necrotic volume and % lipidic volume were significantly correlated and % fibrotic volume was inversely significantly correlated with the total volume of microvessel (r = 0.485, p = 0.0009; r = 0.401, p = 0.007; r = - 0.432, p = 0.003, respectively). The number of plaque with an angioscopic yellow grade of two or more was significantly correlated with the total volume of microvessel (r = 0.461, p = 0.002). The greater the luminal volume of microvessels, the more the percent content of necrotic/lipidic tissue volume within plaque and the more the number of yellow plaques. These data suggested that microvessels within coronary plaque might be related to plaque vulnerability.
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Affiliation(s)
- Toshihiko Nishida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Tadateru Takayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hironori Haruta
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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40
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Borén J, Chapman MJ, Krauss RM, Packard CJ, Bentzon JF, Binder CJ, Daemen MJ, Demer LL, Hegele RA, Nicholls SJ, Nordestgaard BG, Watts GF, Bruckert E, Fazio S, Ference BA, Graham I, Horton JD, Landmesser U, Laufs U, Masana L, Pasterkamp G, Raal FJ, Ray KK, Schunkert H, Taskinen MR, van de Sluis B, Wiklund O, Tokgozoglu L, Catapano AL, Ginsberg HN. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2021; 41:2313-2330. [PMID: 32052833 PMCID: PMC7308544 DOI: 10.1093/eurheartj/ehz962] [Citation(s) in RCA: 726] [Impact Index Per Article: 242.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/10/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
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Affiliation(s)
- Jan Borén
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M John Chapman
- Endocrinology-Metabolism Division, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France.,National Institute for Health and Medical Research (INSERM), Paris, France
| | - Ronald M Krauss
- Department of Atherosclerosis Research, Children's Hospital Oakland Research Institute and UCSF, Oakland, CA 94609, USA
| | - Chris J Packard
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jacob F Bentzon
- Department of Clinical Medicine, Heart Diseases, Aarhus University, Aarhus, Denmark.,Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Mat J Daemen
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Linda L Demer
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Physiology, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert A Hegele
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia.,Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia
| | - Eric Bruckert
- INSERM UMRS1166, Department of Endocrinology-Metabolism, ICAN - Institute of CardioMetabolism and Nutrition, AP-HP, Hopital de la Pitie, Paris, France
| | - Sergio Fazio
- Departments of Medicine, Physiology and Pharmacology, Knight Cardiovascular Institute, Center of Preventive Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - Brian A Ference
- Centre for Naturally Randomized Trials, University of Cambridge, Cambridge, UK.,Institute for Advanced Studies, University of Bristol, Bristol, UK.,MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Jay D Horton
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, Leipzig, Germany
| | - Luis Masana
- Research Unit of Lipids and Atherosclerosis, IISPV, CIBERDEM, University Rovira i Virgili, C. Sant Llorenç 21, Reus 43201, Spain
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Faculty of Medicine, Technische Universität München, Lazarettstr, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marja-Riitta Taskinen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Bart van de Sluis
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Olov Wiklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, and IRCCS MultiMedica, Milan, Italy
| | - Henry N Ginsberg
- Department of Medicine, Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
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41
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Bonnet S, Prévot G, Mornet S, Jacobin-Valat MJ, Mousli Y, Hemadou A, Duttine M, Trotier A, Sanchez S, Duonor-Cérutti M, Crauste-Manciet S, Clofent-Sanchez G. A Nano-Emulsion Platform Functionalized with a Fully Human scFv-Fc Antibody for Atheroma Targeting: Towards a Theranostic Approach to Atherosclerosis. Int J Mol Sci 2021; 22:ijms22105188. [PMID: 34068875 PMCID: PMC8153629 DOI: 10.3390/ijms22105188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is at the onset of the cardiovascular diseases that are among the leading causes of death worldwide. Currently, high-risk plaques, also called vulnerable atheromatous plaques, remain often undiagnosed until the occurrence of severe complications, such as stroke or myocardial infarction. Molecular imaging agents that target high-risk atheromatous lesions could greatly improve the diagnosis of atherosclerosis by identifying sites of high disease activity. Moreover, a "theranostic approach" that combines molecular imaging agents (for diagnosis) and therapeutic molecules would be of great value for the local management of atheromatous plaques. The aim of this study was to develop and characterize an innovative theranostic tool for atherosclerosis. We engineered oil-in-water nano-emulsions (NEs) loaded with superparamagnetic iron oxide (SPIO) nanoparticles for magnetic resonance imaging (MRI) purposes. Dynamic MRI showed that NE-SPIO nanoparticles decorated with a polyethylene glycol (PEG) layer reduced their liver uptake and extended their half-life. Next, the NE-SPIO-PEG formulation was functionalized with a fully human scFv-Fc antibody (P3) recognizing galectin 3, an atherosclerosis biomarker. The P3-functionalized formulation targeted atheromatous plaques, as demonstrated in an immunohistochemistry analyses of mouse aorta and human artery sections and in an Apoe-/- mouse model of atherosclerosis. Moreover, the formulation was loaded with SPIO nanoparticles and/or alpha-tocopherol to be used as a theranostic tool for atherosclerosis imaging (SPIO) and for delivery of drugs that reduce oxidation (here, alpha-tocopherol) in atheromatous plaques. This study paves the way to non-invasive targeted imaging of atherosclerosis and synergistic therapeutic applications.
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Affiliation(s)
- Samuel Bonnet
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
- Institut de Chimie de la Matière Condensée, CNRS UMR 5026, Université de Bordeaux, Bordeaux INP, ICMCB, 33600 Pessac, France; (S.M.); (M.D.)
- Correspondence:
| | - Geoffrey Prévot
- ARNA, ARN, Régulations Naturelle et Artificielle, ChemBioPharm, INSERM U1212, CNRS UMR 5320, Université de Bordeaux, 33076 Bordeaux, France; (G.P.); (Y.M.); (S.C.-M.)
| | - Stéphane Mornet
- Institut de Chimie de la Matière Condensée, CNRS UMR 5026, Université de Bordeaux, Bordeaux INP, ICMCB, 33600 Pessac, France; (S.M.); (M.D.)
| | - Marie-Josée Jacobin-Valat
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | - Yannick Mousli
- ARNA, ARN, Régulations Naturelle et Artificielle, ChemBioPharm, INSERM U1212, CNRS UMR 5320, Université de Bordeaux, 33076 Bordeaux, France; (G.P.); (Y.M.); (S.C.-M.)
| | - Audrey Hemadou
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | - Mathieu Duttine
- Institut de Chimie de la Matière Condensée, CNRS UMR 5026, Université de Bordeaux, Bordeaux INP, ICMCB, 33600 Pessac, France; (S.M.); (M.D.)
| | - Aurélien Trotier
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | - Stéphane Sanchez
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
| | | | - Sylvie Crauste-Manciet
- ARNA, ARN, Régulations Naturelle et Artificielle, ChemBioPharm, INSERM U1212, CNRS UMR 5320, Université de Bordeaux, 33076 Bordeaux, France; (G.P.); (Y.M.); (S.C.-M.)
| | - Gisèle Clofent-Sanchez
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS UMR 5536, Université de Bordeaux, CRMSB, 33076 Bordeaux, France; (M.-J.J.-V.); (A.H.); (A.T.); (S.S.); (G.C.-S.)
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Schade DS, Gonzales K, Eaton RP. Stop Stenting; Start Reversing Atherosclerosis. Am J Med 2021; 134:301-303. [PMID: 33176125 DOI: 10.1016/j.amjmed.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 01/09/2023]
Affiliation(s)
- David S Schade
- Department of Internal Medicine, Division of Endocrinology, University of New Mexico Health Sciences Center, Albuquerque.
| | - Kristen Gonzales
- Department of Internal Medicine, Division of Endocrinology, University of New Mexico Health Sciences Center, Albuquerque
| | - R Philip Eaton
- Department of Internal Medicine, Division of Endocrinology, University of New Mexico Health Sciences Center, Albuquerque
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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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44
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Baba O, Huang LH, Elvington A, Szpakowska M, Sultan D, Heo GS, Zhang X, Luehmann H, Detering L, Chevigné A, Liu Y, Randolph GJ. CXCR4-Binding Positron Emission Tomography Tracers Link Monocyte Recruitment and Endothelial Injury in Murine Atherosclerosis. Arterioscler Thromb Vasc Biol 2021; 41:822-836. [PMID: 33327748 PMCID: PMC8105279 DOI: 10.1161/atvbaha.120.315053] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE vMIP-II (viral macrophage inflammatory protein 2)/vCCL2 (viral chemotactic cytokine ligand 2) binds to multiple chemokine receptors, and vMIP-II-based positron emission tomography tracer (64Cu-DOTA-vMIP-II: vMIP-II tracer) accumulates at atherosclerotic lesions in mice. Given that it would be expected to react with multiple chemokine receptors on monocytes and macrophages, we wondered if its accumulation in atherosclerosis lesion-bearing mice might correlate with overall macrophage burden or, alternatively, the pace of monocyte recruitment. Approach and Results: We employed a mouse model of atherosclerosis regression involving adenoassociated virus 8 vector encoding murine Apoe (AAV-mApoE) treatment of Apoe-/- mice where the pace of monocyte recruitment slows before macrophage burden subsequently declines. Accumulation of 64Cu-DOTA-vMIP-II at Apoe-/- plaque sites was strong but declined with AAV-mApoE-induced decline in monocyte recruitment, before macrophage burden reduced. Monocyte depletion indicated that monocytes and macrophages themselves were not the only target of the 64Cu-DOTA-vMIP-II tracer. Using fluorescence-tagged vMIP-II tracer, competitive receptor blocking with CXCR4 antagonists, endothelial-specific Cre-mediated deletion of CXCR4, CXCR4-specific tracer 64Cu-DOTA-FC131, and CXCR4 staining during disease progression and regression, we show endothelial cell expression of CXCR4 is a key target of 64Cu-DOTA-vMIP-II imaging. Expression of CXCR4 was low in nonplaque areas but strongly detected on endothelium of progressing plaques, especially on proliferating endothelium, where vascular permeability was increased and monocyte recruitment was the strongest. CONCLUSIONS Endothelial injury status of plaques is marked by CXCR4 expression and this injury correlates with the tendency of such plaques to recruit monocytes. Furthermore, our findings suggest positron emission tomography tracers that mark CXCR4 can be used translationally to monitor the state of plaque injury and monocyte recruitment.
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MESH Headings
- Animals
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/immunology
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Atherosclerosis/diagnostic imaging
- Atherosclerosis/immunology
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Biomarkers/metabolism
- Cell Line
- Chemokines/administration & dosage
- Chemokines/pharmacokinetics
- Disease Models, Animal
- Endothelial Cells/immunology
- Endothelial Cells/metabolism
- Endothelial Cells/pathology
- Endothelium, Vascular/diagnostic imaging
- Endothelium, Vascular/immunology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Injections, Intravenous
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Knockout, ApoE
- Molecular Imaging
- Monocytes/immunology
- Monocytes/metabolism
- Monocytes/pathology
- Organometallic Compounds/administration & dosage
- Organometallic Compounds/pharmacokinetics
- Plaque, Atherosclerotic
- Positron-Emission Tomography
- Predictive Value of Tests
- Radiopharmaceuticals/administration & dosage
- Radiopharmaceuticals/pharmacokinetics
- Receptors, CXCR4/genetics
- Receptors, CXCR4/metabolism
- Mice
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Affiliation(s)
- Osamu Baba
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis
| | - Li-Hao Huang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis
| | - Andrew Elvington
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis
| | - Martyna Szpakowska
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Deborah Sultan
- Department of Radiology, Washington University School of Medicine, St. Louis
| | - Gyu Seong Heo
- Department of Radiology, Washington University School of Medicine, St. Louis
| | - Xiaohui Zhang
- Department of Radiology, Washington University School of Medicine, St. Louis
| | - Hannah Luehmann
- Department of Radiology, Washington University School of Medicine, St. Louis
| | - Lisa Detering
- Department of Radiology, Washington University School of Medicine, St. Louis
| | - Andy Chevigné
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Yongjian Liu
- Department of Radiology, Washington University School of Medicine, St. Louis
| | - Gwendalyn J. Randolph
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis
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45
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Preemptive percutaneous coronary intervention for coronary artery disease: identification of the appropriate high-risk lesion. Curr Opin Cardiol 2021; 35:712-719. [PMID: 32852346 DOI: 10.1097/hco.0000000000000789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Management of patients with coronary artery disease (CAD) has been based on identification of a coronary obstruction causing ischemia and performing a revascularization procedure to reduce that ischemia, with the goal of thereby preventing subsequent major adverse cardiac events (MACEs) in that vascular territory. Recent investigations demonstrate that preemptive percutaneous coronary intervention (PCI) of nonculprit coronary lesions (NCLs) that may not cause ischemia in patients with ST-segment elevation myocardial infarction (STEMI) reduces MACE. In this review, we focus on preemptive PCI, discuss its mechanistic benefits and speculate on its potential value for other coronary syndromes. RECENT FINDINGS The COMPLETE trial in STEMI patients treated with primary PCI demonstrated that preemptive PCI of NCL obstructions, which may not cause ischemia, but often exhibit high-risk OCT plaque characteristics, reduced cardiovascular death or nonfatal myocardial infarction. Reduction in MACE from preemptive PCI of NCL was similar for lesions confirmed to cause ischemia (fractional flow reserve <0.80) and for lesions that were only visually assessed to have luminal obstruction at least 70%.The ISCHEMIA trial in patients with stable CAD and moderate/severe ischemia demonstrated that MACE risk increased progressively with more extensive atherosclerosis, but that performing PCI of ischemia-producing lesions did not reduce MACE. Adverse cardiac events likely originated in high-risk plaque areas not treated with PCI. SUMMARY In STEMI patients, preemptive PCI of high-risk NCL that may not cause ischemia improves long-term MACE. In stable CAD patients, MACE increases as the atherosclerotic burden increases, but PCI of the ischemia-producing lesion itself does not improve outcomes compared with optimal medical therapy. Adverse events likely originate in high-risk plaque areas that are distinct from ischemia-producing obstructions. Identification of highest-risk atherosclerotic lesions responsible for future MACE may provide an opportunity for preemptive PCI in patients with a variety of coronary syndromes.
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46
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Casolo G, Del Meglio J, Tessa C. Epidemiology and pathophysiologic insights of coronary atherosclerosis relevant for contemporary non-invasive imaging. Cardiovasc Diagn Ther 2020; 10:1906-1917. [PMID: 33381434 PMCID: PMC7758762 DOI: 10.21037/cdt-20-157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
In the past few years significant changes have taken place in the diagnostic and therapeutic approach to patients with coronary artery disease (CAD) and/or ischemic heart disease (IHD). New discoveries about the development and progression of coronary atherosclerosis have changed the clinical landscape. At the same time a marked decrease in cardiovascular (CV) mortality and CAD incidence have been observed in many Countries but particularly in the most industrialized ones. This fall has been also observed in the incidence of stroke, sudden death, myocardial ischemia, myocardial infarction (MI), and prevalence of CAD. As a consequence, an increasing number of patients with chest pain exhibits non-significant stenosis at both invasive and non-invasive coronary angiography and the rate of coronary vessels revascularizations has greatly reduced. Coronary atherosclerosis and its characteristics have shown to be both diagnostic and therapeutic targets beyond obstructive CAD. The decreased prevalence of CAD in the general population has modified the pre-test probability (PTP) of disease. In this landscape the conventional stress imaging tests appear to have limited accuracy making the diagnosis of obstructive CAD very challenging. These diagnostic tests have been introduced and tested in a population with a much higher probability of disease and therefore the contemporary accuracy of these old tests appear much lower than in the past. In addition, in the past few years the relevance of the traditional ischemia guided coronary intervention strategy has been questioned. Given the low CV events granted by an optimal medical therapy in CAD the major attention has been directed on detecting coronary atherosclerosis. The earlier the better. At the same time, a growing number of data from clinical studies have shown a significant prognostic role for non-obstructive CAD and coronary atherosclerosis. All these facts have shifted the clinicians' attention from the functional evaluation of the coronary circulation to the anatomic burden of disease.
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Affiliation(s)
- Giancarlo Casolo
- Cardiology Department, Versilia Hospital, Lido di Camaiore, Italy
| | | | - Carlo Tessa
- Radiology Department, Versilia Hospital, Lido di Camaiore, Italy
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47
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Ateş AH, Yorgun H, Canpolat U, Kaya EB, Şahiner L, Hazirolan T, Dural M, Okşul M, Şener YZ, Karahan S, Aytemir K. Long-Term Prognostic Value of Coronary Atherosclerotic Plaque Characteristics Assessed by Computerized Tomographic Angiography. Angiology 2020; 72:252-259. [PMID: 33118364 DOI: 10.1177/0003319720963677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We aimed to present the long-term prognostic role of coronary computed tomography angiography (CTA) in a cohort of patients with coronary artery disease (CAD) and noncritical stenosis. A total of 1138 patients who underwent coronary CTA for suspected CAD were included in the study. For the categorization of the coronary atherosclerotic plaque (CAP), the coronary system was divided into 16 segments. For each segment, CAPs were categorized as calcified, noncalcified, and mixed. All-cause and cardiovascular (CV) mortality data were collected for prognostic evaluation. Coronary CTA analyses showed that 34.5% of patients had noncalcified CAP, 14.5% of patients had calcified CAP, and 11% of patients had mixed CAP. During a median of 141.5 months follow-up, CV and all-cause mortality was observed in 57 (5%) and 149 (13.1%) patients, respectively. In multivariable Cox regression analysis, calcified CAP morphology and the extent of involved segments were significant predictors of both CV and all-cause mortality. The presence of calcified CAP morphology and the higher number of diseased coronary segments via coronary CTA might help stratify patients at risk for adverse CV outcomes during long-term follow-up. Patients with these features at index coronary CTA may be evaluated more closely with aggressive preventive measures.
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Affiliation(s)
- Ahmet Hakan Ateş
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ergun Baris Kaya
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Levent Şahiner
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muhammet Dural
- Department of Cardiology, 64063Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Metin Okşul
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yusuf Ziya Şener
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
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48
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, McNulty I, Uemura S, Kakuta T, Jang IK. Predictors of Rapid Plaque Progression: An Optical Coherence Tomography Study. JACC Cardiovasc Imaging 2020; 14:1628-1638. [PMID: 33011121 DOI: 10.1016/j.jcmg.2020.08.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to identify morphological predictors of rapid plaque progression. BACKGROUND Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former pattern will cause stable angina when the narrowing reaches a critical threshold, whereas the latter pattern may lead to acute coronary syndromes or sudden cardiac death. METHODS Patients who underwent optical coherence tomography (OCT) imaging during the index procedure and follow-up angiography with a minimum interval of 6 months were selected. Nonculprit lesions with a diameter stenosis of ≥30% on index angiography were assessed. Lesion progression was defined as a decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with rapid progression, morphological changes from baseline to follow-up were assessed. RESULTS Among 517 lesions in 248 patients, 50 lesions showed rapid progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%, respectively), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%, respectively), layered plaque (60.0% vs. 34.0%, respectively), macrophage accumulation (62.0% vs. 42.4%, respectively), microvessel (46.0% vs. 29.1%, respectively), plaque rupture (12.0% vs. 4.7%, respectively), and thrombus (6.0% vs. 1.1%, respectively) at baseline compared with those without rapid progression. Multivariate analysis identified lipid-rich plaque (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.02 to 4.62; p = 0.045]), TCFA (OR: 5.85; 95% CI: 2.01 to 17.03; p = 0.001), and layered plaque (OR: 2.19; 95% CI: 1.03 to 4.17; p = 0.040) as predictors of subsequent rapid lesion progression. In a subgroup analysis for plaques with rapid progression, a new layer was detected in 25 of 41 plaques (61.0%) at follow-up. CONCLUSIONS Lipid-rich plaques, TCFA, and layered plaques were predictors of subsequent rapid plaque progression. A new layer, a signature of previous plaque disruption and healing, was detected in more than half of the lesions with rapid progression at follow-up. (Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
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Affiliation(s)
- Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea.
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49
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Marano R, Rovere G, Savino G, Flammia FC, Carafa MRP, Steri L, Merlino B, Natale L. CCTA in the diagnosis of coronary artery disease. Radiol Med 2020; 125:1102-1113. [PMID: 32964325 DOI: 10.1007/s11547-020-01283-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
The world of cardiac imaging is proposing to physicians an ever-increasing spectrum of options and tools with the disadvantages of patients presently submitted to multiple, sequential, time-consuming, and costly diagnostic procedures and tests, sometimes with contradicting results. In the last two decades, the CCTA has evolved into a valuable diagnostic test in today's patient care, changing the official existing guidelines and clinical practice with a pivotal role to exclude significant CAD, in the referral of patients to the Cath-Lab, in the follow-up after coronary revascularization, and finally in the cardiovascular risk stratification.
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Affiliation(s)
- Riccardo Marano
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesco Ciriaco Flammia
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Rachele Pia Carafa
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Steri
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
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Watanabe K, Watanabe T, Otaki Y, Kato S, Tamura H, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Watanabe M. Impact of pre-operative coronary artery disease on the clinical outcomes of patients with aortic aneurysms. Heart Vessels 2020; 36:308-314. [PMID: 32926229 DOI: 10.1007/s00380-020-01700-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
Aortic aneurysm is an increasingly important public health problem with high morbidity and mortality. It is associated with coronary artery disease (CAD), which is a comorbidity of high incidence that is reported to worsen perioperative complications and long-term clinical outcomes in patients with an aortic aneurysm. Patients with significant coronary artery stenosis may require coronary revascularization and/or optimal medical therapy in the perioperative period of aneurysm surgery. However, the prognostic impact of non-significant coronary artery stenosis not indicated for coronary revascularization on clinical outcomes of patients with aortic aneurysms remains unclear. We performed coronary angiography on 239 consecutive patients with thoracic and abdominal aortic aneurysms before endovascular aortic repair or surgical repair. The patients were divided into the following 3 groups according to the severity of stenosis of major coronary arteries: non-CAD group (with < 25% stenosis), non-significant CAD group (with ≥ 25% but < 75% stenosis), and significant CAD group (with ≥ 75% stenosis). CAD was diagnosed in 133 (56%) patients consisting of 48 (20%) patients with non-significant CAD and 85 (36%) patients with significant CAD. Thirty-nine major adverse cardiovascular and cerebrovascular events (MACCEs) occurred in a median follow-up period of 723 days. Kaplan-Meier analysis revealed that the risk of MACCEs was higher in the significant and non-significant CAD groups than in the non-CAD group. Multivariate Cox proportional hazard regression analysis showed that the risk of MACCEs was equally high in the non-significant CAD and significant CAD groups compared to that in the non-CAD group after adjustment for confounding factors. CAD is significantly associated with poor outcomes in patients with aortic aneurysms, irrespective of the significance of CAD.
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Affiliation(s)
- Ken Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Shigehiko Kato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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