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Kinoshita D, Suzuki K, Usui E, Hada M, Yuki H, Niida T, Minami Y, Lee H, McNulty I, Ako J, Ferencik M, Kakuta T, Jang IK. High-Risk Plaques on Coronary Computed Tomography Angiography: Correlation With Optical Coherence Tomography. JACC Cardiovasc Imaging 2024; 17:382-391. [PMID: 37715773 DOI: 10.1016/j.jcmg.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Although patients with high-risk plaque (HRP) on coronary computed tomography angiography (CTA) are reportedly at increased risk for future cardiovascular events, individual HRP features have not been systematically validated against high-resolution intravascular imaging. OBJECTIVES The aim of this study was to correlate HRP features on CTA with plaque characteristics on optical coherence tomography (OCT). METHODS Patients who underwent both CTA and OCT before coronary intervention were enrolled. Plaques in culprit vessels identified by CTA were evaluated with the use of OCT at the corresponding sites. HRP was defined as a plaque with at least 2 of the following 4 features: positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC). Patients were followed for up to 3 years. RESULTS The study included 448 patients, with a median age of 67 years and of whom 357 (79.7%) were male, and 203 (45.3%) presented with acute coronary syndromes. A total of 1,075 lesions were analyzed. All 4 HRP features were associated with thin-cap fibroatheroma. PR was associated with all OCT features of plaque vulnerability, LAP was associated with lipid-rich plaque, macrophage, and cholesterol crystals, NRS was associated with cholesterol crystals, and SC was associated with microvessels. The cumulative incidence of the composite endpoint (target vessel nontarget lesion revascularization and cardiac death) was significantly higher in patients with HRP than in those without HRP (4.7% vs 0.5%; P = 0.010). CONCLUSIONS All 4 HRP features on CTA were associated with features of vulnerability on OCT. (Massachusetts General Hospital and Tsuchiura Kyodo General Hospital Coronary Imaging Collaboration; NCT04523194).
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Affiliation(s)
- Daisuke Kinoshita
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Keishi Suzuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Takayuki Niida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, 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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Rahoual G, Zeitouni M, Charpentier E, Ritvo PG, Rouanet S, Procopi N, Boukhelifa S, Charleux P, Guedeney P, Kerneis M, Barthélémy O, Silvain J, Montalescot G, Redheuil A, Collet JP. Phenotyping coronary plaque by computed tomography in premature coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:257-266. [PMID: 37597177 DOI: 10.1093/ehjci/jead212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/06/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
AIMS Premature coronary artery disease (CAD) is an aggressive disease with multiple recurrences mostly related to new coronary lesions. This study aimed to compare coronary plaque characteristics of individuals with premature CAD with those of incidental plaques found in matched individuals free of overt cardiovascular disease, using coronary computed tomography angiography (CCTA). METHODS AND RESULTS Of 1552 consecutive individuals who underwent CCTA, 106 individuals with history of acute or stable obstructive CAD ≤45 years were matched by age, sex, smoking status, cardiovascular heredity, and dyslipidaemia with 106 controls. CCTA were analysed for Coronary Artery Disease Reporting and Data System score, plaque composition, and high-risk plaque (HRP) features, including spotty calcification, positive remodelling, low attenuation, and napkin-ring sign. The characteristics of 348 premature CAD plaques were compared with those of 167 incidental coronary plaques of matched controls. The prevalence of non-calcified plaques was higher among individuals with premature CAD (65.1 vs. 30.2%, P < 0.001), as well as spotty calcification (42.5 vs. 17.9%, P < 0.001), positive remodelling (41.5 vs. 9.4%, P < 0.001), low attenuation (24.5 vs. 3.8%, P < 0.001), and napkin-ring sign (1.9 vs. 0.0%). They exhibited an average of 2.2 (2.7) HRP, while the control group displayed 0.4 (0.8) HRP (P < 0.001). Within a median follow-up of 24 (16, 34) months, individuals with premature CAD and ischaemic recurrence (n = 24) had more HRP [4.3 (3.9)] than those without ischaemic recurrence [1.5 (1.9)], mostly non-calcified with low attenuation and positive remodelling. CONCLUSION Coronary atherosclerosis in individuals with premature CAD is characterized by a high and predominant burden of non-calcified plaque and unusual high prevalence of HRP, contributing to disease progression with multiple recurrences. A comprehensive qualitative CCTA assessment of plaque characteristics may further risk stratify our patients, beyond cardiovascular risk factors.
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Affiliation(s)
- Ghilas Rahoual
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Michel Zeitouni
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Etienne Charpentier
- INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France
| | - Paul-Gydeon Ritvo
- INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Niki Procopi
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Sena Boukhelifa
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Pierre Charleux
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Mathieu Kerneis
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Olivier Barthélémy
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Johanne Silvain
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
| | - Alban Redheuil
- INSERM UMRS 1146, CNRS, Institute of Cardiometabolism and Nutrition, unité d'Imagerie Cardiovasculaire et Thoracique, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris 75013, France
| | - Jean-Philippe Collet
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, 47-83 boulevard de l'Hôpital, Paris 75013, France
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3
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Gallone G, Bellettini M, Gatti M, Tore D, Bruno F, Scudeler L, Cusenza V, Lanfranchi A, Angelini A, de Filippo O, Iannaccone M, Baldetti L, Audisio K, Demetres M, Risi G, Rizzello G, Porto I, Fonio P, Prati F, Williams MC, Koo BK, Pontone G, Depaoli A, Libby P, Stone GW, Narula J, de Ferrari GM, d'Ascenzo F. Coronary Plaque Characteristics Associated With Major Adverse Cardiovascular Events in Atherosclerotic Patients and Lesions: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:1584-1604. [PMID: 37804276 DOI: 10.1016/j.jcmg.2023.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/19/2023] [Accepted: 08/11/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non-flow-limiting lesions remains uncertain. OBJECTIVES The authors performed a systematic review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE). METHODS Thirty studies (21 retrospective, 9 prospective) with 30,369 patients evaluating the association of CPCs with MACE were included. CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling. RESULTS CPCs were evaluated with the use of intracoronary modalities in 9 studies (optical coherence tomography in 4 studies, intravascular ultrasound imaging in 3 studies, and near-infrared spectroscopy intravascular ultrasound imaging in 2 studies) and by means of coronary computed tomographic angiography in 21 studies. CPCs significantly predicted patient-level and lesion-level MACE in both unadjusted and adjusted analyses. For most CPCs, accuracy for MACE was modest to good at the patient level and moderate to good at the lesion level. Plaques with more than 1 CPC had the highest accuracy for lesion-level MACE (AUC: 0.87). Because the prevalence of CPCs among plaques was low, estimated positive predictive values for lesion-level MACE were modest. Results were mostly consistent across imaging modalities and clinical presentations, and in studies with prevailing hard outcomes. CONCLUSIONS Characterization of CPCs identifies high-risk atherosclerotic plaques that place lesions and patients at risk for future MACE, albeit with modest sensitivity and positive predictive value (Coronary Plaque Characteristics Associated With Major Adverse Cardiovascular Events Among Atherosclerotic Patients and Lesions; CRD42021251810).
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Matteo Bellettini
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Luca Scudeler
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Vincenzo Cusenza
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Antonio Lanfranchi
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ovidio de Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Michelle Demetres
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA; Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, USA
| | - Gaetano Risi
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Italo Porto
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Prati
- UniCamillus, Saint Camillus International University of Health and Medical Sciences Rome, Italy; Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alessandro Depaoli
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio d'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
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4
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Park HB, Arsanjani R, Sung JM, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study. Eur Heart J Cardiovasc Imaging 2023; 24:1536-1543. [PMID: 37232393 DOI: 10.1093/ehjci/jead110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
AIMS To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS We analyzed mild stenosis (25-49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02-3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09-2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07-2.22; P = 0.020). CONCLUSION In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02803411.
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Affiliation(s)
- Hyung-Bok Park
- Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Ji Min Sung
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Ran Heo
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa, Italy
| | - Hugo Marques
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Unit of Cardiovascular Imaging, Hospital da Luz, Catolica Medical School, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sang-Eun Lee
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sanghoon Shin
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Habib Samady
- Department of Cardiology, Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | - Peter H Stone
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY 10029, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10021, USA
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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5
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Jiang S, Fang C, Xu X, Xing L, Sun S, Peng C, Yin Y, Lei F, Wang Y, Li L, Chen Y, Pei X, Jia R, Tang C, Li S, Li S, Yu H, Chen T, Tan J, Liu X, Hou J, Dai J, Yu B. Identification of High-Risk Coronary Lesions by 3-Vessel Optical Coherence Tomography. J Am Coll Cardiol 2023; 81:1217-1230. [PMID: 36925409 DOI: 10.1016/j.jacc.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) may provide a method for detecting histologically defined high-risk plaques in vivo. OBJECTIVES The authors aimed to investigate the prognostic value of OCT for identifying patients and lesions that are at risk for adverse cardiac events. METHODS Between January 2017 and May 2019, OCT of all the 3 main epicardial arteries was performed in 883 patients with acute myocardial infarction (MI) who were referred for primary percutaneous coronary intervention. The primary endpoint was the composite of cardiac death, nonculprit lesion-related nonfatal MI, and unplanned coronary revascularization. Patients were followed for up to 4 years (median 3.3 years). RESULTS The 4-year cumulative rate of the primary endpoint was 7.2%. In patient-level analysis, thin-cap fibroatheroma (TCFA) (adjusted HR: 3.05; 95% CI: 1.67-5.57) and minimal lumen area (MLA) <3.5 mm2 (adjusted HR: 3.71; 95% CI: 1.22-11.34) were independent predictors of the primary endpoint. In lesion-level analysis, nonculprit lesions responsible for subsequent events were not angiographically severe at baseline (mean diameter stenosis 43.8% ± 13.4%). TCFA (adjusted HR: 8.15; 95% CI: 3.67-18.07) and MLA <3.5 mm2 (adjusted HR: 4.33; 95% CI: 1.81-10.38) were predictive of events arising from each specific lesion. TCFAs with an MLA <3.5 mm2 carried a higher risk and were sufficient for identifying patients at risk for the composite of cardiac death and nonculprit lesion-related nonfatal MI. CONCLUSIONS OCT imaging of angiographically nonobstructive territories in patients with acute MI can aid in identifying patients and lesions at increased risk for adverse cardiac events.
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Affiliation(s)
- Senqing Jiang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chao Fang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xueming Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lei Xing
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Sibo Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Cong Peng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yanwei Yin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Fangmeng Lei
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yuzhu Chen
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xueying Pei
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ruyi Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Caiying Tang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Song Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shuang Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tao Chen
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jinfeng Tan
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xiaohui Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
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6
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Dai N, Chen Z, Zhou F, Zhou Y, Hu N, Duan S, Wang W, Zhang L, Qian J, Ge J. Coronary CT angiography-derived plaque characteristics and physiologic patterns for peri-procedural myocardial infarction and subsequent events. Eur Heart J Cardiovasc Imaging 2023:7048458. [PMID: 36808235 DOI: 10.1093/ehjci/jead025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
AIMS Peri-procedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) has been shown to be associated with worse clinical outcomes. We aimed to investigate the value of coronary plaque characteristics and physiologic disease patterns (focal vs. diffuse) assessed by coronary computed tomography angiography (CTA) in predicting PMI and adverse events. METHODS AND RESULTS Three hundred fifty-nine patients with normal pre-PCI high-sensitivity cardiac troponin T (hs-cTnT) underwent CTA before PCI were analysed. The high-risk plaque characteristics (HRPC) were assessed on CTA. The physiologic disease pattern was characterized using CTA fractional flow reserve-derived pullback pressure gradients (FFRCT PPG). PMI was defined as an increase in hs-cTnT to >5 times the upper limit of normal after PCI. The major adverse cardiovascular events (MACE) were a composite of cardiac death, spontaneous myocardial infarction, and target vessel revascularization. The presence of ≥3 HRPC in the target lesions [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.29-3.80, P = 0.004] and low FFRCT PPG (OR 1.23, 95% CI 1.02-1.52, P = 0.028) were independent predictors of PMI. In a four-group classification according to HRPC and FFRCT PPG, patients with ≥3 HRPC and low FFRCT PPG had the highest risk of MACE (19.3%; overall P = 0.001). Moreover, the presence of ≥3 HRPC and low FFRCT PPG was an independent predictor of MACE and showed incremental prognostic value compared with a model with clinical risk factors alone [C index = 0.78 vs. 0.60, P = 0.005, net reclassification index = 0.21 (95% CI: 0.04-0.48), P = 0.020]. CONCLUSIONS Coronary CTA can evaluate plaque characteristics and physiologic disease patterns simultaneously, which plays an important role for risk stratification before PCI.
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Affiliation(s)
- Neng Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.,National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Zhangwei Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.,National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Xuanwu District, Nanjing, Jiangsu 210016, China
| | - You Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.,National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Nan Hu
- School of Electronics and Information Engineering, Soochow University, 333 East Ganjiang Road, Gusu District, Suzhou 213016, China
| | - Shaofeng Duan
- GE Healthcare China, 1 Huatuo Road, Pudong District, Shanghai 210000, China
| | - Wei Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Xuanwu District, Nanjing, Jiangsu 210016, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.,National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.,National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
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7
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Oleksiak A, Kępka C, Rucińska K, Marcinkiewicz K, Demkow M, Kruk M. High-density lipoprotein cholesterol, triglycerides, and characteristics of coronary atherosclerosis in patients with significant coronary artery disease newly diagnosed by computed tomography coronary angiography. Kardiol Pol 2023; 81:273-280. [PMID: 36475513 DOI: 10.33963/kp.a2022.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/04/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND The Current European Society of Cardiology guidelines indicate specific target low-density lipoprotein cholesterol (LDL-C) levels for different cardiovascular risk categories in terms of prevention. However, the target for high-density lipoprotein cholesterol (HDL-C) and triglycerides has not been established. AIM The study aims to investigate the associations betweenHDL-C,triglycerides, andcoronary plaque characteristics. METHODS This was a prospective single-center study with enrolled consecutive patients with newly diagnosed significant (≥1stenosis ≥50%) CAD on computed tomography coronary angiography (CTCA). Patients had lipids andCTCA analysis, including high-risk plaque (HRP) features: low-attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling (PR), and spotty calcium (SC), type of the plaque (calcified, noncalcified, mixed), and their composition (calcified, fibrous, fibro-fatty, necrotic core). RESULTS The study included 300 patients (191 men, 66 [8] years). Sixty-six percent of them had lipid-lowering therapy. HRPwas found in 208 patients. There was no association between LDL-C, plaque composition, and HRP presence. There was a negative correlation between HDL-C, fibro-fatty and necrotic core plaque components (P = 0.0002, P = 0.0009). There was a positive correlation between triglycerides and necrotic core (P = 0.038). There were differences in HDL-C and triglycerides in patients with and without NRS (47 vs. 53 mg/dl, P = 0.0002 and 128 vs. 109 mg/dl, P = 0.02). In logistic regression, HDL-C (odds ratio [OR], 0.95;95% confidence interval [CI], 0.93-0.98; P <0.001), triglycerides (OR, 1.00; 95% CI, 1.00-1.01; P = 0.02), and male sex (OR, 3.04; 95% CI, 1.41-6.52; P = 0.004) were NRS predictors. In multivariable regression, only HDL-C (OR, 0.96; 95% CI, 0.93-0.99; P = 0.02) was an independent predictor of NRS. CONCLUSION Lower HDL-C and higher triglycerides were associated with NRS presence and more necrotic core plaque components in coronary plaques in patients with newly diagnosed CAD.
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Affiliation(s)
- Anna Oleksiak
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warszawa, Poland.
| | - Cezary Kępka
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Karolina Rucińska
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warszawa, Poland
| | - Kamil Marcinkiewicz
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warszawa, Poland
| | - Marcin Demkow
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
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Nishihara T, Miyoshi T, Ichikawa K, Osawa K, Nakashima M, Miki T, Ito H. Association of Oxidized Low-Density Lipoprotein in Nonalcoholic Fatty Liver Disease with High-Risk Plaque on Coronary Computed Tomography Angiography: A Matched Case-Control Study. J Clin Med 2022; 11. [PMID: 35628964 DOI: 10.3390/jcm11102838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a risk factor for the development of atherosclerotic cardiovascular diseases (CVDs), and oxidative stress has been proposed as a shared pathophysiological condition. This study examined whether oxidized low-density lipoprotein (LDL) is involved in the underlying mechanism that links coronary atherosclerosis and NAFLD. This study included 631 patients who underwent coronary computed tomography angiography (CTA) for suspected coronary artery disease. NAFLD was defined on CT images as a liver-to-spleen attenuation ratio of <1.0. Serum-malondialdehyde-modified LDL (MDA-LDL) and coronary CTA findings were analyzed in a propensity-score-matched cohort of patients with NAFLD (n = 150) and those without NAFLD (n = 150). This study analyzed 300 patients (median age, 65 years; 64% men). Patients with NAFLD had higher MDA-LDL levels and a greater presence of CTA-verified high-risk plaques than those without NAFLD. In the multivariate linear regression analysis, MDA-LDL was independently associated with NAFLD (β = 11.337, p = 0.005) and high-risk plaques (β = 12.487, p = 0.007). Increased MDA-LDL may be a mediator between NAFLD and high-risk coronary plaque on coronary CTA. Increased oxidative stress in NAFLD, as assessed using MDA-LDL, may be involved in the development of CVDs.
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9
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Wang Y, Zhao X, Zhou P, Liu C, Liao Z, Wang X, Yan S, Sheng Z, Li J, Zhou J, Chen R, Chen Y, Song L, Zhao H, Yan H. High-Risk Culprit Plaque Predicts Cardiovascular Outcomes Independently of Plaque Rupture in ST-Segment Elevation Myocardial Infarction: Insight From Optical Coherence Tomography. Angiology 2022; 73:946-955. [PMID: 35506476 DOI: 10.1177/00033197221087778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study explored the predictive value of culprit high-risk plaque (HRP) detected by optical coherence tomography (OCT) for predicting major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI). HRP was defined as the simultaneous presence of four criteria: minimum lumen area <3.5 mm2, fibrous cap thickness <75 μm, lipid plaque with lipid arc extension >180°, and presence of macrophages. Patients (n = 274) were divided into non-HRP group (n = 206) and HRP group (n = 68). MACEs were defined as a composite of all-cause death, myocardial infarction, stroke, and revascularization. During a mean follow-up of 2.2 years, 47 (17.5%) MACEs were observed: 28 (13.6%) in the non-HRP group and 19 (27.9%) in the HRP group (log-rank P = .005). Patients with HRP were 2.05 times more likely to suffer from a MACE than those without HRP (hazards ratio: 2.05, 95% confidence interval: 1.04-4.02, P = .038); MACE risk was comparable between plaque rupture and plaque erosion. In conclusion, HRP was present in 24.8% of STEMI patients and associated with higher cardiovascular risk independent of plaque rupture, suggesting that HRP detected by OCT may help identify patients at high risk of future cardiac events.
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Affiliation(s)
- Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyong Liao
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiaoqing Wang
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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10
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Yamaura H, Otsuka K, Ishikawa H, Shirasawa K, Fukuda D, Kasayuki N. Determinants of Non-calcified Low-Attenuation Coronary Plaque Burden in Patients Without Known Coronary Artery Disease: A Coronary CT Angiography Study. Front Cardiovasc Med 2022; 9:824470. [PMID: 35463764 PMCID: PMC9021435 DOI: 10.3389/fcvm.2022.824470] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
Background Although epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), it is unclear whether EAT volume (EAV) can be used to diagnose high-risk coronary plaque burden associated with coronary events. This study aimed to investigate (1) the prognostic impact of low-attenuation non-calcified coronary plaque (LAP) burden on patient level analysis, and (2) the association of EAV with LAP volume in patients without known CAD undergoing coronary computed tomography angiography (CCTA). Materials and Methods This retrospective study consisted of 376 patients (male, 57%; mean age, 65.2 ± 13 years) without known CAD undergoing CCTA. Percent LAP volume (%LAP, <30 HU) was calculated as the LAP volume divided by the vessel volume. EAT was defined as adipose tissue with a CT attenuation value ranging from −250 to −30 HU within the pericardial sac. The primary endpoint was a composite event of death, non-fatal myocardial infarction, and unstable angina and worsening symptoms requiring unplanned coronary revascularization >3 months after CCTA. The determinants of %LAP (Q4) were analyzed using a multivariable logistic regression model. Results During the follow-up period (mean, 2.2 ± 0.9 years), the primary endpoint was observed in 17 patients (4.5%). The independent predictors of the primary endpoint were %LAP (Q4) (hazard ratio [HR], 3.05; 95% confidence interval [CI], 1.09–8.54; p = 0.033] in the Cox proportional hazard model adjusted by CAD-RADS category. Cox proportional hazard ratio analysis demonstrated that %LAP (Q4) was a predictor of the primary endpoint, independnet of CAD severity, Suita score, EAV, or CACS. The independent determinants of %LAP (Q4) were CACS ≥218.3 (p < 0.0001) and EAV ≥125.3 ml (p < 0.0001). The addition of EAV to CACS significantly improved the area under the curve (AUC) to identify %LAP (Q4) than CACS alone (AUC, EAV + CACS vs. CACS alone: 0.728 vs. 0.637; p = 0.013). Conclusions CCTA-based assessment of EAV, CACS, and LAP could help improve personalized cardiac risk management by administering patient-suited therapy.
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Affiliation(s)
- Hiroki Yamaura
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
| | - Kenichiro Otsuka
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan.,Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirotoshi Ishikawa
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan.,Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kuniyuki Shirasawa
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriaki Kasayuki
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
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11
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Lu G, Ye W, Ou J, Li X, Tan Z, Li T, Liu H. Coronary Computed Tomography Angiography Assessment of High-Risk Plaques in Predicting Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:743538. [PMID: 34660742 PMCID: PMC8517134 DOI: 10.3389/fcvm.2021.743538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 01/07/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is a comprehensive, non-invasive and cost-effective imaging assessment approach, which can provide the ability to identify the characteristics and morphology of high-risk atherosclerotic plaques associated with acute coronary syndrome (ACS). The development of CCTA and latest advances in emerging technologies, such as computational fluid dynamics (CFD), have made it possible not only to identify the morphological characteristics of high-risk plaques non-invasively, but also to assess the hemodynamic parameters, the environment surrounding coronaries and so on, which may help to predict the risk of ACS. In this review, we present how CCTA was used to characterize the composition and morphology of high-risk plaques prone to ACS and the current role of CCTA, including emerging CCTA technologies, advanced analysis, and characterization techniques in prognosticating the occurrence of ACS.
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Affiliation(s)
- Guanyu Lu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiehao Ou
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinyun Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zekun Tan
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tingyu Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,College of Medicine, Shantou University, Shantou, China
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12
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Yuvaraj J, Lin A, Nerlekar N, Munnur RK, Cameron JD, Dey D, Nicholls SJ, Wong DTL. Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease. Cells 2021; 10:1143. [PMID: 34068518 PMCID: PMC8150579 DOI: 10.3390/cells10051143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND High-risk plaques (HRP) detected on coronary computed tomography angiography (CTA) confer an increased risk of acute coronary syndrome (ACS). Pericoronary adipose tissue attenuation (PCAT) is a novel biomarker of coronary inflammation. This study aimed to evaluate the association of PCAT with HRP and subsequent ACS development in patients with stable coronary artery disease (CAD). METHODS Patients with stable CAD who underwent coronary CTA from 2011 to 2016 and had available outcome data were included. We studied 41 patients with HRP propensity matched to 41 controls without HRP (60 ± 10 years, 67% males). PCAT was assessed using semi-automated software on a per-patient basis in the proximal right coronary artery (PCATRCA) and a per-lesion basis (PCATLesion) around HRP in cases and the highest-grade stenosis lesions in controls. RESULTS PCATRCA and PCATLesion were higher in HRP patients than controls (PCATRCA: -80.7 ± 6.50 HU vs. -84.2 ± 8.09 HU, p = 0.03; PCATLesion: -79.6 ± 7.86 HU vs. -84.2 ± 10.3 HU, p = 0.04), and were also higher in men (PCATRCA: -80.5 ± 7.03 HU vs. -86.1 ± 7.08 HU, p < 0.001; PCATLesion: -79.6 ± 9.06 HU vs. -85.2 ± 7.96 HU, p = 0.02). Median time to ACS was 1.9 years, within a median follow-up of 5.3 years. PCATRCA alone was higher in HRP patients who subsequently presented with ACS (-76.8 ± 5.69 HU vs. -82.0 ± 6.32 HU, p = 0.03). In time-dependent analysis, ACS was associated with HRP and PCATRCA. CONCLUSIONS PCAT attenuation is increased in stable CAD patients with HRP and is associated with subsequent ACS development. Further investigation is required to determine the clinical implications of these findings.
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Affiliation(s)
- Jeremy Yuvaraj
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.L.); (D.D.)
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Ravi K. Munnur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - James D. Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (A.L.); (D.D.)
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Dennis T. L. Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Clayton, VIC 3800, Australia; (J.Y.); (N.N.); (R.K.M.); (J.D.C.); (S.J.N.)
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13
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Chen X, Dang Y, Hu H, Ma S, Ma Y, Wang K, Liu T, Lu X, Hou Y. Pericoronary adipose tissue attenuation assessed by dual-layer spectral detector computed tomography is a sensitive imaging marker of high-risk plaques. Quant Imaging Med Surg 2021; 11:2093-2103. [PMID: 33936990 DOI: 10.21037/qims-20-860] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The pericoronary fat attenuation index (FAI) derived from conventional polychromatic computed tomography (CT) can capture the presence of coronary inflammation. However, conventional polychromatic CT has limitations in material component differentiation, and spectral CT could have a better ability to discriminate tissue characteristics. Hence, this study sought to assess pericoronary adipose tissue (PCAT) attenuation using spectral CT and explore its association with atherosclerotic plaque characteristics. Methods We enrolled 104 patients with coronary atherosclerosis who met the inclusion criteria and underwent coronary CT angiography with dual-layer spectral detector computed tomography (SDCT). Plaque anatomical characteristics were measured, and the PCAT attenuation was assessed by polychromatic images (CTpoly), virtual mono-energetic images at 40 keV (CT40 keV), the slope of spectral attenuation curve (λHU), and the effective atomic number (Zeff). The association of PCAT attenuation indicators with the presence of high-risk plaques was analyzed, along with the indicators' ability to identify high-risk plaques. Results PCAT attenuation indicators around high-risk plaques were higher than those around non-high-risk plaques, especially CT40 keV [-153.76±24.97 (non-high-risk plaque) vs. -119.87±22.74 (high-risk plaque), P<0.001]. CT40 keV was a predictive factor of high-risk plaques, and high CT40 keV (≥-120.60 HU) could assist in the identification of high-risk plaques, with an area under the curve of 0.883 (95% CI: 0.83-0.94, P<0.05). Conclusions PCAT surrounding high-risk plaques showed higher attenuation; a finding that has been associated with coronary artery inflammation. The metrics derived from SDCT, especially CT40 keV, showed higher discriminatory power for detecting changes in PCAT attenuation than polychromatic CT. PCAT attenuation assessed by CT40 keV may provide a novel imaging marker of plaque vulnerability.
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Affiliation(s)
- Xujiao Chen
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuxue Dang
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Hu
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaowei Ma
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kunhua Wang
- Radiology Department, People's Hospital of Liaoning Province, Shenyang, China
| | - Ting Liu
- Radiology Department, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang, China
| | - Yang Hou
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
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Ichikawa K, Miyoshi T, Osawa K, Miki T, Ito H. Increased Circulating Malondialdehyde-Modified Low-Density Lipoprotein Level Is Associated with High-Risk Plaque in Coronary Computed Tomography Angiography in Patients Receiving Statin Therapy. J Clin Med 2021; 10:1480. [PMID: 33918383 DOI: 10.3390/jcm10071480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the association of serum malondialdehyde low-density lipoprotein (MDA-LDL), an oxidatively modified LDL, with the prevalence of high-risk plaques (HRP) determined with coronary computed tomography angiography (CTA) in statin-treated patients. Methods: This study was a single-center retrospective cohort comprising 268 patients (mean age 67 years, 58% men) with statin therapy and who underwent coronary CTA for suspected stable coronary artery disease. Patients were classified into two groups according to median MDA-LDL level or median LDL-C level. Coronary CTA-verified HRP was defined when two or more characteristics, including positive remodeling, low-density plaques, and spotty calcification, were present. Results: Patients with HRP had higher MDA-LDL (p = 0.011), but not LDL-C (p = 0.867) than those without HRP. High MDA-LDL was independently associated with HRP (odds ratio 1.883, 95% confidential interval 1.082–3.279) after adjustment for traditional risk factors. Regarding incremental value of MDA-LDL for predicting CTA-verified HRP, addition of serum MDA-LDL levels to the baseline model significantly increased global chi-square score from 26.1 to 32.8 (p = 0.010). Conclusions: A high serum MDA-LDL level is an independent predictor of CTA-verified HRP, which can lead to cardiovascular events in statin-treated patients.
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15
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Porro B, Conte E, Zaninoni A, Bianchi P, Veglia F, Barbieri S, Fiorelli S, Eligini S, Di Minno A, Mushtaq S, Tremoli E, Cavalca V, Andreini D. Red Blood Cell Morphodynamics: A New Potential Marker in High-Risk Patients. Front Physiol 2021; 11:603633. [PMID: 33519509 PMCID: PMC7838560 DOI: 10.3389/fphys.2020.603633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
In the last years, a substantial contribution of red blood cells (RBCs) in cardiovascular homeostasis has been evidenced, as these cells are able to regulate cardiovascular function by the export of adenosine triphosphate and nitric oxide as well as to maintain redox balance through a well-developed antioxidant system. Recently a link between high-risk plaque (HRP) features and myocardial ischemia, in the absence of severe lumen stenosis, has been evidenced. Nonobstructive coronary artery disease (nonob CAD) has been associated in fact with a greater 1-year risk of myocardial infarction and all-cause mortality compared with no apparent CAD. This new evidence increases interest in searching new triggers to identify these high-risk patients, in the absence/or on top of traditional hazard markers. In this study, we investigated the existence of any association between RBC morphodynamics and HRP features in individuals with different grades of coronary stenosis detected by coronary computed tomography angiography (CCTA). Ninety-one consecutive individuals who underwent CCTA [33 no CAD; 26 nonobstructive (nonob), and 32 obstructive (ob) CAD] were enrolled. RBC morphodynamic features, i.e., RBC aggregability and deformability, were analyzed by means of Laser Assisted Optical Rotation Cell Analyzer (LoRRca MaxSis). The putative global RBC morphodynamic (RMD) score and the related risk chart, associating the extent of HRP (e.g., the non-calcified plaque volume) with both the RMD score and the max % stenosis were computed. In nonob CAD group only positive correlations between RBC rigidity, osmotic fragility or aggregability and HRP features (plaque necrotic core, fibro-fatty and fibro-fatty plus necrotic core plaque volumes) were highlighted. Interestingly, in this patient cohort three of these RBC morphodynamic features result to be independent predictors of the presence of non-calcified plaque volume in this patients group. The risk chart created shows that only in nonob CAD plaque vulnerability increases according to the score quartile. Findings of this work, by evidencing the association between erythrocyte morphodynamic characteristics assessed by LoRRca and plaque instability in a high-risk cohort of nonob CAD, suggest the use of these blood cell features in the identification of high-risk patients, in the absence of severe coronary stenosis.
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Affiliation(s)
- Benedetta Porro
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Anna Zaninoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Unità Operativa Complessa (UOC) Ematologia, Unità Operativa Semplice (UOS) Fisiopatologia delle Anemie, Milan, Italy
| | - Paola Bianchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Unità Operativa Complessa (UOC) Ematologia, Unità Operativa Semplice (UOS) Fisiopatologia delle Anemie, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Simone Barbieri
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Susanna Fiorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sonia Eligini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alessandro Di Minno
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Viviana Cavalca
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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16
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Daghem M, Newby DE. Detecting unstable plaques in humans using cardiac CT: Can it guide treatments? Br J Pharmacol 2020; 178:2204-2217. [PMID: 31596945 DOI: 10.1111/bph.14896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/15/2019] [Accepted: 09/27/2019] [Indexed: 12/15/2022] Open
Abstract
Advances in imaging technology have driven the rapid expansion in the use of CT in the assessment of coronary atherosclerotic plaque. Based on a rapidly growing evidence base, current guidelines recommend coronary CT angiography as the first-line diagnostic test for patients presenting with stable chest pain. There is a growing need to refine current methods for diagnosis and risk stratification to improve the individualisation of preventative therapies. Imaging assessments of high-risk plaque with CT can be used to differentiate stable from unstable patterns of coronary atherosclerosis and potentially to improve patient risk stratification. This review will focus on coronary imaging with CT with a specific focus on the detection of coronary atherosclerosis, high-risk plaque features, and the implications for patient management.
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Affiliation(s)
- Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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17
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Bittner DO, Mayrhofer T, Budoff M, Szilveszter B, Foldyna B, Hallett TR, Ivanov A, Janjua S, Meyersohn NM, Staziaki PV, Achenbach S, Ferencik M, Douglas PS, Hoffmann U, Lu MT. Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. JACC Cardiovasc Imaging 2019; 13:1534-1545. [PMID: 31734213 DOI: 10.1016/j.jcmg.2019.09.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/13/2019] [Accepted: 09/13/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The purpose of this study was to compare Coronary Artery Disease Reporting and Data System (CAD-RADS) to traditional stenosis categories and the coronary artery calcium score (CACS) for predicting cardiovascular events in patients with stable chest pain and suspected coronary artery disease (CAD). BACKGROUND The 2016 CAD-RADS has been established to standardize the reporting of CAD on coronary CT angiography (CTA). METHODS PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial participants' CTAs were assessed by a central CT core laboratory for CACS, traditional stenosis-based categories, and modified CAD-RADS grade including high-risk coronary plaque (HRP) features. Traditional stenosis categories and CAD-RADS grade were compared for the prediction of the composite endpoint of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 25 months. Incremental prognostic value over traditional risk factors and CACS was assessed. RESULTS In 3,840 eligible patients (mean age: 60.4 ± 8.2 years; 49% men), 3.0% (115) experienced events. CAD-RADS (concordance statistic [C-statistic] 0.747) had significantly higher discriminatory value than traditional stenosis-based assessments (C-statistic 0.698 to 0.717; all p for comparison ≤0.001). With no plaque (CAD-RADS 0) as the baseline, the hazard ratio (HR) for an event increased from 2.43 (95% confidence interval [CI]: 1.16 to 5.08) for CAD-RADS 1 to 21.84 (95% CI: 8.63 to 55.26) for CAD-RADS 4b and 5. In stepwise nested models, CAD-RADS added incremental prognostic value beyond ASCVD risk score and CACS (C-statistic 0.776 vs. 0.682; p < 0.001), and added incremental value persisted in all CACS strata. CONCLUSIONS These data from a large representative contemporary cohort of patients undergoing coronary CTA for stable chest pain support the prognostic value of CAD-RADS as a standard reporting system for coronary CTA.
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Affiliation(s)
- Daniel O Bittner
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany.
| | - Thomas Mayrhofer
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Matt Budoff
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Balint Szilveszter
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Borek Foldyna
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Travis R Hallett
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander Ivanov
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sumbal Janjua
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nandini M Meyersohn
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pedro V Staziaki
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephan Achenbach
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany
| | - Maros Ferencik
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Udo Hoffmann
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael T Lu
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Watase H, Canton G, Sun J, Zhao X, Hatsukami TS, Yuan C. Four Different Carotid Atherosclerotic Behaviors Based on Luminal Stenosis and Plaque Characteristics in Symptomatic Patients: An in Vivo Study. Diagnostics (Basel) 2019; 9:diagnostics9040137. [PMID: 31581663 PMCID: PMC6963409 DOI: 10.3390/diagnostics9040137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 01/19/2023] Open
Abstract
Correct stratification of ischemic stroke risk allows for the proper treatment of carotid atherosclerotic disease. We seek to differentiate plaque types based on stenosis level and plaque morphology. The Chinese Atherosclerosis Risk Evaluation (CARE-II) study is a cross-sectional, observational, multicenter study to assess carotid atherosclerotic plaques in symptomatic subjects using vessel wall magnetic resonance imaging. Plaque morphology and presence of plaque components were reviewed using multi-contrast magnetic resonance imaging. The carotid arteries were divided into four groups based on stenosis level and plaque components. Out of 1072 ischemic stroke subjects, 452 ipsilateral side carotid arteries were included. Significant stenosis (SS) (≥50% stenosis) with high-risk plaque (HRP) features was present in 37 arteries (8.2%), SS(+)/HRP(-) in 29 arteries (6.4%), SS(-)/HRP(+) in 57 arteries (12.6%), and SS(-)/HRP(-) in 329 arteries (72.8%). The prevalence of SS(-)/HRP(+) arteries in this cohort was substantial and had greater wall thickness than the SS(+)/HRP(-) group. These arteries may be misclassified for carotid revascularization by current guidelines based on the degree of luminal stenosis only. These findings have implications for further studies to assess stroke risk using vessel wall imaging.
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Affiliation(s)
- Hiroko Watase
- Department of Surgery, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Gador Canton
- Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Jie Sun
- Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, China Haidian District, Beijing 100084, China.
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
| | - Chun Yuan
- Department of Radiology, University of Washington, United States 850 Republican Street, Seattle, WA 98109, USA.
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19
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Kwiecinski J, Dey D, Cadet S, Lee SE, Otaki Y, Huynh PT, Doris MK, Eisenberg E, Yun M, Jansen MA, Williams MC, Tamarappoo BK, Friedman JD, Dweck MR, Newby DE, Chang HJ, Slomka PJ, Berman DS. Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. JACC Cardiovasc Imaging 2019; 12:2000-10. [PMID: 30772226 DOI: 10.1016/j.jcmg.2018.11.032] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study aimed to assess the association between increased lesion peri-coronary adipose tissue (PCAT) density and coronary 18F-sodium fluoride (18F-NaF) uptake on positron emission tomography (PET) in stable patients with high-risk coronary plaques (HRPs) shown on coronary computed tomography angiography (CTA). BACKGROUND Coronary 18F-NaF uptake reflects the rate of calcification of coronary atherosclerotic plaque. Increased PCAT density is associated with vascular inflammation. Currently, the relationship between increased PCAT density and 18F-NaF uptake in stable patients with HRPs on coronary CTA has not been characterized. METHODS Patients who underwent coronary CTA were screened for HRP, which was defined by 3 concurrent plaque features: positive remodeling; low attenuation plaque (LAP) (<30 Hounsfield units [HU]) and spotty calcification; and obstructive coronary stenosis ≥50% (plaque volume >100 mm3). Patients with HRPs were recruited to undergo 18F-NaF PET/CT. In lesions with stenosis ≥25%, quantitative plaque analysis, mean PCAT density, maximal coronary motion-corrected 18F-NaF standard uptake values (SUVmax), and target-to-background ratios (TBR) were measured. RESULTS Forty-one patients (age 65 ± 6 years; 68% men) were recruited. Fifty-one lesions in 23 patients (56%) showed increased coronary 18F-NaF activity. Lesions with 18F-NaF uptake had higher surrounding PCAT density than those without 18F-NaF uptake (-73 HU; interquartile range -79 to -68 HU vs. -86 HU; interquartile range -94 to -80 HU; p < 0.001). 18F-NaF TBR and SUVmax were correlated with PCAT density (r = 0.63 and r = 0.68, respectively; all p < 0.001). On adjusted multiple regression analysis, increased lesion PCAT density and LAP volume were associated with 18F-NaF TBR (β = 0.25; 95% confidence interval: 0.17 to 0.34; p < 0.001 for PCAT, and β = 0.07; 95% confidence interval: 0.03 to 0.11; p = 0.002 for LAP). CONCLUSIONS In patients with HRP features on coronary CTA, increased density of PCAT was associated with focal 18F-NaF PET uptake. Simultaneous assessment of these imaging biomarkers by 18F-NaF PET and CTA might refine cardiovascular risk prediction in stable patients with HRP features.
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20
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Feuchtner G, Kerber J, Burghard P, Dichtl W, Friedrich G, Bonaros N, Plank F. The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study. Eur Heart J Cardiovasc Imaging 2018; 18:772-779. [PMID: 27502292 DOI: 10.1093/ehjci/jew167] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/16/2016] [Indexed: 01/14/2023] Open
Abstract
Aims To assess the prognostic value of coronary CT angiography (CTA) for prediction of major adverse cardiac events (MACE) over a long-term follow-up period. Methods and Results A total of 1469 low-to-intermediate-risk patients (65.9 years; 44.2% females) were included in our prospective cohort study. CTA was evaluated for (i) stenosis severity (minimal <10%; mild <50%; moderate 50-70%; severe >70%), (ii) plaque types (calcified, mixed dominantly calcified, mixed dominantly non-calcified, non-calcified), and (iii) high-risk plaque criteria [low-attenuation plaque (LAP) quantified by HU, napkin-ring (NR) sign, spotty calcification <3 mm, and remodelling index (RI)]. Over a follow-up of mean 7.8 years, MACE rate was 41 (2.8%) and 0% in patients with negative CTA. MACE rate increased along with stenosis severity by CTA (from 1.3 to 7.8%) (P < 0.001) and was higher in T3/T4 plaques than in T2/T1 (7.8 vs. 1.9%; P < 0.0001). LAP density was lower (35.2 HU ± 32 vs. 108.8 HU ± 53) (P < 0.001) and both NR-sign prevalence with n = 26 (63.4%) vs. n = 40 (28%) and LAP <30, <60, and <90 HU prevalence with 46.3-78% vs. 2.4-7% were higher in the MACE group (P < 0.001). On univariate and unadjusted multivariable proportional Hazards model, LAP <60 HU and NR were the strongest MACE predictors (HR 4.96; 95% CI: 2.0-12.2 and HR 3.85; 95% CI: 1.7-8.6) (P < 0.0001), while spotty calcification (HR 2.2; 95% CI: 1.1-4.3, P < 0.001), stenosis severity, and plaque type (HR 1.5; 95% CI: 1.1-2.3 and HR 1.7; 95% CI: 1.1-2.6) (P < 0.001) were less powerful. After adjusting for risk factors, CTA stenosis severity, and plaque type, LAP <60 HU and the NR sign remained significant (P < 0.001), while the effect of NR sign was even enhancing. HRP criteria were independent predictors from other risk factors. Conclusion Prognosis is excellent over a long-term period if CTA is negative and worsening with an increasing non-calcifying plaque component. LAP <60 HU and NR sign are the most powerful MACE predictors.
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Affiliation(s)
- Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria
| | - Johannes Kerber
- Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria
| | - Philipp Burghard
- Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Fabian Plank
- Department of Radiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria.,Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria
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21
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Chatzizisis YS, Toutouzas K, Giannopoulos AA, Riga M, Antoniadis AP, Fujinom Y, Mitsouras D, Koutkias VG, Cheimariotis G, Doulaverakis C, Tsampoulatidis I, Chouvarda I, Kompatsiaris I, Nakamura S, Rybicki FJ, Maglaveras N, Tousoulis D, Giannoglou GD. Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of 'shear stress score'. Eur Heart J Cardiovasc Imaging 2018; 18:888-897. [PMID: 27461211 DOI: 10.1093/ehjci/jew134] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/02/2016] [Indexed: 11/15/2022] Open
Abstract
Aims The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes. Methods and results A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 ± 84 vs.138 ± 83 µm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina. Conclusion Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.
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Affiliation(s)
- Yiannis S Chatzizisis
- Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Andreas A Giannopoulos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Riga
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Yusuke Fujinom
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Dimitrios Mitsouras
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vassilis G Koutkias
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece.,Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Grigorios Cheimariotis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Charalampos Doulaverakis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Ioannis Tsampoulatidis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece.,Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicos Maglaveras
- Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece.,Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece
| | - George D Giannoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
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22
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Lerman JB, Joshi AA, Chaturvedi A, Aberra TM, Dey AK, Rodante JA, Salahuddin T, Chung JH, Rana A, Teague HL, Wu JJ, Playford MP, Lockshin BA, Chen MY, Sandfort V, Bluemke DA, Mehta NN. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study. Circulation 2017; 136:263-276. [PMID: 28483812 DOI: 10.1161/circulationaha.116.026859] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psoriasis, a chronic inflammatory disease associated with an accelerated risk of myocardial infarction, provides an ideal human model to study inflammatory atherogenesis in vivo. We hypothesized that the increased cardiovascular risk observed in psoriasis would be partially attributable to an elevated subclinical coronary artery disease burden composed of noncalcified plaques with high-risk features. However, inadequate efforts have been made to directly measure coronary artery disease in this vulnerable population. As such, we sought to compare total coronary plaque burden and noncalcified coronary plaque burden (NCB) and high-risk plaque (HRP) prevalence between patients with psoriasis (n=105), patients with hyperlipidemia eligible for statin therapy under National Cholesterol Education Program-Adult Treatment Panel III guidelines (n=100) who were ≈10 years older, and healthy volunteers without psoriasis (n=25). METHODS Patients underwent coronary computed-tomography angiography for total coronary plaque burden and NCB quantification and HRP identification, defined as low attenuation (<30 hounsfield units), positive remodeling (>1.10), and spotty calcification. A consecutive sample of the first 50 patients with psoriasis was scanned again 1 year after therapy. RESULTS Despite being younger and at lower traditional risk than patients with hyperlipidemia, patients with psoriasis had increased NCB (mean±SD: 1.18±0.33 versus 1.11±0.32, P=0.02) and similar HRP prevalence (P=0.58). Furthermore, compared to healthy volunteers, patients with psoriasis had increased total coronary plaque burden (1.22±0.31 versus 1.04±0.22, P=0.001), NCB (1.18±0.33 versus 1.03±0.21, P=0.004), and HRP prevalence beyond traditional risk (odds ratio, 6.0; 95% confidence interval, 1.1-31.7; P=0.03). Last, among patients with psoriasis followed for 1 year, improvement in psoriasis severity was associated with improvement in total coronary plaque burden (β=0.45, 0.23-0.67; P<0.001) and NCB (β=0.53, 0.32-0.74; P<0.001) beyond traditional risk factors. CONCLUSIONS Patients with psoriasis had greater NCB and increased HRP prevalence than healthy volunteers. In addition, patients with psoriasis had elevated NCB and equivalent HRP prevalence as older patients with hyperlipidemia. Last, modulation of target organ inflammation (eg, skin) was associated with an improvement in NCB at 1 year, suggesting that control of remote sites of inflammation may translate into reduced coronary artery disease risk.
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Affiliation(s)
- Joseph B Lerman
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Aditya A Joshi
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Abhishek Chaturvedi
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Tsion M Aberra
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Amit K Dey
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Justin A Rodante
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Taufiq Salahuddin
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Jonathan H Chung
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Anshuma Rana
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Heather L Teague
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Jashin J Wu
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Martin P Playford
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Benjamin A Lockshin
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Marcus Y Chen
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Veit Sandfort
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - David A Bluemke
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.)
| | - Nehal N Mehta
- From National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD (J.B.L., A.A.J., A.C., T.M.A., A.K.D., J.A.R., T.S., J.H.C., A.R., H.L.T., M.P.P., M.Y.C., V.S., D.A.B., N.N.M.); Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA (J.J.W.); and DermAssociates, Silver Spring, MD (B.A.L.).
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23
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Fleg JL, Stone GW, Fayad ZA, Granada JF, Hatsukami TS, Kolodgie FD, Ohayon J, Pettigrew R, Sabatine MS, Tearney G, Waxman S, Domanski MJ, Srinivas PR, Narula J. Detection of high-risk atherosclerotic plaque: report of the NHLBI Working Group on current status and future directions. JACC Cardiovasc Imaging 2012; 5:941-55. [PMID: 22974808 PMCID: PMC3646061 DOI: 10.1016/j.jcmg.2012.07.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 07/18/2012] [Accepted: 07/19/2012] [Indexed: 12/27/2022]
Abstract
The leading cause of major morbidity and mortality in most countries around the world is atherosclerotic cardiovascular disease, most commonly caused by thrombotic occlusion of a high-risk coronary plaque resulting in myocardial infarction or cardiac death, or embolization from a high-risk carotid plaque resulting in stroke. The lesions prone to result in such clinical events are termed vulnerable or high-risk plaques, and their identification may lead to the development of pharmacological and mechanical intervention strategies to prevent such events. Autopsy studies from patients dying of acute myocardial infarction or sudden death have shown that such events typically arise from specific types of atherosclerotic plaques, most commonly the thin-cap fibroatheroma. However, the search in human beings for vulnerable plaques before their becoming symptomatic has been elusive. Recently, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study demonstrated that coronary plaques that are likely to cause future cardiac events, regardless of angiographic severity, are characterized by large plaque burden and small lumen area and/or are thin-cap fibroatheromas verified by radiofrequency intravascular ultrasound imaging. This study opened the door to identifying additional invasive and noninvasive imaging modalities that may improve detection of high-risk atherosclerotic lesions and patients. Beyond classic risk factors, novel biomarkers and genetic profiling may identify those patients in whom noninvasive imaging for vulnerable plaque screening, followed by invasive imaging for risk confirmation is warranted, and in whom future pharmacological and/or device-based focal or regional therapies may be applied to improve long-term prognosis.
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Affiliation(s)
- Jerome L. Fleg
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Gregg W. Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Juan F. Granada
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | | | - Jacques Ohayon
- National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, Maryland
| | - Roderic Pettigrew
- National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, Maryland
| | - Marc S. Sabatine
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Guillermo Tearney
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Jagat Narula
- Mount Sinai School of Medicine, New York, New York
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24
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Abstract
The High-Risk Plaque (HRP) Initiative is a research and development effort to advance the understanding, recognition, and management of asymptomatic individuals at risk for a near-term atherothrombotic event such as myocardial infarction or stroke. Clinical studies using the newest technologies have been initiated, including the BioImage Study in which novel approaches are tested in a typical health plan population. Asymptomatic at-risk individuals were enrolled, including a survey-only group (n = 865), a group undergoing traditional risk factor scoring (n = 718), and a group in which all were assessed for both risk factors and subclinical atherosclerosis (n = 6104). The latter two groups underwent baseline examination in a dedicated mobile facility equipped with advanced imaging tools suitable for noninvasive screening for subclinical atherosclerosis (coronary artery calcium by computed tomography [CT], carotid and aortic disease by ultrasound, and ankle-brachial index). Selected participants were offered advanced imaging (contrast-enhanced CT, magnetic resonance imaging, and positron emission tomography/CT). Plasma, PAXgene RNA, and DNA samples were obtained for biomarker discovery studies. All individuals will be followed until 600 major atherothrombotic events have occurred in those undergoing imaging.
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Affiliation(s)
- Erling Falk
- Atherosclerosis Research Unit, Department of Cardiology/Institute of Clinial Medicine, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, Aarhus, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen O, Denmark
| | | | - Valentin Fuster
- Mount Sinai Heart, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029 USA
- The Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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25
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Abstract
Stroke is a leading cause of mortality and long-term morbidity. As a means for stroke prevention, an estimated 99,000 carotid endarterectomy procedures were performed in the USA in 2006. Traditionally, the degree of luminal stenosis has been used as a marker of the stage of atherosclerosis and as an indication for surgical intervention. However, prospective clinical trials have shown that the majority of patients with a history of recent transient ischemic attack or stroke have mild-to-moderate carotid stenosis. Using stenosis criteria, many of these symptomatic individuals would be considered to have early-stage carotid atherosclerosis. It is evident that improved criteria are needed for identifying the high-risk carotid plaque across a range of stenoses. Histological studies have led to the hypothesis that plaques with larger lipid-rich necrotic cores, thin fibrous cap rupture, intraplaque hemorrhage, plaque neovasculature and vessel wall inflammation are characteristics of the high-risk, 'vulnerable plaque'. Despite the widespread consensus on the importance of these plaque features, testing the vulnerable plaque hypothesis in prospective clinical studies has been hindered by the lack of reliable imaging tools for in vivo plaque characterization. MRI has been shown to accurately identify key carotid plaque features, including the fibrous cap, lipid-rich necrotic core, intraplaque hemorrhage, neovasculature and vascular wall inflammation. Thus, MRI is a histologically validated technique that will permit prospective testing of the vulnerable plaque hypothesis. This article will provide a summary of the histological validation of carotid MRI, and highlight its application in prospective clinical studies aimed at early identification of the high-risk atherosclerotic carotid plaque.
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Affiliation(s)
- Thomas S Hatsukami
- Department of Surgery, Vascular Imaging Lab, University of Washington, 815 Mercer Street, Box 358050, Seattle, WA 98109, USA, Tel.: +1 206 543 3061, ,
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