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Artemisinin, the well-known natural product for treating malaria, is biosynthesised and stored in the glandular-secreting trichomes (GSTs) of Artemisia annua. While numerous efforts have clarified artemisinin metabolism and regulation, the molecular association between artemisinin biosynthesis and GST development remains elusive. Here, we identified AaMYC3, a bHLH transcription factor of A. annua, induced by jasmonic acid (JA), which simultaneously regulates GST density and artemisinin biosynthesis. Overexpressing AaMYC3 led to a substantial increase in GST density and artemisinin accumulation. Conversely, in the RNAi-AaMYC3 lines, both GST density and artemisinin content were markedly reduced. Through RNA-seq and analyses conducted both in vivo and in vitro, AaMYC3 not only directly activates AaHD1 transcription, initiating GST development, but also up-regulates the expression of artemisinin biosynthetic genes, including CYP71AV1 and ALDH1, thereby promoting artemisinin production. Furthermore, AaMYC3 acts as a co-activator, interacting with AabHLH1 and AabHLH113, to trigger the transcription of two crucial enzymes in the artemisinin biosynthesis pathway, ADS and DBR2, ultimately boosting yield. Our findings highlight a critical connection between GST initiation and artemisinin biosynthesis in A. annua, providing a new target for molecular design breeding of traditional Chinese medicine.
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Artemisinin, a sesquiterpene lactone isolated from Artemisia annua, is in huge market demand due to its efficient antimalarial action, especially after the COVID-19 pandemic. Many researchers have elucidated that phytohormones jasmonic acid (JA) and abscisic acid (ABA) positively regulate artemisinin biosynthesis via types of transcription factors (TFs). However, the crosstalk between JA and ABA in regulating artemisinin biosynthesis remains unclear. Here, we identified a novel ABA- and JA-induced bHLH TF, AabHLH113, which positively regulated artemisinin biosynthesis by directly binding to the promoters of artemisinin biosynthetic genes, DBR2 and ALDH1. The contents of artemisinin and dihydroartemisinic acid increased by 1.71- to 2.06-fold and 1.47- to 2.23-fold, respectively, in AabHLH1113 overexpressed A. annua, whereas they decreased by 14-36% and 26-53%, respectively, in RNAi-AabHLH113 plants. Furthermore, we demonstrated that AabZIP1 and AabHLH112, which, respectively, participate in ABA and JA signaling pathway to regulate artemisinin biosynthesis, directly bind to and activate the promoter of AabHLH113. Collectively, we revealed a complex network in which AabHLH113 plays a key interrelational role to integrate ABA- and JA-mediated regulation of artemisinin biosynthesis.
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Artemisia annua , Artemisininas , Ácido Abscísico/metabolismo , Artemisia annua/genética , Artemisia annua/metabolismo , Artemisininas/metabolismo , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismoRESUMO
Coronary artery ectasia (CAE) is defined as segmental dilatation with a diameter of 1.5-fold greater than that of an adjacent normal segment. Whether CAE is a unique clinical finding or results from other clinical entities remains to be determined. The purpose of the study was to investigate the prevalence, and clinical and angiographic characteristics of CAE in patients with coronary artery disease (CAD). Among the 8,845 coronary angiograms reviewed between the years 2014 and 2022, 142 patients had CAE yielding a detection rate of 4.9% among 2,870 CAD angiograms, and 28 patients had isolated CAE showing a detection rate of 0.32% (28/8,845) among total coronary angiography procedures. Overall, the incidence of CAE was 1.92% (170/8,845). The most commonly affected coronary artery by ectasia was the right coronary artery (RCA) (46.28%) among CAE coexisting with CAD cohort. The proportion of obesity, family history of CAD, and the proportion of hyperlipidemia in CAD patients who had ectasia were significantly higher than that in CAD patients who did not have ectasia (P < 0.05). In conclusion, CAE is an uncommon finding in coronary angiography, most commonly affecting the RCA. The obesity, family history of CAD, and the coexistence of hyperlipidemia were independent variables associated with CAE in CAD patients.
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Aneurisma Coronário , Doença da Artéria Coronariana , Hiperlipidemias , Humanos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Estudos Retrospectivos , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Vasos Coronários/diagnóstico por imagem , Prevalência , Angiografia Coronária/métodos , ObesidadeRESUMO
BACKGROUND: There are no ideal plates or approaches for anatomical restoration and rigid fixation of posterolateral tibial plateau fractures. This study aimed to evaluate the short-term preliminary outcomes of our novel anatomical plate placed via the trans-supra-fibular approach to treat posterolateral tibial plateau fractures. METHODS: From May 2016 to May 2018, 23 consecutive patients with posterolateral tibial quadrant fractures underwent open reduction with internal fixation via the trans-supra-fibular-head approach with our newly developed plate. The tibial plateau-tibial shaft angle (TPTSA), lateral posterior tibial slope angle (LPSTA), step-off, and condylar widening were measured on radiological images pre-operatively, 3 days post-operatively, 3 months post-operatively, and at the final follow-up examination. The radiological Rasmussen score was calculated, and the Hospital for Special Surgery (HSS) knee score was assessed to evaluate the functional outcomes. RESULTS: The LTPSA, TPTSA, step-off, and condylar widening at 3 days post-operatively, 3 months post-operatively, and at the final follow-up were significantly different (p = 0.001) compared with those pre-operatively, as was the radiological Rasmussen score (p = 0.001). The HSS score at the final follow-up was 89.10 ± 5.94 (range, 78-98), which was significantly higher than that at the 3-month follow-up 84.36 ± 6.76 (range, 74-96); p = 0.001). CONCLUSIONS: Our newly designed anatomical plate placed via the trans-supra-fibular approach can effectively treat posterolateral tibial plateau fractures. We noted minor trauma, stable fixation, and satisfactory clinical results.
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Consolidação da Fratura , Fraturas da Tíbia , Placas Ósseas , Fíbula , Fixação Interna de Fraturas , Humanos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Manual or machine-based analysis of chest radiographs needs the images acquired with technical adequacy. Currently, the equidistance between the medial end of clavicles and the center of spinous processes serves as the only criterion to assess whether a frontal PA chest radiograph is taken with any rotation. However, this measurement is normally difficult to implement because there exists overlapping of anatomies within the region. Moreover, there is no way available to predict exact rotating angles even the distances were correctly measured from PA chest radiographs. OBJECTIVE: To quantitatively assess positioning adequacy of PA chest examination, this study proposes and investigates a new method to estimate rotation angles from asymmetric projection of thoracic cage on radiographs. METHOD: By looking into the process of radiographic projection, generalized expressions have been established to correlate rotating angles of thorax with projection difference of left and right sides of thoracic cage. A trunk phantom with different positioning angles is employed to acquire radiographs as standard reference to verify the theoretical expressions. RESULTS: The angles estimated from asymmetric projections of thoracic cage yield good agreement with those actual rotated angles, and an approximate linear relationship exists between rotation angle and asymmetric projection of thoracic cage. Under the experimental projection settings, every degree of rotation corresponds to the width difference of two sides of thoracic cage around 13-14 pixels. CONCLUSION: The proposed new method may be used to quantify rotating angles of chest and assess image quality for thoracic radiographic examination.
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Radiografia Torácica , Tórax , Imagens de Fantasmas , Radiografia , Radiografia Torácica/métodos , Rotação , Tórax/diagnóstico por imagemRESUMO
PURPOSE: Glaucoma is a chronic and irreversible retinopathy threatening the vision of millions of patients around the world. Its early diagnosis and treatment can help to prolong the period of sight deterioration from no visual impairment to blindness, whereas the screening and diagnosis of glaucoma in clinical remains challenging because some key assessment criteria like cup-to-disc ratio is limited by subjective analysis and intra- and inter-observer variability. This paper exploits the potential of new augmented image data of the optic nerve head (ONH) combining with the latest deep learning networks to achieve better diagnosis of glaucoma. METHODS: This paper explores the potential value of additional three-dimensional topographic map of the optic nerve head proceeded by the latest deep learning approaches, i.e. convolutional neural networks to improve the diagnosis efficiency. Specifically, 3D topography map of the ONH and RGB fundus image has been used to train the transferred AlexNet and VGG-16 networks. The diagnostic performance is compared to those achieved by using the 2D fundus images only. RESULTS: The 3D topographic map of ONH reconstructed from the shape from shading method provides better visualization of the structure of optic cup and disc. These new enhanced dataset was employed to train the proposed deep learning networks and finally achieve diagnostic accuracy of 94.3% which is superior to the networks trained via 2D conventional images. CONCLUSION: Employing the deep learning neural networks with augmented 3D images can increase the accuracy of automatic separating glaucoma and non-glaucoma fundus images. It may be used as an objective tool in developing computer assisted diagnosis systems for assessment of glaucoma.
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Glaucoma , Disco Óptico , Diagnóstico por Computador , Fundo de Olho , Glaucoma/diagnóstico , Humanos , Redes Neurais de Computação , Disco Óptico/diagnóstico por imagemRESUMO
This article systematically explores the imaging and clinical characteristics of a relatively rare cardiac anomaly: the right coronary artery originating from the left coronary sinus. Through a comprehensive analysis of existing literature, this study aims to provide a comprehensive understanding of the prevalence, diagnostic methods, and potential clinical implications of this anatomical variation. Anatomical classification is introduced, along with clinical imaging diagnostic methods, including coronary angiography, computed tomography, and magnetic resonance imaging. Additionally, the review delves into the clinical significance of this anomaly, including its potential associations with myocardial ischemia, arrhythmias, and acute cardiac events, outlining clinical approaches to diagnosing myocardial ischemia. The study results consolidate current knowledge about this cardiac variation, emphasizing the importance of recognizing and appropriately managing it in clinical practice.
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The right atrial appendage is an important anatomical marker of the right heart. With the developments in cardiology, more attention has been paid to the right atrial appendage. This article summarizes the progress in research regarding the right atrial appendage anatomy and its clinical value, to collate and augment the relevant data. The shape of the right atrial appendage differs from the left atrial appendage: its outer surface is relatively flat and its internal structure comprises a terminal crest and musculi pectinati. In clinical interventional therapy, the right atrial appendage is often used as the electrode implantation site. The thickness of the musculi pectinati and the wall thickness of the right atrial appendage are closely related to the outcomes in atrial lead implantation. In terms of atrial fibrillation, wherein thrombi formation is frequent, the right atrial appendage is one of the predilection sites of thrombosis. However, the incidence of thrombosis in the right atrial appendage is lower than that in the left atrial appendage. Familiarity with the anatomy of the right atrial appendage is of prime importance in atrial lead implantation, and the role of the right atrial appendage in atrial fibrillation requires further investigation.
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Conforming to the current replace-reduce-refine 3Rs' guidelines in animal experiments, a series of explorative efforts have been made to set up operable biomedical imaging-guided platforms for qualitative and quantitative evaluations on pharmacological effects of tumor vascular-disrupting agents (VDAs), based on the chick embryos (CEs) with its chorioallantoic membrane (CAM), in this overview. The techniques and platforms have been hierarchically elaborated, from macroscopic to microscopic and from overall to specific aspects. A protocol of LED lamplight associated with a new deep-learning algorithm was consolidated to screen out weak CEs by using the CAM vasculature imaging. 3D magnetic resonance imaging (MRI) and laser speckle contrast imaging (LSCI) to monitor the evolution of CE and vascular changes in CAM are introduced. A LSCI-CAM platform for studying the effects of VDAs on normal and cancerous vasculature of CAM and possible molecular mechanisms has been demonstrated. Finally, practical challenges and future perspectives are highlighted. The aim of this article is to help peers in biomedical research to familiarize with the CAM platform and to optimize imaging protocols for the evaluation of vasoactive pharmaceuticals, especially anticancer vascular targeted therapy.
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Membrana Corioalantoide , Imageamento por Ressonância Magnética , Animais , Embrião de Galinha , Membrana Corioalantoide/irrigação sanguínea , Preparações FarmacêuticasRESUMO
Angiogenesis is one of the hallmarks of cancer and plays a crucial role in carcinogenesis and progression of epithelial ovarian cancer. Antiangiogenic agent is the first approved targeted agent in ovarian cancer. Anti-angiogenic agents mainly include agents target VEGF/VEGFR pathway, such as bevacizumab and agents target receptor tyrosine kinase, and non-VEGF/VEGFR targets of angiogenesis. Antiangiogenic agents demonstrate certain effects in ovarian cancer treatment either as monotherapy or combined with chemotherapy. Unfortunately, antiangiogenic agents, such as bevacizumab, integrated into the ovarian cancer treatment paradigm do not increase cures. Thus, the benefits of anti-angiogenic agents must be carefully weighed against the cost and associated toxicities. Antiangiogenic agents drug resistance and short of predictive biomarkers are main obstacles in ovarian cancer treatment. A combination of poly (ADP-ribose) polymerase inhibitors or immune checkpoint inhibitors might be great strategies to overcome resistance as well as enhance anti-tumor activity of anti-angiogenic drugs. Predictive biomarkers of antiangiogenic agents are in urgent need.
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The bHLH transcription factors play important roles in the regulation of plant growth, development, and secondary metabolism. ß-Caryophyllene, epi-cedrol, and ß-farnesene, three kinds of sesquiterpenes mainly found in plants, are widely used as spice in the food industry and biological pesticides in agricultural production. Furthermore, they also have a significant value in the pharmaceutical industry. However, there is currently a lack of knowledge on the function of bHLH family TFs in ß-caryophyllene, epi-cedrol, and ß-farnesene biosynthesis. Here, we found that AabHLH112 transcription factor had a novel function to positively regulate ß-carophyllene, epi-cedrol, and ß-farnesene biosynthesis in Artemisia annua. Exogenous MeJA enhanced the expression of AabHLH112 and genes of ß-caryophyllene synthase (CPS), epi-cedrol synthase (ECS), and ß-farnesene synthase (BFS), as well as sesquiterpenes content. Dual-LUC assay showed the activation of AaCPS, AaECS, and AaBFS promoters were enhanced by AabHLH112. Yeast one-hybrid assay showed AabHLH112 could bind to the G-box (CANNTG) cis-element in promoters of both AaCPS and AaECS. In addition, overexpression of AabHLH112 in A. annua significantly elevated the expression levels of AaCPS, AaECS, and AaBFS as well as the contents of ß-caryophyllene, epi-cedrol, and ß-farnesene, while suppressing AabHLH112 expression by RNAi reduced the expression of the three genes and the contents of the three sesquiterpenes. These results suggested that AabHLH112 is a positive regulator of ß-caryophyllene, epi-cedrol, and ß-farnesene biosynthesis in A. annua.
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Discovery of remarkable porous materials for CO2 capture from wet flue gas is of great significance to reduce the CO2 emissions, but elucidating the most critical structure features for boosting CO2 capture capabilities remains a great challenge. Here, machine-learning-assisted Monte Carlo computational screening on 516 experimental covalent organic frameworks (COFs) identifies the superior secondary building units (SBUs) for wet flue gas separation using COFs, which are tetraphenylporphyrin units for boosting CO2 adsorption uptake and functional groups for boosting CO2/N2 selectivity. Accordingly, 1233 COFs are assembled using the identified superior SBUs. Density functional theory calculation analysis on frontier orbitals, electrostatic potential, and binding energy reveals the influencing mechanism of the SBUs on the wet flue gas separation performance. The "electron-donating-induced vdW interaction" effect is discovered to construct the better-performing COFs, which can achieve high CO2 uptake of 4.4 mmol·g-1 with CO2/N2 selectivity of 104.8. Meanwhile, the "electron-withdrawing-induced vdW + electrostatic coupling interaction" effect is unearthed to construct the better-performing COFs with superior CO2/N2 selectivity, which can reach 277.6 with CO2 uptake of 2.2 mmol·g-1; in this case, H2O plays a positive contribution in improving CO2/N2 selectivity. This work provides useful guidelines for designing optimized two-dimensional-COF adsorbents for wet flue gas separation.
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Bone marrow adipocytes may be responsible for cancer progression. Although marrow adipogenesis is suspected to be involved in prostate carcinogenesis, an association between marrow adiposity and prostate cancer risk has not been clearly established in vivo. This work included 115 newly diagnosed cases of histologically confirmed prostate cancer (range, 48-79 years) and 87 age-matched healthy controls. Marrow proton density fat fraction (PDFF) was measured by 3.0-T MR spectroscopy at the spine lumbar. Associations between marrow PDFF and risk of prostate cancer by stage of disease and grade sub-types were performed using multivariable polytomous logistic regression. There were no significant group differences in the vertebral marrow PDFF, despite prostate cancer patients having 6.6% higher marrow PDFF compared to the healthy controls (61.7 ± 9.8% vs. 57.9 ± 6.5%; t = 1.429, p = 0.161). After adjusting for various clinical and demographic characteristics, we found that elevated marrow PDFF was related to an increased risk of high-grade prostate cancer [odds ratios (OR) = 1.31; 95% confidence interval (CI), 1.08-1.57; p = 0.003]. Likewise, increased marrow PDFF had a significantly positive correlation with aggressive prostate cancer risk (OR = 1.54; 95% CI, 1.13-1.92; p <0.001). There were no associations between marrow PDFF and low-grade (p = 0.314) or non-aggressive (p = 0.435) prostate cancer risk. The data support the hypothesis that marrow adiposity was correlated with increased risk of aggressive prostate cancer, supporting a link between adipogenesis and prostate cancer risk.
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Medula Óssea , Neoplasias da Próstata , Medula Óssea/patologia , Humanos , Vértebras Lombares , Imageamento por Ressonância Magnética/métodos , Masculino , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/patologia , PrótonsRESUMO
Artemisia annua is the main natural source of artemisinin production. In A. annua, extended drought stress severely reduces its biomass and artemisinin production while short-term water-withholding or abscisic acid (ABA) treatment can increase artemisinin biosynthesis. ABA-responsive transcription factor AabZIP1 and JA signaling AaMYC2 have been shown in separate studies to promote artemisinin production by targeting several artemisinin biosynthesis genes. Here, we found AabZIP1 promote the expression of multiple artemisinin biosynthesis genes including AaDBR2 and AaALDH1, which AabZIP1 does not directly activate. Subsequently, it was found that AabZIP1 up-regulates AaMYC2 expression through direct binding to its promoter, and that AaMYC2 binds to the promoter of AaALDH1 to activate its transcription. In addition, AabZIP1 directly transactivates wax biosynthesis genes AaCER1 and AaCYP86A1. The biosynthesis of artemisinin and cuticular wax and the tolerance of drought stress were significantly increased by AabZIP1 overexpression, whereas they were significantly decreased in RNAi-AabZIP1 plants. Collectively, we have uncovered the AabZIP1-AaMYC2 transcriptional module as a point of cross-talk between ABA and JA signaling in artemisinin biosynthesis, which may have general implications. We have also identified AabZIP1 as a promising candidate gene for the development of A. annua plants with high artemisinin content and drought tolerance in metabolic engineering breeding.
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The glymphatic system has recently been shown to clear brain extracellular solutes and can be extensively impaired after traumatic brain injury (TBI). Despite hypothermia being identified as a protective method for the injured brain via minimizing the formation of edema in the animal study, little is known about how hypothermia affects the glymphatic system following TBI. We use dynamic contrast-enhanced MRI (DCE-MRI) following cisterna magna infusion with a low molecular weight contrast agent to track glymphatic transport in male Sprague-Dawley rats following TBI with hypothermia treatment and use diffusion-weighted imaging (DWI) sequence to identify edema after TBI, and further distinguish between vasogenic and cytotoxic edema. We found that hypothermia could attenuate brain edema, as demonstrated by smaller injured lesions and less vasogenic edema in most brain subregions. However, in contrast to reducing cerebral edema, hypothermia exacerbated the reduction of efficiency of glymphatic transportation after TBI. This deterioration of glymphatic drainage was present brain-wide and showed hemispherical asymmetry and regional heterogeneity across the brain, associated with vasogenic edema. Moreover, our data show that glymphatic transport reduction and vasogenic edema are closely related to reducing perivascular aquaporin-4 (AQP4) expression. The suppression of glymphatic transportation might eliminate the benefits of brain edema reduction induced by hypothermia and provide an alternative pathophysiological factor indicating injury to the brain after TBI. Thus, this study poses a novel emphasis on the potential role of hypothermia in managing severe TBI.
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BACKGROUND: Serious infections caused by bacteria and their resistance to antibiotics are one of the biggest healthcare threats to mankind. Therefore, the present study aimed to isolate endophytes from medicinal plant Ampelopsis grossedentata, an endemic species of Western Hubei, China and to investigate its antibacterial efficacy and chemical diversity of the secondary metabolites. METHODS: The antibacterial potential of the endophytes was evaluated by disc diffusion method against a panel of eleven type strains and some multidrug resistant pathogenic bacteria. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were estimated by broth microdilution using iodonitrotetrazolium chloride assay. Further, the chemical diversity of the metabolites was estimated using LC-Q-TOF-MS/MS and GC-MS fingerprinting. RESULTS: Four endophytic fungi were isolated from the tender shoot of A. grossedentata; they were identified as Fusarium graminearum TC-1, Phomopsis mali TC-3, Pestalotiopsis maculans TC-5 and Alternaria alternata TC-11. Among the endophytes screened, A. alternata TC-11 exhibited significant antibacterial activity with the zones of inhibition ranging from 13.72 ± 0.30 to 21.76 ± 0.53 mm against all the tested type strains and multidrug resistant bacterial pathogens. Further, it showed significant antibacterial activity with MIC values ranging from 0.37 to 3.00 µg/mL. The combined LC-Q-TOF-MS/MS and GC-MS analyses of active extract revealed that alternarian acid, altertenuol, dimethyl sulfone, docosane, dodecane, duclauxin, ergosta-4,6,8(14),22-tetraen-3-one, ethyl 6-cyano-5-oxo-1-phenyl-7-thiophen-2-yl-[1,2,4]triazolo[4,3-a]pyrimidine-3-carboxylate, heptacosane, linoleic acid, neodecanoic acid, oxiranylmethyl ester, pentadecane, verrulactone E, 2,6,11-Trimethyldodecane and 4-[(E,4R,6R)-11-(furan-3-yl)-6-hydroxy-4,8-dimethylundec-8-enyl]-2-hydroxy-2H-furan-5-one were the most abundant compounds present which were responsible for the significant antibacterial activity. CONCLUSIONS: To our knowledge, this is the first report of fungal endophytes isolated from the tender shoot of A. grossedentata with bacteriostatic and bactericidal activities. Our finding provides a new insight into the antibacterial potential of endophytes and envisages the possibility of using them for drug discovery.
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Ampelopsis , Endófitos , Antibacterianos/farmacologia , Humanos , Metaboloma , Testes de Sensibilidade Microbiana , Espectrometria de Massas em TandemRESUMO
To investigate the correlation of epicardial adipose tissue (EAT) characteristics and high-risk plaque features characterized by coronary CT angiography (CCTA) for identifying the presence of thin-cap fibroatheroma (TCFA). Patients who underwent both CCTA and intravascular ultrasound (IVUS) within 4 weeks were retrospectively included. CT-derived quantitative and qualitative parameters, including diameter stenosis, low attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling and spotty calcification, were recorded. EAT volume and density were also measured. TCFA lesions and non-TCFA lesions were determined by IVUS. Multivariate regression analysis was used to determine the independent predictors of TCFA lesions. Sixty-eight patients (mean age: 68.6 ± 9.7 years; 40 males) with 91 lesions were finally included in our study. For CT-derived plaque features, LAP (77.8% versus 25%, p < 0.001) and NRS (40.7% versus 9.4%, p < 0.001) was more frequently presented in TCFA lesions than was in non-TCFA lesions. For EAT characteristics, EAT volume (110 ± 14 cm3 versus 98 ± 12 cm3, p < 0.001) was significantly larger whereas EAT density (-77 ± 4 HU versus -80 ± 5, p = 0.003) was markedly higher in TCFA lesions. According to multivariate logistic regression analysis, LAP, EAT volume and EAT density were significant predictors (odds ratio: 9.758, 1.095 and 1.202, all p value < 0.05) for the presence of TCFA lesions. EAT volume and density was greater in patients with TCFA lesions whereas LAP and NRS was more frequently presented. In addition, EAT characteristics and LAP were independent predictors of vulnerable plaques as determined by IVUS.
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Tecido Adiposo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Placa Aterosclerótica , Ultrassonografia de Intervenção , Idoso , Progressão da Doença , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruptura EspontâneaRESUMO
BACKGROUND: To investigate the diagnostic performance of quantified plaque analysis and high-risk plaque characterization by coronary computed tomography angiography (CCTA) for identifying thin-cap fibroatheroma (TCFA). METHODS: Patients who underwent both CCTA and intravascular ultrasound (IVUS) within 4 weeks were retrospectively included. CT-derived quantitative and qualitative parameters, including diameter stenosis, minimal lumen area (MLA), low attenuation plaque (LAP) volume napkin-ring sign (NRS), positive remodeling (PR) and spotty calcification, were recorded. TCFA lesions and non-TCFA lesions were determined by IVUS. Multivariate regression analysis was used to determine the independent predictors of TCFA lesions. RESULTS: Sixty-five patients (mean age: 69.8±9.2 years, 29 females) with 89 lesions were finally included. LAP and NRS were more frequently presented in the group of TCFA lesions. The mean LAP volume of TCFA lesions was significantly larger than that of non-TCFA lesions [16.5 (11.0-23.0) vs. 0 (0-1.5) mm3, P<0.001]. According to multivariate logistic regression analysis, LAP volume was the only significant predictor for IVUS-confirmed vulnerable plaques (odds ratio =3.294, 95% confidence interval: 1.177-9.223, P=0.023). LAP volume showed largest area under curve (AUC) for diagnosing TCFA lesions (AUC =0.901, 95% confidence interval: 0.819-0.954, P<0.0001). When using >8 mm3 as the best cutoff value, the diagnostic accuracy, sensitivity and specificity of LAP volume for predicting TCFA lesions were 91.0% (81/89), 84.6% (22/26) and 96.8% (61/63) respectively. CONCLUSIONS: CT-derived LAP volume of TCFA lesions was significantly higher than those of non-TCFA lesions. LAP volume was the strongest predictor for TCFA lesions as validated by IVUS.