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1.
No Shinkei Geka ; 49(2): 432-437, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762469

RESUMO

The risk of future ischemic events, such as angiographically determined stenosis and ulceration, in patients with atherosclerosis has long been mainly assessed using luminal morphology. However, recent remarkable advances in vessel wall imaging combined with a deeper understanding of vascular biology have shown that vessel wall characteristics also have a considerable influence on the onset of ischemic events. Among the modalities for vessel wall imaging, such as ultrasound, CT, and MRI, MRI is useful for plaque characterization because of its high accuracy and less invasiveness. Several features of vulnerable plaques, such as intraplaque hemorrhage, large lipid-rich necrotic cores, and ruptured fibrous caps, can be observed using contemporary high-resolution MRI. The assessment of plaque characteristics is essential for the management of atherosclerosis. In this article, the current status of carotid plaque characterization using black-blood MRI will be briefly highlighted, and potential clinical implications of MRI plaque imaging will be demonstrated.


Assuntos
Estenose das Carótidas , Placa Aterosclerótica , Afro-Americanos , Artérias Carótidas , Estenose das Carótidas/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Placa Aterosclerótica/diagnóstico por imagem
2.
Zhonghua Yi Xue Za Zhi ; 101(7): 458-463, 2021 Feb 23.
Artigo em Chinês | MEDLINE | ID: mdl-33631888

RESUMO

Objective: To investigate the diagnostic value of radiomics model based on plain CT scan of peripheral coronary artery adipose tissue for non-calcified plaque. Methods: The image data of 461 patients undergoing coronary CT angiography (CCTA) in the Department of Radiology of the First Affiliated Hospital of Suzhou University from August 1,2019 to July 31,2020 were retrospectively analyzed. Two hundred and six cases (355 branches) with non-calcified plaques, and 255 cases (510 branches) with no coronary artery disease were detected by CCTA. The regions of interest (ROI) of the pericoronary adipose tissue were segmented on the plain CT scan images (coronary calcification score (CCS) sequence). The coronary ROI was determined by selecting the coronary artery with a length of 40 mm and starting at 10 mm from the opening of the coronary artery, and the pericoronary adipose ROI was generated automatically. The pericoronary fat attenuation index (FAI) was then performed, and the radiomics features were extracted. The 865 coronary arteries were divided into the training group (n=606) and the testing group (n=259) at a ratio of 7∶3, and the radiomics model was carried out. The receiver operating characteristic (ROC) analysis was used to assess the FAI value and the diagnostic efficacy of the radiomics model for non-calcified plaque. Results: A total of 1 692 features were extracted from images of pericoronary adipose based on plain scan. All features were screened by using max-relevance and min-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO), and 14 features were selected for the establishment of the radiomics model. The accuracy, sensitivity, specificity and area under the curve (AUC) of the model in distinguishing patients with non-calcified plaque and those without coronary stenosis in the testing group were 70.3%, 63.2%, 75.2% and 0.75, respectively. Conclusion: The radiomics model based on plain CT scan of the pericoronary adipose tissue had good diagnostic efficacy for non-calcified plaque.


Assuntos
Placa Aterosclerótica , Tecido Adiposo/diagnóstico por imagem , Angiografia Coronária , Estudos de Viabilidade , Humanos , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(2): 150-157, 2021 Feb 24.
Artigo em Chinês | MEDLINE | ID: mdl-33611901

RESUMO

Objective: To determine the impact of inflammatory reaction levels and the culprit plaque characteristics on preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: The is a retrospective study. A total of 1 268 STEMI patients who underwent pre-intervention optical coherence tomography (OCT) examination of culprit lesion during emergency PCI were divided into 2 groups by preprocedural TIMI flow grade (TIMI 0-1 group (n =964, 76.0%) and TIMI 2-3 group (n =304, 24.0%)). Baseline clinical data of the 2 groups were collected; blood samples were collected for the detection of inflammatory markers such as high sensitivity C-reactive protein (hsCRP), myocardial injury marker, blood lipid, etc.; echocardiography was used to determine left ventricular ejection fraction; coronary angiography and OCT were performed to define the lesion length, diameter stenosis degree of the infarct-related arteries, presence or absence of complex lesions, culprit lesion type, area stenosis degree and vulnerability of culprit plaques. Multivariable logistic regression analysis was performed to identify independent correlation factors. The receiver operating characteristic (ROC) curve of continuous independent correlation factors was analyzed, and the best cut-off value of TIMI 0-1 was respectively determined according to the maximum value of Youden index. Results: The mean age of 1 268 STEMI patients were (57.6±11.4) years old and 923 cases were males (72.8%). Compared with TIMI 2-3 group, the patients in TIMI 0-1 group were older and had higher N-terminal-pro-B-type natriuretic peptide level, lower cardiac troponin I (cTnI) level, lower left ventricular ejection fraction, and higher hsCRP level (5.16(2.06, 11.78) mg/L vs. 3.73(1.51, 10.46) mg/L). Moreover, the hsCRP level of patients in TIMI 0-1 group was higher in the plaque rupture subgroup (all P<0.05). Coronary angiography results showed that compared with TIMI 2-3 group, the proportion of right coronary artery (RCA) as the infarct-related artery was higher, the angiographical lesion length was longer, minimal lumen diameter was smaller, and diameter stenosis was larger in TIMI 0-1 group (all P<0.05). The prevalence of plaque rupture was higher (75.8% vs. 61.2%) in TIMI 0-1 group. Plaque vulnerability was significantly higher in TIMI 0-1 group than that in TIMI 2-3 group with larger mean lipid arc (241.27°±46.78° vs. 228.30°±46.32°), more thin-cap fibroatheroma (TCFA, 72.4% vs. 57.9%), more frequent appearance of macrophage accumulation (84.4% vs. 70.7%) and cholesterol crystals (39.1% vs. 25.7%). Minimal flow area was smaller [1.3(1.1-1.7)mm2 vs. 1.4(1.1-1.9)mm2, all P<0.05] and flow area stenosis was higher (78.2%±10.6% vs. 76.3%±12.3%) in TIMI 0-1 group. Multivariable analysis showed that mean lipid arc>255.55°, cholesterol crystals, angiographical lesion length>16.14 mm, and hsCRP>3.29 mg/L were the independent correlation factors of reduced preprocedural TIMI flow grade in STEMI patients. Conclusions: Plaque vulnerability and inflammation are closely related to reduced preprocedural TIMI flow grade in STEMI patients.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Placa Aterosclerótica , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Angiografia Coronária , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico , Terapia Trombolítica , Função Ventricular Esquerda
4.
Quintessence Int ; 0(0): 348-359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491393

RESUMO

Objective: Calcified carotid artery atheroma (CCAA) detected by panoramic radiographs has been suggested as an accurate biomarker for cerebrovascular accidents (CVAs). However, there has not been agreement on the relationship between CCAA and risk for stroke or other CVA. Method and materials: The question asked was, "Are patients with CCAA detected on panoramic radiographs more likely to get a stroke or CVA in the future compared to those who do not have CCAA and, further, would Doppler ultrasonography of the neck obtained secondary to panoramic radiography in suspected individuals add value to this association with stroke or CVA?" This meta-analysis was conducted by searching PubMed, Ovid Medline, Dentistry & Oral Sciences Source, CINAHL, Web of Science, Google Scholar, and ClinicalTrials.gov. Six studies that met the inclusion criteria were included in the final analysis; three used panoramic radiography and the rest used panoramic radiography and ultrasonography. Multiple random effect meta-analyses were conducted using RevMan 5.2 software. Conclusion: Evidence from this meta-analysis shows that although detection of CCAA via panoramic radiography to predict risk for stroke may be comparable to Doppler ultrasonography, risk prediction is somewhat more significant when diagnostic confirmation is made using Doppler ultrasonography than panoramic radiography alone. Clinical implications: Because stroke risk assessment is complicated and comprises many additional systemic factors beyond calcification of the carotid artery, CVA prediction is more reliable when Doppler ultrasonography is used after panoramic radiography. Managing hypertension, diabetes, and smoking habit are far more important in risk management of patients with CCAA detection on panoramic radiography.


Assuntos
Placa Aterosclerótica , Acidente Vascular Cerebral , Biomarcadores , Artérias Carótidas , Humanos , Placa Aterosclerótica/diagnóstico por imagem , Radiografia Panorâmica , Medição de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler
6.
Maturitas ; 143: 171-177, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308625

RESUMO

OBJECTIVES: Observational studies suggest that the risk of cardiovascular disease increases during menopause; however, the menopause-related risk of subclinical atherosclerosis is unclear. The aim of the current study is to evaluate menopause and the risk of subclinical carotid atherosclerosis through a retrospective analysis of data from a population-based prospective cohort study. STUDY DESIGN: The study sample comprised 879 women in the Beijing community enrolled in the Chinese Multi-provincial Cohort Study at baseline study in 1992 and followed up to at least one carotid ultrasound examination at three on-site follow-up surveys. Age at menopause was categorized as <40 years (premature menopause), 40-44 years (early menopause), 45-49 years (relatively early menopause), 50-51 years (reference), and >51 years (relatively late menopause). Menopause staging at baseline was categorized as: reproductive, menopausal transition/perimenopause, early postmenopause, and late postmenopause. Menopause as a time-varying covariate was calculated using waiting time to menopause and menopause status at the last follow-up (2012). MAIN OUTCOME MEASURES: The main outcome measures included carotid plaque and intima-media thickening. Gray's test was performed to assess the equality of cumulative incidence functions between age groups at menopause and between menopause stages. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) associated with menopause. RESULTS: Of the 879 women included (mean [SD] age at baseline, 48.6 [8.1] years), 573 (65.2%) developed carotid plaques and 430 (48.9%) developed intima-media thickening during follow-up. Menopause was significantly associated with risk of developing carotid plaques (HR 1.93, 95% CI 1.05-3.54; P = 0.03) after adjustment for age at baseline, age at menopause, use of oral estrogen due to menopause, and traditional cardiovascular risk factors at baseline. No significant association was found between age at menopause and risk of carotid atherosclerosis. CONCLUSION: Menopausal women, irrespective of age at menopause, had an increased risk of carotid plaque.


Assuntos
Artérias Carótidas/patologia , Doenças das Artérias Carótidas/epidemiologia , Menopausa , Placa Aterosclerótica/epidemiologia , Adulto , Pequim/epidemiologia , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Feminino , Humanos , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Estudos Retrospectivos , Fatores de Risco
7.
PLoS One ; 15(12): e0241779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315867

RESUMO

Accurate quantification and characterization of atherosclerotic plaques with MRI requires high spatial resolution acquisitions with excellent image quality. The intrinsically better signal-to-noise ratio (SNR) at high-field clinical 7T compared to the widely employed lower field strengths of 1.5 and 3T may yield significant improvements to vascular MRI. However, 7T atherosclerosis imaging also presents specific challenges, related to local transmit coils and B1 field inhomogeneities, which may overshadow these theoretical gains. We present the development and evaluation of 3D, black-blood, ultra-high resolution vascular MRI on clinical high-field 7T in comparison lower-field 3T. These protocols were applied for in vivo imaging of atherosclerotic rabbits, which are often used for development, testing, and validation of translatable cardiovascular MR protocols. Eight atherosclerotic New Zealand White rabbits were imaged on clinical 7T and 3T MRI scanners using 3D, isotropic, high (0.63 mm3) and ultra-high (0.43 mm3) spatial resolution, black-blood MR sequences with extensive spatial coverage. Following imaging, rabbits were sacrificed for validation using fluorescence imaging and histology. Image quality parameters such as SNR and contrast-to-noise ratio (CNR), as well as morphological and functional plaque measurements (plaque area and permeability) were evaluated at both field strengths. Using the same or comparable imaging parameters, SNR and CNR were in general higher at 7T compared to 3T, with a median (interquartiles) SNR gain of +40.3 (35.3-80.1)%, and a median CNR gain of +68.1 (38.5-95.2)%. Morphological and functional parameters, such as vessel wall area and permeability, were reliably acquired at 7T and correlated significantly with corresponding, widely validated 3T vessel wall MRI measurements. In conclusion, we successfully developed 3D, black-blood, ultra-high spatial resolution vessel wall MRI protocols on a 7T clinical scanner. 7T imaging was in general superior to 3T with respect to image quality, and comparable in terms of plaque area and permeability measurements.


Assuntos
Aterosclerose/diagnóstico , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Placa Aterosclerótica/diagnóstico por imagem , Animais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Aorta Abdominal/patologia , Aterosclerose/etiologia , Aterosclerose/patologia , Dieta Hiperlipídica/efeitos adversos , Modelos Animais de Doenças , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética/instrumentação , Masculino , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/patologia , Coelhos , Reprodutibilidade dos Testes , Razão Sinal-Ruído
8.
BMJ Case Rep ; 13(12)2020 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-33376091

RESUMO

Transcatheter aortic valve implantation (TAVI) is a rapidly evolving treatment option with an inherent risk of causing cerebral infarctions. The mechanism of cerebral infarction during TAVI mainly involves embolisms from the aortic wall and valve. Transoesophageal echocardiography (TEE) is useful for detecting aortic atheromas. We present the case of a patient in whom the dispersal of aortic atheromas was monitored by TEE during TAVI. This report demonstrates the importance of preoperatively predicting embolisms from aortic atheromas in patients with severe aortic stenosis.


Assuntos
Aorta/diagnóstico por imagem , Estenose da Valva Aórtica , Aterosclerose , Infarto Cerebral , Ecocardiografia Transesofagiana/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Aterosclerose/complicações , Aterosclerose/diagnóstico , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Monitorização Intraoperatória/métodos , Cuidados Pré-Operatórios/métodos , Risco Ajustado , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
9.
PLoS One ; 15(12): e0244015, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332434

RESUMO

High-risk coronary plaques have been considered predictive of adverse cardiac events. Both wall shear stress (WSS) in patients with hemodynamically significant lesions and optical coherence tomography (OCT) -verified thin-cap fibroatheroma (TCFA) are associated with plaque rupture, the most common underlying mechanism of acute coronary syndrome. The aim of the study was to test the hypothesis that invasive coronary angiography-based high WSS is associated with the presence of TCFA detected by OCT in obstructive lesions. From a prospective study of patients who underwent OCT examination for angiographically obstructive lesions (Yellow II), we selected patients who had two angiographic projections to create a 3-dimensional reconstruction model to allow assessment of WSS. The patients were divided into 2 groups according to the presence and absence of TCFA. Mean WSS was assessed in the whole lesion and in the proximal, middle and distal segments. Of 70 patients, TCFA was observed in 13 (19%) patients. WSS in the proximal segment (WSSproximal) (10.20 [5.01, 16.93Pa]) and the whole lesion (WSSlesion) (12.37 [6.36, 14.55Pa]) were significantly higher in lesions with TCFA compared to WSSproximal (5.84 [3.74, 8.29Pa], p = 0.02) and WSSlesion (6.95 [4.41, 11.60], p = 0.04) in lesions without TCFA. After multivariate analysis, WSSproximal was independently associated with the presence of TCFA (Odds ratio 1.105; 95%CI 1.007-1.213, p = 0.04). The optimal cutoff value of WSSproximal to predict TCFA was 6.79 Pa (AUC: 0.71; sensitivity: 0.77; specificity: 0.63 p = 0.02). Our results demonstrate that high WSS in the proximal segments of obstructive lesions is an independent predictor of OCT-verified TCFA.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Hemodinâmica , Placa Aterosclerótica/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Idoso , Angiografia Coronária/métodos , Doença da Artéria Coronariana/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/patologia , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia
10.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(6): 948-955, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369333

RESUMO

Atherosclerosis is a complex and multi-factorial pathophysiological process. Researches over the past decades have shown that the development of atherosclerotic vulnerable plaque is closely related to its components, morphology, and stress status. Biomechanical models have been developed by combining with medical imaging, biological experiments, and mechanical analysis, to study and analyze the biomechanical factors related to plaque vulnerability. Numerical simulation could quantify the dynamic changes of the microenvironment within the plaque, providing a method to represent the distribution of cellular and acellular components within the plaque microenvironment and to explore the interaction of lipid deposition, inflammation, angiogenesis, and other processes. Studying the pathological mechanism of plaque development would improve our understanding of cardiovascular disease and assist non-invasive inspection and early diagnosis of vulnerable plaques. The biomechanical models and numerical methods may serve as a theoretical support for designing and optimizing treatment strategies for vulnerable atherosclerosis.


Assuntos
Aterosclerose , Placa Aterosclerótica , Fenômenos Biomecânicos , Simulação por Computador , Humanos , Inflamação , Modelos Cardiovasculares , Placa Aterosclerótica/diagnóstico por imagem
11.
Rev. cuba. med ; 59(4): e1366, oct.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144500

RESUMO

Introducción: La enfermedad arterial de miembros inferiores es un marcador de riesgo coronario, causa de invalidez y muerte en quienes la padecen, su identificación temprana puede atenuar estos efectos. Objetivo: Identificar la enfermedad arterial de miembros inferiores no diagnosticada a través de Eco-Doppler en pacientes con factores de riesgo aterogénicos. Método: Se realizó un estudio descriptivo de tipo transversal que incluyó a 100 pacientes de 40 años o más, fumadores, diabéticos y/o hipertensos, sin diagnóstico de enfermedad arterial de miembros inferiores, a quienes se le realizó Eco-Doppler de miembro inferior. Resultados: Se identificaron lesiones compatibles con EAMI en 69 por ciento de los estudiados, cuya edad media fue de 64,81 ± 10,12 años, y discreto predominio del sexo masculino. Las arterias más afectadas fueron la tibial posterior y la pedia con 43 por ciento y 39 por ciento respectivamente, las medidas de asociación mostraron OR (IC 95 por ciento) de 4,15 para la diabetes mellitus, 1,63 para el tabaquismo seguido de la hipertensión arterial con 0,27. Conclusiones: Seis de cada diez pacientes presentaron lesiones ateroscleróticas identificables por Eco-Doppler, predominaron las del sector tibial posterior y pedio en fumadores y diabéticos, estos últimos tuvieron cuatro veces más riesgo de padecer la enfermedad(AU)


Introduction: Arterial disease of the lower limbs is a marker of coronary risk, causing disability and death in those who suffer from it. Early detection can mitigate these effects. Objective: To identify undiagnosed lower limb arterial disease through Echo-Doppler in patients with atherogenic risk factors. Method: A descriptive, cross-sectional study was carried out in 100 patients aged 40 years or older, smoking habits history, and diabetic and / or hypertensive patients, with no diagnosis of arterial disease in the lower limbs, who underwent Eco-Doppler of the lower limb. Results: EAMI compatible lesions were identified in 69 percent of those studied, whose mean age was 64.81 ± 10.12 years, and a discrete male predominance. The most affected arteries were the posterior tibial and pediatric arteries in 43 percent and 39 percent respectively, the association measures showed OR (95 percent CI) of 4.15 for diabetes mellitus, 1.63 for smoking followed by arterial hypertension with 0.27. Conclusions: Six out of ten patients showed atherosclerotic lesions identifiable by Echo-Doppler, those of the posterior tibial sector and pedium predominated in smokers and diabetics, the latter had four times the risk of suffering from the disease(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ecocardiografia Doppler/métodos , Fatores de Risco , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Estudos Transversais , Estudo Observacional
12.
Medicine (Baltimore) ; 99(41): e21562, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031255

RESUMO

The importance of monocyte/lymphocyte ratio (MLR) has been indicated in the initiation and progression of coronary artery disease. However, few previous researches demonstrated the relationship between MLR and plaque vulnerability. We aimed to investigate coronary non-culprit plaque vulnerability in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT).A total of 72 ACS patients who underwent coronary angiography and OCT test in Beijing Anzhen Hospital were included in this retrospective study. The plaque vulnerability and plaque morphology were assessed by OCT.The non-culprit plaque in high MLR group exhibited more vulnerable features, characterizing as thinner thickness of fibrous cap (P = .013), greater maximum lipid core angle (P = .010) and longer lipid plaque length (P = .041). A prominently negative liner relation was found between MLR and thickness of fibrous cap (R = -0.225, P = .005). Meanwhile, the proportion of OCT-detected thin cap fibro-atheroma (TCFA) (P = .014) and plaque rupture (P = .017) were higher in high MLR group. Most importantly, multivariable logistic regression analysis showed MLR level was identified as an independent contributor to the presence of TCFA (OR:3.316, 95%: 1.448-7.593, P = .005). MLR could differentiate TCFA with a sensitivity of 60.0% and a specificity of 85.1%.Circulating MLR level has potential value in identifying the presence of vulnerable plaque in patients with ACS. MLR, as a non- invasive biomarker of inflammation, may be valuable in revealing plaque vulnerability.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico por imagem , Tomografia de Coerência Óptica , Angiografia Coronária , Feminino , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Monócitos
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2088-2091, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018417

RESUMO

A relationship between ultrasound strain indices in carotid plaque to cognitive domains of executive and language function are studied in 42 symptomatic and 34 asymptomatic patients. The mean and standard deviation of the percentage stenosis were 72.10 ± 15.19 and 77.41 ± 11.20 for symptomatic and asymptomatic patients respectively. Pearson's correlation between axial, lateral and shear strain indices versus executive and language composite scores was performed.. A significant inverse correlation for both executive and language function for symptomatic patients to strain indices was found. On the other hand, for asymptomatic patients only executive function was inversely correlated with the corresponding strain indices. Our hypothesis that microemboli from vulnerable plaque and possible 'silent strokes' may be responsible for decline in executive function for both symptomatic and asymptomatic patients'. Strokes and transient ischemic attacks may be responsible for further cognitive decline in language function for symptomatic patients.


Assuntos
Estenose das Carótidas , Disfunção Cognitiva , Placa Aterosclerótica , Estenose das Carótidas/diagnóstico por imagem , Humanos , Placa Amiloide , Placa Aterosclerótica/diagnóstico por imagem , Ultrassonografia
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2129-2132, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018427

RESUMO

Cardiovascular diseases are the biggest threat to human being's health all over the world, and carotid atherosclerotic plaque is the leading cause of ischemic cardiovascular diseases. To determine the location and shape of the plaque, it is of great significance to detect the intima-media (IM). In this paper, a new IM detection method based on convolution neural network (IMD-CNN) is proposed for the detection of IM of blood vessels in longitudinal ultrasonic images. In IMD-CNN, firstly the region of interest (ROI) is automatically extracted by morphological processing, then the patch-wise training data are constructed, and finally a simple CNN is trained to detect the IM. The experimental results obtained on 23 images show that the test accuracy of IMD-CNN is over 86% and the performance of IMD-CNN is also visually proved to be effective.


Assuntos
Meios de Comunicação , Placa Aterosclerótica , Espessura Intima-Media Carotídea , Humanos , Redes Neurais de Computação , Placa Aterosclerótica/diagnóstico por imagem , Ultrassonografia
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2808-2811, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018590

RESUMO

In this work we present a novel method for the prediction and generation of atherosclerotic plaques. This is performed in a two-step approach, by employing first a multilevel computational plaque growth model and second a correlation between the model's results and the 3D reconstructed follow-up plaques. In particular, computer tomography coronary angiography (CTCA) data and blood tests were collected from patients at two time points. Using the baseline data, the plaque growth is simulated using a multi-level computational model which includes: i) modeling of the blood flow dynamics, ii) modeling of low and high density lipoproteins and monocytes' infiltration in the arterial wall, and the species reactions during the atherosclerotic process, and iii) modeling of the arterial wall thickening. The correlation between the followup plaques and the simulated plaque density distribution resulted to the extraction of a threshold of the plaque density, that can be used to identify plaque areas.Clinical Relevance- The methodology presented in this work is a first step to the prediction of the plaque shape and location of patients with atherosclerosis and could be used as an additional tool for patient-specific risk stratification.


Assuntos
Doença da Artéria Coronariana , Placa Aterosclerótica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Coração , Humanos , Placa Aterosclerótica/diagnóstico por imagem
16.
PLoS One ; 15(9): e0239447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991605

RESUMO

The paper deals with the impact of chosen geometric and material factors on maximal stresses in carotid atherosclerotic plaque calculated using patient-specific finite element models. These stresses are believed to be decisive for the plaque vulnerability but all applied models suffer from inaccuracy of input data, especially when obtained in vivo only. One hundred computational models based on ex vivo MRI are used to investigate the impact of wall thickness, MRI slice thickness, lipid core and fibrous tissue stiffness, and media anisotropy on the calculated peak plaque and peak cap stresses. The investigated factors are taken as continuous in the range based on published experimental results, only the impact of anisotropy is evaluated by comparison with a corresponding isotropic model. Design of Experiment concept is applied to assess the statistical significance of these investigated factors representing uncertainties in the input data of the model. The results show that consideration of realistic properties of arterial wall in the model is decisive for the stress evaluation; assignment of properties of fibrous tissue even to media and adventitia layers as done in some studies may induce up to eightfold overestimation of peak stress. The impact of MRI slice thickness may play a key role when local thin fibrous cap is present. Anisotropy of media layer is insignificant, and the stiffness of fibrous tissue and lipid core may become significant in some combinations.


Assuntos
Artérias Carótidas/patologia , Fenômenos Mecânicos , Modelagem Computacional Específica para o Paciente , Placa Aterosclerótica/patologia , Fenômenos Biomecânicos , Artérias Carótidas/diagnóstico por imagem , Análise de Elementos Finitos , Humanos , Imagem por Ressonância Magnética , Modelos Cardiovasculares , Placa Aterosclerótica/diagnóstico por imagem
17.
Int J Nanomedicine ; 15: 6137-6152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884268

RESUMO

Background: Beyond clinical atherosclerosis imaging of vessel stenosis and plaque morphology, early detection of inflamed atherosclerotic lesions by molecular imaging could improve risk assessment and clinical management in high-risk patients. To identify inflamed atherosclerotic lesions by molecular imaging in vivo, we studied the specificity of our radiotracer based on maleylated (Mal) human serum albumin (HSA), which targets key features of unstable atherosclerotic lesions. Materials and Methods: Mal-HSA was radiolabeled with a positron-emitting metal ion, zirconium-89 (89Zr4+). The targeting potential of this probe was compared with unspecific 89Zr-HSA and 18F-FDG in an experimental model of atherosclerosis (Apoe-/- mice, n=22), and compared with wild-type (WT) mice (C57BL/6J, n=21) as controls. Results: PET/MRI, gamma counter measurements, and autoradiography showed the accumulation of 89Zr-Mal-HSA in the atherosclerotic lesions of Apoe-/- mice. The maximum standardized uptake values (SUVmax) for 89Zr-Mal-HSA at 16 and 20 weeks were 26% and 20% higher (P<0.05) in Apoe-/- mice than in control WT mice, whereas no difference in SUVmax was observed for 18F-FDG in the same animals. 89Zr-Mal-HSA uptake in the aorta, as evaluated by a gamma counter 48 h postinjection, was 32% higher (P<0.01) for Apoe-/- mice than in WT mice, and the aorta-to-blood ratio was 8-fold higher (P<0.001) for 89Zr-Mal-HSA compared with unspecific 89Zr-HSA. HSA-based probes were mainly distributed to the liver, spleen, kidneys, bone, and lymph nodes. The phosphor imaging autoradiography (PI-ARG) results corroborated the PET and gamma counter measurements, showing higher accumulation of 89Zr-Mal-HSA in the aortas of Apoe-/- mice than in WT mice (9.4±1.4 vs 0.8±0.3%; P<0.001). Conclusion: 89Zr radiolabeling of Mal-HSA probes resulted in detectable activity in atherosclerotic lesions in aortas of Apoe-/- mice, as demonstrated by quantitative in vivo PET/MRI. 89Zr-Mal-HSA appears to be a promising diagnostic tool for the early identification of macrophage-rich areas of inflammation in atherosclerosis.


Assuntos
Aterosclerose/diagnóstico por imagem , Maleatos/química , Imagem Molecular/métodos , Radioisótopos , Albumina Sérica Humana/química , Zircônio , Animais , Aorta/diagnóstico por imagem , Aorta/patologia , Aterosclerose/patologia , Autorradiografia , Modelos Animais de Doenças , Feminino , Fluordesoxiglucose F18 , Humanos , Marcação por Isótopo , Macrófagos/patologia , Imagem por Ressonância Magnética , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , Sondas Moleculares/química , Sondas Moleculares/farmacocinética , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Tomografia por Emissão de Pósitrons , Radioisótopos/química , Radioisótopos/farmacocinética , Compostos Radiofarmacêuticos/química , Distribuição Tecidual , Zircônio/química , Zircônio/farmacocinética
18.
Int Heart J ; 61(5): 1041-1043, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879262

RESUMO

The current treatment of radiation-induced coronary artery disease (RCAD) is comparable to that of generic coronary artery disease (CAD); however, the outcomes of these treatment measures have not been fully examined in RCAD. A 33-year-old woman, without conventional cardiovascular risk factors, presented with left main coronary artery (LMCA) lesions. At the age of 26, she received mediastinal radiation therapy (RT) to treat mixed cellularity Hodgkin lymphoma. One BiodivYsio 3.5 × 18 mm stent was implanted at the LMCA site. At the age of 38, the patient was treated by balloon dilatation because of approximately 50% in-stent stenosis. At the last follow-up in February 2018, when the patient was 51 years old, she no longer complained of chest pain. Coronary angiography showed no de novo or in-stenosis lesions, although optical coherence tomography showed mild neointimal proliferation, calcific plaque, small ruptured intima, and several uncovered struts. The experience of treating this case may shed some light on coronary stenting in coronary lesions caused by RCAD.


Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/terapia , Reestenose Coronária/terapia , Doença de Hodgkin/radioterapia , Lesões por Radiação/terapia , Stents , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Mediastino , Pessoa de Meia-Idade , Neointima/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Tomografia de Coerência Óptica
19.
Am J Cardiol ; 134: 48-54, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892992

RESUMO

Statin therapy reduces low-density lipoprotein cholesterol (LDL-C), inflammation, and atherosclerotic cardiovascular disease. We investigated the association between LDL-C and statin therapy on the prevalence of plaque rupture (PR). Patients with acute coronary syndromes who underwent optical coherence tomography imaging of the culprit lesion were divided into 4 groups based on LDL-C level and statin use (Group 1: LDL-C ≤ 100 without statin; Group 2; LDL-C ≤ 100 with statin; Group 3: LDL-C > 100 with statin; Group 4: LDL-C > 100 without statin), and the prevalence of PR was compared between the groups. Among 896 patients, PR was diagnosed in 444 (49.6%) patients. The prevalence of PR was significantly different among the 4 groups (p = 0.007): it was highest in the high LDL-C without statin group and lowest in the low LDL-C without statin group (53.9% and 39.2%, respectively). Compared with the high LDL-C without statin group, the low LDL-C without statin and low LDL-C with statin groups had a significantly lower prevalence of PR (p = 0.001, p = 0.040, respectively), and the low LDL-C with statin group had a significantly higher prevalence of calcification (p = 0.037). The patients with naturally low LDL-C have the lowest risk of PR. The patients with low LDL-C achieved by statin therapy had a higher prevalence of calcification. When LDL-C level is elevated, early and aggressive treatment with statin may help to prevent PR by stabilizing plaques through calcification.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , LDL-Colesterol/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Placa Aterosclerótica/diagnóstico por imagem , Síndrome Coronariana Aguda/sangue , Idoso , Doença da Artéria Coronariana/sangue , Feminino , Humanos , Hipercolesterolemia/sangue , Modelos Logísticos , Macrófagos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Ruptura Espontânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Tomografia de Coerência Óptica , Calcificação Vascular/diagnóstico por imagem
20.
Stroke ; 51(10): 2983-2989, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921261

RESUMO

BACKGROUND AND PURPOSE: Long-term dietary patterns can influence the intensity of systemic inflammation and, therefore, the development of atherosclerosis. This study aimed to evaluate the association between dietary inflammatory index (DII) and vulnerability characteristics of carotid atherosclerotic plaques in patients with ischemic stroke. METHODS: Patients with ischemic stroke within 7 days of onset were enrolled. DII was calculated from 32 food components with the help of a food frequency questionnaire. Vulnerable plaque was defined as presence of artery positive remodeling (remodeling index >1.1) and low CT attenuation plaques (<35 HU) on carotid arteries by computed tomography angiography. RESULTS: Of the 398 enrolled patients, 144 (36.2%) were detected with vulnerable plaque. Their DII ranged from -4.58 to 4.18. Patients with vulnerable plaques consumed less nutrients with anti-inflammatory properties, less fruits and vegetables (85.6±64.3 versus 94.6±74.4 g/d, P=0.027), and less nuts (5.66±7.14 versus 8.84±15.9 g/d, P=0.024) than patients without vulnerable plaques. Patients with vulnerable plaque had higher DII than patients without vulnerable plaque (-0.26±1.54 versus -0.64±1.53, P=0.018). Logistic regression analysis revealed that DII was associated with vulnerable plaques after adjusted for major confounding factors (odds ratio=1.307; 95% CI, 1.113-1.533). CONCLUSIONS: DII is associated with the vulnerability of carotid plaques in patients with ischemic stroke. Considering a possible causal relationship, the mechanisms underlying the association between diet and atherosclerosis warrant further study.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Dieta , Placa Aterosclerótica/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Inflamação/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
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