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1.
Kardiologiia ; 60(12): 64-75, 2021 Jan 19.
Artigo em Russo | MEDLINE | ID: mdl-33522469

RESUMO

Aim      To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods  This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion      According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Placa Aterosclerótica , Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Placa Aterosclerótica/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção
2.
ESC Heart Fail ; 8(2): 971-973, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33410259

RESUMO

Increased risk of cardiovascular complications during and post-COVID-19 infection is more and more recognized-including myocarditis, arrhythmias, and myocardial infarctions (MIs). The mechanisms leading to these complications are direct virus-induced injuries, as well as potential thrombotic and inflammatory-induced mechanisms. To the latter, inflammatory plaque instability and plaque rupture are discussed entities contributing to MI-induced post-COVID-19 complications. Our case report describes the first time, when a temporary impairment of LVEF in the COVID-19-convalescence phase unmasks a silent MI due to coronary plaque rupture by using invasive (OCT) and non-invasive (CMR) modalities. Myocardial infarction might be an important differential diagnosis to consider in deteriorating patients with COVID-19, especially if dyspnoea persists after acute infection.


Assuntos
/complicações , Convalescença , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/etiologia , Idoso , Humanos , Masculino , Infarto do Miocárdio/terapia , Placa Aterosclerótica/terapia , Volume Sistólico
4.
Angiol Sosud Khir ; 26(3): 179-184, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063766

RESUMO

Acute coronary syndrome has for a long time been giving no way of decreasing mortality related to ischaemic heart disease. The primary cause of acute coronary syndrome in the majority of cases is rupture of an unstable atherosclerotic plaque in the coronary artery followed by thrombosis thereof. The main missions of modern cardiology include: assessment of the risk of acute coronary syndrome, identification of predictors of adverse events, and working-out of measures aimed at prevention and optimal management of patients with ischaemic heart disease. This article deals with clinical and morphological factors associated with destabilization of coronary plaques, their rupture, and the development of an acute coronary event.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Placa Aterosclerótica , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Humanos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico
5.
Sci Rep ; 10(1): 5707, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32235850

RESUMO

Coronary plaque distribution, frequency and cut-off value of percent stenosis for developing vasospasm are uncertain in patients with vasospastic angina (VA). We enrolled 2960 patients who received coronary angiography (CAG) and ergonovine provocation test prospectively in 11 university hospitals in Korea. A total of 1836 patients with VA and 867 without VA were included. Plaque and % stenosis were defined as ≥1% luminal narrowing and mean of each segmental stenosis. Overall frequency of plaque and % diameter stenosis was compared among VA-patients with index coronary spasm positive, those with index arterial spasm negative/other arterial spasm positive (INOP) and non-VA patients. Diameter stenosis associated with the spasm positivity was investigated. Overall plaque frequency and % stenosis were higher in VA patients than non-VA patients. Plaque frequency was 27.6% (243/881) in spasm positive at LAD, 16.4% (157/955) in LAD INOP and 12.6% (109/867) in non-VA with statistic difference (P < 0.001). Same trend for higher rate was observed in LCx and RCA. For % stenosis, 36.6 vs 32.4% (p = 0.010) in LAD, 36.1 vs. 28% (p < 0.001) in LCx and 35.3 vs.30.0% (p = 0.047) in RCA, respectively. Diameter stenosis of LAD with spasm positive vs. LAD INOP vs. non-VA were 38.3%, 34.0%, 32% (P = 0.002) with similar pattern in LCx and RCA. By multivariate logistic regression analysis, coronary stenosis of LAD ≥ 35% or LCx ≥35% or RCA ≥ 40% were independent predictor of developing spasm (OR 2.019, 95% CI 1.315-3.100, P = 0.001). In conclusions, spastic coronary artery had more plaque frequency, higher % stenosis than in non-spastic coronary in VA patients. The spasm related and unrelated coronary in VA patients had more plaque than in matched and unmatched coronary arteries in non-VA patients. Coronary stenosis ≥35% in LAD and LCx was an independent predictor of developing spasm.


Assuntos
Angina Pectoris/complicações , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/complicações , Vasoespasmo Coronário/etiologia , Placa Aterosclerótica/diagnóstico , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Índice de Gravidade de Doença
6.
Circ Cardiovasc Imaging ; 13(3): e009750, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32160786

RESUMO

Background Progression of coronary artery disease using serial coronary computed tomography angiography (CTA) is of clinical interest. Our primary aim was to prospectively assess the impact of clinical characteristics and statin use on quantitatively assessed coronary plaque progression in a low-risk study population during long-term follow-up. Methods Patients who previously underwent coronary CTA for suspected coronary artery disease were prospectively included to undergo follow-up coronary CTA. The primary end point was coronary artery disease progression, defined as the absolute annual increase in total, calcified, and noncalcified plaque volume by quantitative CTA analysis. Results In total, 202 patients underwent serial coronary CTA with a mean interscan period of 6.2±1.4 years. On a per-plaque basis, increasing age (ß=0.070; P=0.058) and hypertension (ß=1.380; P=0.075) were nonsignificantly associated with annual total plaque progression. Male sex (ß=1.676; P=0.009), diabetes mellitus (ß=1.725; P=0.012), and statin use (ß=1.498; P=0.046) showed an independent association with annual progression of calcified plaque. While hypertension (ß=2.259; P=0.015) was an independent determinant of noncalcified plaque progression, statin use (ß=-2.178; P=0.050) was borderline significantly associated with a reduced progression of noncalcified plaque. Conclusions Statin use was associated with an increased progression of calcified coronary plaque and a reduced progression of noncalcified coronary plaque, potentially reflecting calcification of the noncalcified plaque component. Whereas hypertension was the only modifiable risk factor predictive of noncalcified plaque progression, diabetes mellitus mainly led to an increase in calcified plaque. These findings could yield the need for intensified preventive treatment of patients with diabetes mellitus and hypertension to slow and stabilize coronary artery disease progression and improve clinical outcome.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
7.
Circ Cardiovasc Imaging ; 13(3): e009539, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32164454

RESUMO

BACKGROUND: Inflammation and microcalcification are interrelated processes contributing to atherosclerotic plaque vulnerability. Positron-emission tomography can quantify these processes in vivo. This study investigates (1) 18F-fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) uptake in culprit versus nonculprit carotid atheroma, (2) spatial distributions of uptake, and (3) how macrocalcification affects this relationship. METHODS: Individuals with acute ischemic stroke with ipsilateral carotid stenosis of ≥50% underwent FDG-positron-emission tomography and NaF-positron-emission tomography. Tracer uptake was quantified using maximum tissue-to-background ratios (TBRmax) and macrocalcification quantified using Agatston scoring. RESULTS: In 26 individuals, median most diseased segment TBRmax (interquartile range) was higher in culprit than in nonculprit atheroma for both FDG (2.08 [0.52] versus 1.89 [0.40]; P<0.001) and NaF (2.68 [0.63] versus 2.39 [1.02]; P<0.001). However, whole vessel TBRmax was higher in culprit arteries for FDG (1.92 [0.41] versus 1.71 [0.31]; P<0.001) but not NaF (1.85 [0.28] versus 1.79 [0.60]; P=0.10). NaF uptake was concentrated at carotid bifurcations, while FDG was distributed evenly throughout arteries. Correlations between FDG and NaF TBRmax differed between bifurcations with low macrocalcification (rs=0.38; P<0.001) versus high macrocalcification (rs=0.59; P<0.001). CONCLUSIONS: This is the first study to demonstrate increased uptake of both FDG and NaF in culprit carotid plaques, with discrete distributions of pathophysiology influencing vulnerability in vivo. These findings have implications for our understanding of the natural history of the disease and for the clinical assessment and management of carotid atherosclerosis.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Isquemia Encefálica/etiologia , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico , Placa Aterosclerótica/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Idoso , Isquemia Encefálica/diagnóstico , Estenose das Carótidas/complicações , Estenose das Carótidas/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Placa Aterosclerótica/complicações , Placa Aterosclerótica/fisiopatologia , Estudos Prospectivos
8.
Am J Cardiol ; 125(7): 1006-1012, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31955828

RESUMO

Previous studies reported that elevated serum uric acid level was associated with greater coronary lipid plaque. Xanthine oxidoreductase (XOR) is a rate-limiting enzyme in purine metabolism and is believed to play important roles in coronary atherosclerosis. However, the relation between XOR and coronary lipid plaque is unclear. Patients with stable coronary artery disease who underwent elective percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were prospectively included. They were divided into 3 groups according to plasma XOR activities based on a previous report: low, normal, and high. Quantitative coronary angiography and gray-scale IVUS were analyzed. The primary end point was coronary lipid plaques in a nontarget vessel assessed by NIRS-IVUS with lipid core burden index (LCBI) and maximum LCBI in 4 mm (maxLCBI4mm). Out of 68 patients, 26, 31, and 11 patients were classified as low, normal, and high XOR activity groups. Quantitative coronary angiography demonstrated that the high XOR activity group had longer lesion length, smaller minimum lumen diameter, and higher percentage of diameter stenosis in a nontarget vessel among the 3 groups. Gray-scale IVUS analysis also showed smaller lumen area in the high XOR activity group than the others. LCBI (102.1 ± 56.5 vs 65.6 ± 48.5 vs 55.6 ± 37.8, p = 0.04) and maxLCBI4mm (474.4 ± 171.6 vs 347.4 ± 181.6, 294.0 ± 155.9, p = 0.04) in a nontarget vessel were significantly higher in the high XOR group than in the normal and low groups. In conclusion, elevated XOR activity was associated with coronary lipid-rich plaque in a nontarget vessel in patients with stable coronary artery disease.


Assuntos
Doença da Artéria Coronariana/sangue , Vasos Coronários/diagnóstico por imagem , Lipídeos/sangue , Placa Aterosclerótica/sangue , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ultrassonografia de Intervenção/métodos , Xantina Desidrogenase/sangue , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Placa Aterosclerótica/diagnóstico , Estudos Retrospectivos
9.
Stroke ; 51(3): 766-774, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31992176

RESUMO

Background and Purpose- Recent studies show that mechanical thrombectomy of acute basilar artery occlusions (BAO) results in high rates of successful recanalization and good outcomes, but predictors are not completely established yet. Varying occlusion types may benefit differently, and especially, an underlying basilar stenosis (BS) seems to have an impact. Aim of this study was to investigate angiographic and clinical differences in BAO subtypes and to test the potential of perviousness measures for a preinterventional identification of clinically relevant different occlusion types. Methods- All consecutive patients with acute BAO, endovascular treated at a single comprehensive stroke center, were included. Different occlusion patterns, especially underlying BS, were identified and analyzed in respect of angiographic and clinical (National Institutes of Health Stroke Scale/modified Rankin Scale) outcome parameters (N=115). Thrombus perviousness measures (change in thrombus attenuation Δt and corrected void fraction ε) were assessed in admission computed tomography imaging and correlated to different etiological subgroups. Results- Despite comparable rates of successful recanalization (87% for BAO with BS versus 95% without BS), the BS group showed worse clinical outcome with higher National Institutes of Health Stroke Scale/modified Rankin Scale values (P=0.002/0.003). The group of BS turned out to have lower thrombus density values in unenhanced scans (mean, 42.0 Hounsfield units) and higher perviousness measures Δt (mean, 34.6 Hounsfield units) and ε (mean, 0.23) than thrombi without an underlying BS (mean, 53.6 Hounsfield units/13.1 Hounsfield units/0.08, P=0.01/ 0.004/ 0.001). Conclusions- In agreement with previous studies, outcome of mechanical thrombectomy of BAO seems to depend on pathogenesis with less clinical benefit for underlying BS, raising the question of early identification of this subgroup. Perviousness showed a high potential to differentiate acute BAO with and without BS, possibly usable as an admission imaging marker for BS.


Assuntos
Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Infarto Cerebral/diagnóstico , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Determinação de Ponto Final , Feminino , Humanos , Arteriosclerose Intracraniana/cirurgia , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Trombectomia , Resultado do Tratamento , Insuficiência Vertebrobasilar/cirurgia
10.
Neurology ; 94(11): e1122-e1125, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-31949089

RESUMO

OBJECTIVE: To present the clinical, radiologic, and pathologic findings of a patient with carotid intimal sarcoma. METHODS: Detailed medical interview, neurologic examination, and diagnostic evaluation including CT angiography head and neck, MRI brain and neck, digital subtraction angiography, and biopsy of the mass were performed. RESULTS: We report a patient who presented with symptoms of multifocal, bilateral strokes over weeks caused by an enlarging tumor thrombus associated with an intimal sarcoma of the carotid artery. The presence of a carotid space mass encasing the left internal carotid artery was initially not recognized on imaging and was mistakenly attributed to soft atheromatous plaque rather than tumor thrombus. Rapid disease progression resulted in multiple intracranial metastases from tumor embolization. CONCLUSION: Clinical and radiologic findings of intimal sarcoma may be similar to those of thrombotic disease. However, patients with sarcoma may show an associated perivascular soft tissue mass and an unusual distribution of vessel stenosis. Reevaluation of imaging should be considered in patients presenting with initial imaging findings suggestive of rapidly progressive thrombotic disease who have a poor response to antithrombotic therapy and do not follow an expected clinical course.


Assuntos
Doenças das Artérias Carótidas/patologia , Artéria Carótida Interna/patologia , Sarcoma/secundário , Acidente Vascular Cerebral/etiologia , Neoplasias Vasculares/patologia , Neoplasias Encefálicas/secundário , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes/patologia , Placa Aterosclerótica/diagnóstico , Sarcoma/diagnóstico , Túnica Íntima/patologia , Neoplasias Vasculares/diagnóstico
11.
Eur Radiol ; 30(4): 2403-2411, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31900697

RESUMO

OBJECTIVES: The objective of this study was to evaluate whether baseline 18F-fluorodeoxyglucose (FDG) uptake is associated with carotid plaque progression. METHODS: A total of 156 subjects with carotid plaque were enrolled and underwent carotid magnetic resonance imaging (MRI) (at baseline and the 12-month follow-up) and positron emission tomography-computed tomography (PET-CT) (baseline). Carotid plaque progression was evaluated by two indices (the incidence of plaque progression and percentage of plaque increase) with three-dimensional (3D) imaging, while the 18F-FDG uptake was evaluated by the 18F-FDG uptake levels and 18F-FDG uptake velocity. The association between plaque progression and 18F-FDG uptake was investigated by the trend test and multivariate logistic regression analysis. RESULTS: Of the 156 subjects, 80 (51.3%) showed carotid plaque progression during the 12-month follow-up. Firstly, no association was found between 18F-FDG uptake levels and plaque progression. Secondly, significant differences in the incidence of plaque progression were observed among the groups with different uptake velocities, showing a significant decreasing trend ranging from high to intermediate to low (p = 0.002, trend test). After adjusting for covariates, an adequate prediction of the 18F-FDG uptake velocity for the incidence of plaque progression was revealed (OR = 0.682, p < 0.05). In addition, no association was found between the 18F-FDG uptake velocity and the percentage of plaque increase in the subjects with plaque progression (p = 0.757, trend test). CONCLUSIONS: Our findings suggest 18F-FDG uptake velocity is independently associated with the incidence of carotid plaque progression. Additionally, the 18F-FDG uptake velocity, as another important parameter of PET-CT, warrants further study in future clinical research. KEY POINTS: • The18F-FDG uptake levels were not associated with the carotid plaque progression. • The18F-FDG uptake velocity could predict the incidence of carotid plaque progression. • The18F-FDG uptake velocity with related factors warrants more attention in future clinical research.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Doenças das Artérias Carótidas/diagnóstico , Fluordesoxiglucose F18/farmacologia , Imageamento por Ressonância Magnética/métodos , Placa Aterosclerótica/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Idoso , Doenças das Artérias Carótidas/fisiopatologia , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/fisiopatologia , Compostos Radiofarmacêuticos/farmacologia
12.
Stroke ; 51(2): 504-510, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31847749

RESUMO

Background and Purpose- Carotid artery plaque with <50% luminal stenosis may be an underappreciated stroke mechanism. We assessed how many stroke causes might be reclassified after accounting for nonstenosing plaques with high-risk features. Methods- We included patients enrolled in the Cornell Acute Stroke Academic Registry from 2011 to 2015 who had anterior circulation infarction, magnetic resonance imaging of the brain, and magnetic resonance angiography of the neck. High-risk plaque was identified by intraplaque hemorrhage ascertained from routine neck magnetic resonance angiography studies using validated methods. Infarct location was determined from diffusion-weighted imaging. Intraplaque hemorrhage and infarct location were assessed separately in a blinded fashion by a neuroradiologist. We used the McNemar test for matched data to compare the prevalence of intraplaque hemorrhage ipsilateral versus contralateral to brain infarction. We reclassified stroke subtypes by including large-artery atherosclerosis as a cause if there was intraplaque hemorrhage ipsilateral to brain infarction, regardless of the degree of stenosis. Results- Among the 1721 acute ischemic stroke patients registered in the Cornell Acute Stroke Academic Registry from 2011 to 2015, 579 were eligible for this analysis. High-risk plaque was more common ipsilateral versus contralateral to brain infarction in large-artery atherosclerotic (risk ratio [RR], 3.7 [95% CI, 2.2-6.1]), cryptogenic (RR, 2.1 [95% CI, 1.4-3.1]), and cardioembolic strokes (RR, 1.7 [95% CI, 1.1-2.4]). There were nonsignificant ipsilateral-contralateral differences in high-risk plaque among lacunar strokes (RR, 1.2 [95% CI, 0.4-3.5]) and strokes of other determined cause (RR, 1.5 [95% CI, 0.7-3.3]). After accounting for ipsilateral high-risk plaque, 88 (15.2%) patients were reclassified: 38 (22.6%) cardioembolic to multiple potential etiologies, 6 (8.5%) lacunar to multiple, 3 (15.8%) other determined cause to multiple, and 41 (20.8%) cryptogenic to large-artery atherosclerosis. Conclusions- High-risk carotid plaque was more prevalent ipsilateral to brain infarction across several ischemic stroke subtypes. Accounting for such plaques may reclassify the etiologies of up to 15% of cases in our sample.


Assuntos
Isquemia Encefálica/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Placa Aterosclerótica/patologia , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/epidemiologia , Idoso , Infarto Encefálico/classificação , Infarto Encefálico/patologia , Isquemia Encefálica/classificação , Artérias Carótidas/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico , Prevalência , Fatores de Risco
13.
Arterioscler Thromb Vasc Biol ; 40(1): 220-229, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31619064

RESUMO

OBJECTIVE: Cholesterol crystals (CCs) are frequently found at the site of acute myocardial infarctions (AMIs), but the role of CCs in the onset of AMI remains unclear due to the lack of validated in vivo imaging tools. The aim of this study was to validate the ability of optical coherence tomography (OCT) to detect CCs and to compare the prevalence and distribution of CCs in patients with AMIs and stable angina pectoris. Approach and Results: CC assessment using OCT were compared with histopathology results in 45 coronary samples. We investigated 152 consecutive patients with AMIs and 41 patients with single vessel-diseased stable angina pectoris. Based on the presence of plaque ruptures (PR), AMI patients were divided into 2 groups: those with PR (n=112) and those without PR (n=40). CCs invading fibrous caps were defined as superficial-type CCs. A multivariable logistic regression analysis was performed to determine PR predictors. The sensitivity and specificity of OCT for detecting CCs were 68% and 92%, respectively. The prevalence of plaques with CCs was higher in the AMI with PR group (AMI with PR 81%, AMI without PR 48%, stable angina pectoris 39%, P<0.01). A multivariable logistic model showed that superficial-type CCs and thin-cap fibroatheromas were positive predictors for PR. CONCLUSIONS: OCT has a high specificity and modest sensitivity for the detection of CCs. The combination of CCs invading fibrous cap and thin-cap fibroatheromas detected by OCT may better identify rupture-prone plaques.


Assuntos
Angina Estável/diagnóstico , Colesterol/metabolismo , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/metabolismo , Placa Aterosclerótica/diagnóstico , Tomografia de Coerência Óptica/métodos , Idoso , Angina Estável/etiologia , Angina Estável/metabolismo , Biomarcadores/metabolismo , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/patologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Placa Aterosclerótica/complicações , Placa Aterosclerótica/metabolismo , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes
14.
J Atheroscler Thromb ; 27(2): 155-163, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31231080

RESUMO

AIM: Obesity and metabolic syndrome (MetS) frequently coexist and are both important risk factors for cardiovascular disease. However, the pathophysiological role of obesity without MetS, also referred to as metabolically healthy obesity (MHO), remains unclear. In this study, we aim to clarify the effect of MHO on the development of carotid plaque using a community-based cohort. METHODS: We examined 1,241 subjects who underwent health checkups at our institute. Obesity was defined as body mass index of ≥ 25.0 kg/m2. Subjects were divided into three groups: non-obese, MHO, and metabolically unhealthy obesity (MUO). RESULTS: The prevalence of carotid plaque, defined as intima-media thickness (IMT) ≥ 1.1 mm, was higher in subjects with MUO and MHO than in non-obese subjects. Multivariable analysis demonstrated that MHO (odds ratio 1.6, p=0.012) and MUO (odds ratio 1.9, p=0.003) as well as age of ≥ 65 years, male sex, hypertension, and diabetes mellitus were independently associated with carotid plaque formation. A similar trend was observed in each subgroup according to age and sex. CONCLUSIONS: MHO increased the prevalence of carotid plaque when compared with non-obese subjects, suggesting the potential significance of MHO in the development of subsequent cardiovascular diseases.


Assuntos
Doenças das Artérias Carótidas , Obesidade Metabolicamente Benigna , Placa Aterosclerótica , Idoso , Índice de Massa Corporal , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/metabolismo , Espessura Intima-Media Carotídea , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Obesidade Metabolicamente Benigna/diagnóstico , Obesidade Metabolicamente Benigna/epidemiologia , Obesidade Metabolicamente Benigna/metabolismo , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/metabolismo , Prevalência , Medição de Risco , Fatores de Risco
15.
Diabetes Metab Res Rev ; 36(1): e3201, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31278827

RESUMO

OBJECTIVES: This study aimed to investigate the characteristics of femoral atherosclerotic plaques in patients with diabetes mellitus (DM) compared with those without DM using three-dimensional magnetic resonance vessel wall imaging. METHODS: Lower extremity atherosclerotic disease patients with and without DM (age ≥ 50 year-old) were recruited and underwent three-dimensional magnetic resonance imaging for femoral arteries. The femoral arteries were divided into common femoral artery (CFA), proximal of superficial femoral artery (pSFA), adductor canal (AC), and popliteal artery (PA) segments. The characteristics of femoral artery atherosclerotic plaques were compared between patients with and without DM. RESULTS: Forty-eight patients with DM (69.5 ± 8.2 years; 26 males) and 50 patients without DM (71.9 ± 5.7 years; 28 males) were included. Significant differences were found in maximum wall thickness in CFA and AC segments, eccentricity index in AC segment, prevalence of plaque in CFA, pSFA and AC segments, stenosis and prevalence of calcification in pSFA, AC and PA segments, prevalence of lipid-rich necrotic core (LRNC) in all segments, and prevalence of intraplaque haemorrhage in PA segment between patients with and without DM (all P < .05). After adjusted for confounding factors of age, gender, hyperlipidemia, coronary artery disease, and statin use, the differences in eccentricity index, stenosis and prevalence of plaque, calcification and LRNC in pSFA and AC segments, and stenosis and prevalence of LRNC in PA segment remained statistically significant between patients with and without DM (all P < .05). CONCLUSIONS: Patients with DM have significantly larger plaque burden, higher prevalence of plaques, and more complex plaque compositions in femoral arteries than those without DM.


Assuntos
Diabetes Mellitus/fisiopatologia , Artéria Femoral/patologia , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Placa Aterosclerótica/diagnóstico , Idoso , Estudos de Casos e Controles , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Placa Aterosclerótica/epidemiologia , Prevalência , Prognóstico , Fatores de Risco
16.
Sci Rep ; 9(1): 18011, 2019 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-31784590

RESUMO

It is indicated that lipids profiles are associated with carotid plaque and Atherosclerosis. However, studies about the relationship between serum lipid profiles and carotid plaque composition in Chinese Population is limited. We conducted a cross-sectional study among 3,214 participants between January 2015 and December 2017 in China, to investigate the association between various lipid profiles and the prevalence of carotid plaque. Logistic regression model was used to investigate the association between plasma lipid profiles and odds of carotid plaque. Analysis of covariance (ANCOVA) was used to compare the mean plasma lipid profiles among different number and composition of carotid artery plaques. HDL-C, Non-HDL-C levels, TC/HDL-C, LDL-C/HDL-C were significantly associated with the presence of carotid plaque; HDL-C, LDL-C, Non-HDL-C levels, TC/HDL-C, LDL-C/HDL-C were significantly associated with the presence of common carotid artery (CCA) plaque. Compare with participants without carotid plaque, increased level of LDL-C/HDL-C was found in those with echolucent/polytype plaque. Similarly, compared with participants without CCA plaque, increased level of LDL-C/HDL-C was found in those with echolucent plaque. In conclusion, we found that serum HDL-C, Non-HDLc level, TC/HDLc, and LDLc/HDLc were all associated with the prevalence of carotid plaque, and LDL-C/HDL-C differed among different group of carotid plaque composition.


Assuntos
Estenose das Carótidas/epidemiologia , Lipídeos/sangue , Placa Aterosclerótica/epidemiologia , Adulto , Artérias Carótidas/patologia , Estenose das Carótidas/sangue , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/patologia , Estudos Transversais , Feminino , Humanos , Lipidômica , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/patologia , Prevalência , Fatores de Risco
17.
Echocardiography ; 36(12): 2241-2250, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31742790

RESUMO

AIMS: Two-dimensional ultrasound (2D-US) is the mainstay imaging technique used to evaluate carotid atherosclerosis. An automated single sweep three-dimensional ultrasound (3D-US) technique became available. We evaluated the feasibility and accuracy of 3D-US in the assessment of carotid plaques compared to those of 2D-US. Carotid computed tomography angiography (CTA) was used as a reference. METHODS AND RESULTS: Among 126 stroke patients who underwent carotid 2D-US, 73 underwent 3D-US and carotid CTA. 3D-US was pursued when there were carotid plaques or when area stenosis was ≥ 20% by 2D-US. Both 2D- and 3D-US images of the carotid arteries were acquired using a dedicated ultrasound system that was equipped with the single sweep volumetric transducer. In total, 266 arteries from 73 patients were selected for comparison of the detection rate of carotid plaques between 2D- and 3D-US. Among the 73 patients, carotid CTA detected 139 plaques. 3D-US demonstrated a higher detection rate of carotid plaques than did 2D-US (108 plaques (77.9%) vs. 70 plaques (50.4%)) when using carotid CTA as a reference standard. Carotid plaque volume (PV) of 133 vessels from 73 patients were quantitatively evaluated using both 3D-US and carotid CTA. Plaque volume of carotid artery was comparable between 3D-US and CTA (148.5 ± 133.0 mm3 vs. 154.1 ± 134.6 mm3 , P = .998, R: 0.9825, P-value for r < .001). CONCLUSION: 3D-US using a single sweep technique was a feasible and accurate method of detecting arterial plaques and assessing plaque volume.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Imageamento Tridimensional , Placa Aterosclerótica/diagnóstico , Ultrassonografia/métodos , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
J Am Heart Assoc ; 8(20): e011996, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31590595

RESUMO

Background Intracranial atherosclerotic stroke is prevalent in Asians. We hypothesized that patients with the ring finger protein 213 (RNF213) variant, a susceptibility locus for moyamoya disease in Asians, have different neuroimaging characteristics in terms of the vessel wall and hemodynamics. Methods and Results We analyzed consecutive patients with ischemic events in middle cerebral artery distribution and relevant plaques of the distal internal carotid artery or proximal middle cerebral artery on high-resolution magnetic resonance imaging. Patients with carotid/cardiac sources of embolism or moyamoya disease were excluded. High-resolution magnetic resonance imaging features (eg, outer vessel diameters and plaque characteristics) and fractional flow (as measured by adjusted signal intensity ratio on time-of-flight magnetic resonance angiography) were compared between RNF213 p.Arg4810Lys variant carriers and noncarriers. Among 144 patients included, 44 (29.9%) had the RNF213 variant. Clinical characteristics, including age, sex, body mass index, and vascular risk factors, were not significantly different between RNF213 variant carriers and noncarriers. However, the outer vessel diameter was smaller in RNF213 variant carriers than in noncarriers (P<0.0001 for middle cerebral artery of relevant stenosis [2.05-mm analysis of RNF213 gene for moyamoya disease in the Chinese HAN population 2.75 mm]; P<0.0001 for contralateral side [2.42  versus 3.00 mm] and P<0.001 for basilar artery [3.19 versus 3.53 mm]). Other high-resolution magnetic resonance imaging features, including plaque morphology and eccentricity, were not significantly different. Fractional flow was diminished in patients with smaller-diameter intracranial arteries with a similar degree of stenosis. Conclusions The RNF213 variant may be associated with vasculogenesis, but not with atherogenesis. Patients with this variant had small intracranial arteries predisposing hemodynamic compromise in the presence of intracranial atherosclerosis. In addition to antiatherosclerotic strategies, further studies are warranted to develop novel therapeutic strategies against RNF213 vasculopathy in Asians.


Assuntos
Adenosina Trifosfatases/genética , Isquemia Encefálica/etiologia , Regulação da Expressão Gênica , Arteriosclerose Intracraniana/complicações , Imageamento por Ressonância Magnética/métodos , Placa Aterosclerótica/complicações , Ubiquitina-Proteína Ligases/genética , Remodelação Vascular/fisiologia , Adenosina Trifosfatases/biossíntese , Biomarcadores/metabolismo , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/genética , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Arteriosclerose Intracraniana/diagnóstico , Arteriosclerose Intracraniana/genética , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/genética , Domínios RING Finger , Estudos Retrospectivos , Fatores de Risco , Ubiquitina-Proteína Ligases/biossíntese
19.
Am J Cardiol ; 124(9): 1340-1348, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31481177

RESUMO

This study investigated the impact of coronary CT angiography (cCTA)-derived plaque markers and machine-learning-based CT-derived fractional flow reserve (CT-FFR) to identify adverse cardiac outcome. Data of 82 patients (60 ± 11 years, 62% men) who underwent cCTA and invasive coronary angiography (ICA) were analyzed in this single-center retrospective, institutional review board-approved, HIPAA-compliant study. Follow-up was performed to record major adverse cardiac events (MACE). Plaque quantification of lesions responsible for MACE and control lesions was retrospectively performed semiautomatically from cCTA together with machine-learning based CT-FFR. The discriminatory value of plaque markers and CT-FFR to predict MACE was evaluated. After a median follow-up of 18.5 months (interquartile range 11.5 to 26.6 months), MACE was observed in 18 patients (21%). In a multivariate analysis the following markers were predictors of MACE (odds ratio [OR]): lesion length (OR 1.16, p = 0.018), low-attenuation plaque (<30 HU) (OR 4.59, p = 0.003), Napkin ring sign (OR 2.71, p = 0.034), stenosis ≥50% (OR 3.83, p 0.042), and CT-FFR ≤0.80 (OR 7.78, p = 0.001). Receiver operating characteristics analysis including stenosis ≥50%, plaque markers and CT-FFR ≤0.80 (Area under the curve 0.94) showed incremental discriminatory power over stenosis ≥50% alone (Area under the curve 0.60, p <0.0001) for the prediction of MACE. cCTA-derived plaque markers and machine-learning CT-FFR demonstrate predictive value to identify MACE. In conclusion, combining plaque markers with machine-learning CT-FFR shows incremental discriminatory power over cCTA stenosis grading alone.


Assuntos
Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Aprendizado de Máquina , Tomografia Computadorizada Multidetectores/métodos , Placa Aterosclerótica/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Estenose Coronária/etiologia , Estenose Coronária/mortalidade , Vasos Coronários/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Placa Aterosclerótica/mortalidade , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
20.
Arch Cardiol Mex ; 89(1): 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448766

RESUMO

Background: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.


Assuntos
Doenças das Artérias Carótidas/complicações , Angiografia Coronária , Infarto do Miocárdio/etiologia , Placa Aterosclerótica/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Placa Aterosclerótica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Análise de Sobrevida
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