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1.
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
2.
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
3.
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
4.
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
5.
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
6.
Interv Cardiol Clin ; 8(4): 411-424, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31445725

RESUMO

Intravascular lithotripsy facilitates percutaneous coronary intervention of lesions with severe calcification by using high-pressure ultrasonic energy. It is the newest adjunctive tool for calcium modification and is showing promise as its users gather more experience and it becomes readily available worldwide. This article reviews intravascular lithotripsy technology, the evidence in the literature, and the advantages and disadvantages compared with other forms of calcium modification, and discusses its role in specific subsets of coronary lesions. It concludes with a discussion about the future direction of research involving this new technology as its role within percutaneous cardiac procedures becomes more defined.


Assuntos
Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Litotripsia/métodos , Intervenção Coronária Percutânea/métodos , Placa Aterosclerótica/terapia , Calcificação Vascular/terapia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Humanos , Placa Aterosclerótica/diagnóstico , Calcificação Vascular/diagnóstico
7.
Arch Med Res ; 50(2): 20-28, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31349950

RESUMO

BACKGROUND: Metabolic syndrome (MetS) is a heterogeneous clinical entity associated with insulin resistance, low-grade proinflammatory balance and impaired endothelial function, accelerating atherosclerosis. Atherosclerotic lesions worsen with age, smoking and co-morbidities, making it difficult to accurately diagnose the cardiovascular disease (CVD) risk. AIM: We investigate the association between subclinical atherosclerosis and the presence of blood parameters related to adipocyte and vascular endothelial cell dysfunction, in non-smokers with MetS, under 60 and without previous CVD events. METHODS: Seventy-eight asymptomatic individuals (average 46.5 years, 69% male; 59 MetS and 19 controls) were studied prospectively. Subclinical CVD was defined by the presence of carotid plaque and/or carotid intima-media thickness (CIMT) > 0.9 in 2/3D ultrasound-studies, left ventricular hypertrophy (LVH) or high coronary calcium score (CCS). Multiplex immunoassay by Luminex xMAP was performed to measure plasma levels of adipokines and endothelial cell-derived molecules. RESULTS: Compared with controls, MetS patients had higher prevalence of carotid plaque (25 vs. 0%, p = 0.01), CIMT>0.9 (73 vs. 26%, p = 0.001) and higher CCS (69 vs. 5, p = 0.01), which were associated with a remarkable decrease in plasma Omentin levels and increase in sICAM-1, sVCAM-1 and PAI-1 (p <0.05). There was a statistically significant association between CIMT and sICAM-1 (OR: 14.57, 95% CI: 2.56-82.73, p <0.001), sVCAM-1 (OR:7.33, 95% CI: 1,58-33.96, p = 0.007) and PAI-1 (OR:7.80, 95% CI: 1.04-22.10, p = 0.036) in patients with carotid plaque and/or CIMT>0.9. Positive correlation between plaque volume and sICAM-1 levels was also detected (r = 0.40, p = 0.045). CONCLUSIONS: We demonstrated that the increase of sICAM-1, sVCAM-1 and PAI-1, together with decrease of omentin-1 led to a proinflammatory imbalance pointing to the presence of subclinical atherosclerosis, and improving CVD risk stratification in non-smoking patients at early stage MetS beyond traditional scores.


Assuntos
Aterosclerose/diagnóstico , Citocinas/sangue , Molécula 1 de Adesão Intercelular/sangue , Lectinas/sangue , Síndrome Metabólica/diagnóstico , Inibidor 1 de Ativador de Plasminogênio/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Adulto , Aterosclerose/sangue , Espessura Intima-Media Carotídea , Feminino , Proteínas Ligadas por GPI/sangue , Humanos , Resistência à Insulina/fisiologia , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , não Fumantes , Placa Aterosclerótica/diagnóstico , Prevalência , Estudos Prospectivos , Ultrassonografia
8.
Gastroenterol. hepatol. (Ed. impr.) ; 42(6): 362-371, jun.-jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183787

RESUMO

Introducción: La infección crónica por el virus de la hepatitis C (VHC) es un factor de riesgo para desarrollar placas de ateroma, aunque se desconoce el posible efecto al eliminar el virus. Nuestro objetivo fue analizar si tras 12 meses de la erradicación del VHC por antivirales de acción directa (AAD) mejoraba la ateromatosis subclínica y existía modificación en la composición de las placas. Materiales y métodos: Estudio prospectivo que incluyó 85 pacientes con infección crónica por VHC en diferentes estadios de fibrosis, sometidos a AAD. Se excluyeron pacientes con antecedentes cardiovasculares, diabetes y enfermedad renal. Se realizó ecografía arterial (carótidas y femorales) para diagnosticar placa de ateroma (definida como grosor íntima-media≥1,5mm) y se analizó su composición (porcentaje de lípidos, fibrosis y calcio con software HEMODYN4) al inicio del estudio y tras 12 meses de finalizar la terapia. Resultados: Tras el seguimiento no se detectaron cambios en el grosor íntima-media (0,65mm vs. 0,63mm, p=0,240) ni en la presencia de placas (65,9%vs. 71,8%, p=0,063). Tampoco hubo modificación significativa en la composición de las mismas ni del territorio vascular afecto, observándose un aumento del perfil lipídico en sangre (p<0,001) tras 12 meses del tratamiento. Estos resultados se confirmaron en subgrupos por gravedad de enfermedad hepática. Discusión: La erradicación del VHC por AAD no mejora las placas de ateroma ni varía su composición, independientemente de la fibrosis hepática. Se precisan más estudios prospectivos que evalúen el riesgo residual cardiovascular tras la erradicación viral


Introduction: Chronic infection with hepatitis C virus is a risk factor for developing atheromatous plaques, although the possible effect of virus clearance is unknown. Our aim was to determine whether or not subclinical atheromatosis improved and there was any modification in the composition of the plaques 12 months after eradication of hepatitis C virus by direct-acting antiviral agents. Materials and methods: Prospective study that included 85 patients with chronic hepatitis C virus infection in different stages of fibrosis who were on direct-acting antiviral agents. Patients with a cardiovascular history, diabetes and kidney disease were excluded. An arterial ultrasound (carotid and femoral) was performed to diagnose atheromatous plaques (defined as intima-media thickness ≥1.5mm) and the composition (percentage of lipids, fibrosis and calcium with HEMODYN4 software) was analysed at the beginning of the study and 12 months after stopping the therapy. Results: After follow-up no changes were detected in the intima-media thickness (0.65mm vs. 0.63mm, P=.240) or in the presence of plaques (65.9% vs 71.8%, P=.063). There was also no significant change in their composition or affected vascular territory, with an increase in blood lipid profile (P<.001) after 12 months of treatment. These results were confirmed in subgroups by severity of liver disease. Discussion: The eradication of hepatitis C virus by direct-acting antiviral agents does not improve the atheroma plaques and nor does it vary their composition, regardless of liver fibrosis. More prospective studies are needed to evaluate residual cardiovascular risk after virus eradication


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Hepatite Crônica/complicações , Hepatite Crônica/diagnóstico , Hepatite C/complicações , Aterosclerose/complicações , Artérias Carótidas/diagnóstico por imagem , Placa Aterosclerótica/complicações , Estudos Prospectivos , Antropometria , Hepatite Crônica/sangue , Análise Estatística , Antivirais/uso terapêutico , Fatores de Risco , Placa Aterosclerótica/diagnóstico
9.
J Clin Ultrasound ; 47(8): 477-485, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31168787

RESUMO

OBJECTIVE: Ultrasound Lagrangian carotid strain imaging (LCSI) utilizes physiological deformation caused by arterial pressure variations to generate strain tensor maps of the vessel walls and plaques. LCSI has been criticized for the lack of normalization of magnitude-based strain indices to physiological stimuli, namely blood pressure. We evaluated the impact of normalization of magnitude-based strain indices to blood pressure measured immediately after the acquisition of radiofrequency (RF) data loops for LCSI. MATERIALS AND METHODS: A complete clinical ultrasound examination along with RF data loops for LCSI was performed on 50 patients (30 males and 20 females) who presented with >60% carotid stenosis and were scheduled for carotid endarterectomy. Cognition was assessed using the 60-minute neuropsychological test protocol. RESULTS: For axial strains correlation of maximum accumulated strain indices (MASI), cognition scores were -0.46 for non-normalized and -0.45, -0.49, -0.37, and -0.48 for systolic, diastolic, pulse pressure, and mean arterial pressure normalized data, respectively. The corresponding area under the curve (AUC) values for classifiers designed using maximum likelihood estimation of a binormal distribution with a median-split of the executive function cognition scores were 0.73, 0.70, 0.71, 0.70, and 0.71, respectively. CONCLUSIONS: No significant differences in the AUC estimates were obtained between normalized and non-normalized magnitude-based strain indices.


Assuntos
Pressão Sanguínea/fisiologia , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico , Placa Aterosclerótica/diagnóstico , Ultrassonografia/métodos , Idoso , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/etiologia , Estenose das Carótidas/fisiopatologia , Feminino , Humanos , Masculino , Placa Aterosclerótica/complicações , Placa Aterosclerótica/fisiopatologia
10.
Intern Med ; 58(19): 2851-2855, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31178514

RESUMO

Complex aortic atheroma is a high-risk factor for recurrent embolic stroke. An accurate identification of stroke etiology is clinically important; however, it can be challenging. A 91-year-old man with atrial fibrillation was diagnosed with cardioembolic stroke and treated with mechanical thrombectomy. The removed thrombus microscopically contained foamy cells, suggesting an atheroembolism. An autopsy revealed an atherosclerotic lesion with ulceration, located in the aortic arch. At the lesion, the plaque had microscopically ruptured into the lumen. We therefore concluded that the aortic atherosclerotic lesion was the embolic source. Removed thrombi should be pathologically examined even if a cardioembolic stroke is clinically suspected.


Assuntos
Doenças da Aorta/complicações , Fibrilação Atrial/complicações , Embolia de Colesterol/diagnóstico , Embolia Intracraniana/diagnóstico , Placa Aterosclerótica/complicações , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico , Autopsia , Angiografia Cerebral , Embolia de Colesterol/etiologia , Embolia de Colesterol/cirurgia , Procedimentos Endovasculares/métodos , Evolução Fatal , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/cirurgia , Imagem por Ressonância Magnética , Masculino , Placa Aterosclerótica/diagnóstico
11.
Int J Cardiol ; 289: 131-137, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31079970

RESUMO

BACKGROUND: Impaired bioavailability of endothelium-derived nitric oxide (NO) and endothelial dysfunction may play a pivotal role in the pathogenesis of in-stent restenosis (ISR) after coronary stenting. We aimed to investigate the relation between asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, and the ISR lesions tissue characteristics assessed by optical coherence tomography (OCT). METHODS AND RESULTS: Forty-five patients with symptomatic ISR lesions (17 bare metal stents, 28 drug-eluting stents, medium implantation duration: 58.0 months) were evaluated by OCT for in-stent tissue characteristics and calcification. We defined neoatherosclerosis as the presence of lipid or calcified neointima in ISR lesions, and 12 (26.7%), 33 (73.3%) ISR lesions were classified as with homogenous neointima and neoatherosclerosis respectively. The patients with neoatherosclerosis have significantly higher plasma ADMA levels compared to those of patients with homogenous neointima (1.12 ±â€¯0.21 µmol/l versus 0.83 ±â€¯0.08 µmol/l, p < 0.001). Furthermore, the plasma ADMA level of ISR lesions with intra-stent calcification (n = 24, 53.3%) was also significantly higher than those of ISR lesions without (n = 21, 46.7%; p < 0.001). There was a highly significant association between plasma ADMA level and intra-stent relative calcium index (mean calcium arc × calcium length)/(360 × analyzed length) (p < 0.001, r = 0.702). In multivariate analyses adjusted for age, sex, diabetes, eGFR, plasma ADMA level remained the only significant predictor for the presence of neoatherosclerosis (p = 0.008) and intra-stent calcification (p < 0.001). In contrast, plasma ADMA level correlated with intra-stent relative lipid core index (mean lipid core arc × lipid core length)/(360 × analyzed length) only in subgroup without intra-stent calcification (p = 0.004, r = 0.596, multivariate-adjusted p = 0.022). CONCLUSIONS: Increased plasma ADMA levels were associated with the development of in-stent neoatherosclerosis and calcification.


Assuntos
Arginina/análogos & derivados , Reestenose Coronária/diagnóstico , Vasos Coronários/patologia , Stents Farmacológicos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Placa Aterosclerótica/complicações , Tomografia de Coerência Óptica/métodos , Idoso , Arginina/sangue , Biomarcadores/sangue , Angiografia Coronária , Reestenose Coronária/sangue , Reestenose Coronária/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico , Estudos Prospectivos , Falha de Prótese , Fatores de Risco , Fatores de Tempo
12.
EBioMedicine ; 44: 41-49, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31126891

RESUMO

BACKGROUND: Fibrous cap thickness (FCT), best measured by intravascular optical coherence tomography (OCT), is the most important determinant of plaque rupture in the coronary arteries. Statin treatment increases FCT and thus reduces the likelihood of acute coronary events. However, substantial statin-related FCT increase occurs in only a subset of patients. Currently, there are no methods to predict which patients will benefit. We use transcriptomic data from a clinical trial of rosuvastatin to predict if a patient's FCT will increase in response to statin therapy. METHODS: FCT was measured using OCT in 69 patients at (1) baseline and (2) after 8-10 weeks of 40  mg rosuvastatin. Peripheral blood mononuclear cells were assayed via microarray. We constructed machine learning models with baseline gene expression data to predict change in FCT. Finally, we ascertained the biological functions of the most predictive transcriptomic markers. FINDINGS: Machine learning models were able to predict FCT responders using baseline gene expression with high fidelity (Classification AUC = 0.969 and 0.972). The first model (elastic net) using 73 genes had an accuracy of 92.8%, sensitivity of 94.1%, and specificity of 91.4%. The second model (KTSP) using 18 genes has an accuracy of 95.7%, sensitivity of 94.3%, and specificity of 97.1%. We found 58 enriched gene ontology terms, including many involved with immune cell function and cholesterol biometabolism. INTERPRETATION: In this pilot study, transcriptomic models could predict if FCT increased following 8-10 weeks of rosuvastatin. These findings may have significance for therapy selection and could supplement invasive imaging modalities.


Assuntos
Perfilação da Expressão Gênica , Modelos Biológicos , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/etiologia , Transcriptoma , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Biomarcadores , Biologia Computacional/métodos , Feminino , Perfilação da Expressão Gênica/métodos , Ontologia Genética , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/tratamento farmacológico , Prognóstico , Curva ROC , Tomografia de Coerência Óptica , Resultado do Tratamento
13.
Clin Investig Arterioscler ; 31(4): 160-165, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30971375

RESUMO

AIM: To assess the atherosclerotic burden in hypertensive patients with prediabetes without cardiovascular disease. PATIENTS AND METHODS: We included patients with hypertension and prediabetes (fasting blood glucose: 100-125mg/dL and/or glycohemoglobin A1c: 5.7-6.4%), excluding those with established cardiovascular disease or those at very high risk. We recorded major vascular risk factors. Subclinical arteriosclerosis was measured by the ankle/brachial index (ABI) and carotid intima-medial thickness (IMT). Subclinical arteriosclerosis was mild if IMT was >75p adjusted by age and sex and/or ABI was 0.7-0.9 and was considered moderate-severe when there was plaque and/or ABI<0.7. RESULTS: We included 53 patients, 63±7 years-old; women: 50,9% (95%CI: 36.8-64.9). Atherosclerotic burden was detected in 66.0% (95%CI: 51.7-78.5) of subjects. 24,5% (95%CI: 13.8-38.3) of patients had mild arteriosclerosis disease and 41.5% (95%CI: 28.1-55.9) had moderate-severe. This allowed us to re-stratified as very high vascular risk the 41.5% (95%CI: 28.1-55.9) of patients. 45.4% (95%CI: 16-74.8) of subjects with moderate initial risk were considered high or very high risk. In multivariate analyses, only smoking was associated with atherosclerotic burden (P=.07). CONCLUSIONS: Two thirds of hypertensive patients with prediabetes had subclinical arteriosclerotic disease when they were evaluated by the ankle/brachial index and carotid ultrasonography. Approximately forty percent of patients were re-stratified as very high vascular risk. Nearly half of the prediabetic hypertensive patients initially classified as moderate risk were considered high or very high risk.


Assuntos
Aterosclerose/epidemiologia , Hipertensão/fisiopatologia , Placa Aterosclerótica/epidemiologia , Estado Pré-Diabético/fisiopatologia , Idoso , Índice Tornozelo-Braço , Aterosclerose/diagnóstico , Espessura Intima-Media Carotídea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico , Fatores de Risco , Fumar/epidemiologia
14.
Biomech Model Mechanobiol ; 18(5): 1269-1280, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30937650

RESUMO

Plaque progression and vulnerability are influenced by many risk factors. Our goal is to find a simple method to combine multiple risk factors for better plaque development prediction. Intravascular ultrasound data at baseline and follow-up were acquired from nine patients, and fluid-structure interaction models were constructed to obtain plaque wall stress/strain (PWS/PWSn) and wall shear stress (WSS). Two hundred fifty-four slices with noticeable change in plaque burden were selected for analyses. Data of six key morphological and biomechanical factors were extracted from each slice at baseline to predict plaque development measured by plaque burden increase (PBI) from baseline to follow-up. A multi-factor decision-making strategy was proposed to assign a binary predictive outcome YW (W represents any combination of these six factors) based on simple "threshold value" idea to predict the ground truth YPBI: YPBI = 1 if PBI > 0; YPBI = 0 otherwise. A fivefold cross-validation procedure was employed to identify the optimal predictor among all possible combinations. The results showed that PWS was the best single-factor predictor for PBI with a prediction accuracy of 63.0%. Among all 63 combinations, combining lipid percent, PWS and WSS gave the optimal predictor, achieving a prediction accuracy of 68.1%. This demonstrated that compared to single factor alone, integrating morphological and biomechanical factors would lead to higher prediction accuracy. The simple method could be extended to combine factors from different sources to improve prediction accuracy. Efforts in mechanical analysis and modeling automation are needed to bring this strategy closer to potential clinical applications.


Assuntos
Tomada de Decisão Clínica , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Imageamento Tridimensional , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico , Reologia , Ultrassonografia de Intervenção , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Reprodutibilidade dos Testes
15.
Int J Cardiol ; 288: 12-16, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30928256

RESUMO

BACKGROUND: Although an in vivo diagnosis of coronary plaque erosion has become possible by optical coherence tomography (OCT), angiographic characteristics of erosion have not been studied. The aim of this study was to investigate the angiographic features of plaque erosion in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). METHODS: Patients with NSTE-ACS who underwent OCT of the culprit lesion were collected at 11 institutions from 6 countries. Patients were classified as erosion or non-erosion based on OCT images. Angiographic features of both groups were compared. RESULTS: Among 494 cases with NSTE-ACS, 242 had plaque erosion and 252 had non-erosion. Compared to non-erosion group, erosion patients had less multivessel disease (28.5% vs. 49.6%, p < 0.001), lower Jeopardy score (4.2 vs. 5.0, p < 0.001), lower Gensini score (21.3 vs. 25.6, p = 0.014), and lower Syntax score (8.9 vs. 11.5, p < 0.001). With regard to the culprit lesion morphology, plaque erosion group had smaller reference diameter (2.8 mm vs. 3.0 mm, p = 0.032), less frequent type B2/C lesions (51.2% vs. 71.8%, p < 0.001), and lower prevalence of calcification (4.1% vs. 13.9%, p < 0.001) and thrombus (16.5% vs. 28.2%, p = 0.002). In the mid left anterior descending artery (LAD), erosion was significantly more frequent than non-erosion (30.2% vs. 21.8%, p = 0.034). CONCLUSIONS: Patients with NSTE-ACS caused by plaque erosion have less complex angiographic features both at the 3-vessel level and at the culprit lesion level. Plaque erosion was frequently found in the mid LAD.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico , Tomografia de Coerência Óptica/métodos , Síndrome Coronariana Aguda/etiologia , Angiografia Coronária/métodos , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Sistema de Registros , Ruptura Espontânea
16.
Clin Cardiol ; 42(6): 618-628, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30993750

RESUMO

BACKGROUND: The relationship between eicosapentaenoic acid (EPA) therapy and coronary plaque stability assessed by optical frequency domain imaging (OFDI) has not been thoroughly described. HYPOTHESIS: EPA therapy is associated with decreased plaque instability in patients undergoing percutaneous coronary intervention (PCI) using OFDI. METHODS: Data on coronary artery plaques from 121 patients who consecutively underwent PCI between October 2015 and July 2018 were retrospectively analyzed. Of these patients, 109 were untreated (no-EPA group), whereas 12 were treated with EPA (EPA group). Each plaque's morphological characteristics were analyzed using OFDI. RESULTS: We used 1:4 propensity score matching for patients who received or did not receive EPA therapy before PCI. Baseline characteristics were balanced between both groups (age, sex, body mass index, diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, smoking, previous PCI or coronary artery bypass grafting, previous myocardial infarction, prior statin use, acute coronary syndrome, hemoglobin A1c level, low-density lipoprotein cholesterol concentration, triglyceride concentration, and high-density lipoprotein cholesterol concentration). OFDI data from 60 patients were analyzed in this study. The EPA group had significantly lower mean lipid index (818 ± 806 vs 1574 ± 891) and macrophage grade (13.5 ± 5.9 vs 19.3 ± 7.4) but higher mean minimum fibrous cap thickness (109.2 ± 55.7 vs 81.6 ± 36.4 µm) than the no-EPA group (P = 0.010, 0.019, and 0.040, respectively). Multiple logistic regression analyses showed that prior EPA use was independently associated with lower lipid index and macrophage grade (P = 0.043 and 0.024, respectively). CONCLUSION: This OFDI analysis suggests that EPA therapy is associated with decreased plaque instability in patients undergoing PCI.


Assuntos
Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Ácido Eicosapentaenoico/uso terapêutico , Placa Aterosclerótica/terapia , Tomografia de Coerência Óptica/métodos , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Lipídeos/sangue , Masculino , Intervenção Coronária Percutânea/métodos , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
17.
Korean J Radiol ; 20(5): 729-738, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30993924

RESUMO

OBJECTIVE: To assess the effects of iterative model reconstruction (IMR) on image quality for demonstrating non-calcific high-risk plaque characteristics of coronary arteries. MATERIALS AND METHODS: This study included 66 patients (53 men and 13 women; aged 39-76 years; mean age, 55 ± 13 years) having single-vessel disease with predominantly non-calcified plaques evaluated using prospective electrocardiogram-gated 256-slice CT angiography. Paired image sets were created using two types of reconstruction: hybrid iterative reconstruction (HIR) and IMR. Plaque characteristics were compared using the two algorithms. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the images and the CNR between the plaque and adjacent adipose tissue were also compared between the two reformatted methods. RESULTS: Seventy-seven predominantly non-calcified plaques were detected. Forty plaques showed napkin-ring sign with the IMR reformatted method, while nineteen plaques demonstrated napkin-ring sign with HIR. There was no statistically significant difference in the presentation of positive remodeling, low attenuation plaque, and spotty calcification between the HIR and IMR reconstructed methods (all p > 0.5); however, there was a statistically significant difference in the ability to discern the napkin-ring sign between the two algorithms (χ² = 12.12, p < 0.001). The image noise of IMR was lower than that of HIR (10 ± 2 HU versus 12 ± 2 HU; p < 0.01), and the SNR and CNR of the images and the CNR between plaques and surrounding adipose tissues on IMR were better than those on HIR (p < 0.01). CONCLUSION: IMR can significantly improve image quality compared with HIR for the demonstration of coronary artery and atherosclerotic plaques using a 256-slice CT.


Assuntos
Angiografia por Tomografia Computadorizada , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Algoritmos , Vasos Coronários/fisiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Razão Sinal-Ruído
19.
Angiology ; 70(8): 737-746, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31030528

RESUMO

GlycA, a composite biomarker of systemic inflammation, is associated with cardiovascular disease (CVD) and mortality, but its relationship with peripheral artery disease (PAD) is unknown. We assessed whether plasma GlycA is associated with ankle-brachial index (ABI), carotid plaque (CP), and incident clinical PAD among 6466 Multi-Ethnic Study of Atherosclerosis participants without CVD at baseline. GlycA, ABI, and CP were measured at baseline. Both ABI and CP were remeasured at 10 years. Incident clinical PAD was ascertained from hospital records. We used logistic, Cox, and linear mixed regression models adjusted for demographic and lifestyle factors. Mean (standard deviation, SD) was 62 (10) years for age and 381 (61) µmol/L for GlycA; 53% were women. GlycA was associated with both prevalent low ABI ≤0.8 (prevalence odds ratio [95% confidence interval, CI] per SD increment in GlycA, 1.65 [1.39-1.97]) and CP (1.19 [1.11-1.27]) at baseline. There were no significant associations of GlycA with incident low ABI, incident CP, or 10-year change in ABI or CP score. We identified 110 incident cases of PAD after 79 590 person-years. The hazard ratio (95% CI) of incident PAD per SD increment in GlycA was 1.38 (1.14-1.66). In conclusion, GlycA was associated with prevalent low ABI, prevalent CP, and incident PAD after a median of 14 years.


Assuntos
Aterosclerose/sangue , Biomarcadores/sangue , Inflamação/sangue , Doença Arterial Periférica/sangue , Idoso , Aterosclerose/diagnóstico , Aterosclerose/terapia , Feminino , Humanos , Inflamação/diagnóstico , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco
20.
Eur Radiol ; 29(11): 6119-6128, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31025066

RESUMO

OBJECTIVES: We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS). METHODS: From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain. RESULTS: Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFRCT across the lesion (ΔFFRCT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFRCT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050-0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027-0.029) and plaque volume (0.023, 95% CI 0.022-0.024). Lesions with higher ΔFFRCT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31-8.04, p = 0.010 for ΔFFRCT; HR 2.60, 95% CI 1.36-4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFRCT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724-0.727). CONCLUSION: Non-obstructive lesions with higher ΔFFRCT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions. KEY POINTS: • Change in FFR CT across the lesion (ΔFFR CT ) was the most important predictor of ACS risk in non-obstructive lesions. • Non-obstructive lesions with higher ΔFFR CT or low-attenuation plaque were associated with a higher risk of ACS. • The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Hemodinâmica/fisiologia , Placa Aterosclerótica/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Placa Aterosclerótica/fisiopatologia , Valor Preditivo dos Testes
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