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1.
Int Heart J ; 60(3): 539-545, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-30971630

RESUMO

The association between endothelial function, evaluated using flow-mediated dilatation (FMD), and the severity of coronary artery disease remains to be elucidated.A total of 245 consecutive patients with stable angina were prospectively enrolled. FMD was evaluated in the brachial artery before percutaneous coronary intervention. Patients were divided into 2 groups according to the FMD value (lower FMD group [FMD < 2.0], n = 82; higher FMD group [FMD ≥ 2.0], n = 163). The severity of coronary artery disease was evaluated using findings of angiography and optical coherence tomography, and compared between the 2 groups.The prevalence of left main (LM) disease was significantly higher in the lower FMD group than in the higher FMD group (8.5% versus 2.5%, P = 0.046), although the prevalence of multivessel disease was comparable between the groups. Lower FMD was independently associated with a higher prevalence of LM disease (odds ratio, 3.89; 95% confidence interval, 1.12-15.5; P = 0.033). A general linear model with multiple variables revealed that the minimal lumen area (MLA) in the culprit lesion was significantly smaller in patients with lower FMD than in those with higher FMD (regression coefficient b, -0.249 mm2; 95% confidence interval, -0.479--0.018 mm2; P = 0.035). The prevalence ofvulnerable plaque characteristics was comparable between the 2 groups.Patients with lower FMD had a higher incidence of LM disease and a smaller MLA in the culprit lesion. FMD may be a useful, noninvasive indicator for identifying patients with severe coronary artery disease.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/epidemiologia , Vasodilatação , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/fisiopatologia , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia de Coerência Óptica
2.
Med Eng Phys ; 68: 76-84, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31003909

RESUMO

Numerical simulations of blood flow through a partially-blocked axisymmetric artery are performed to investigate the stress distributions in the plaque. We show that the combined effect of stenosis severity and the stiffness of the lipid core can drastically change the axial stress distribution, strongly affecting the potential sites of plaque rupture. The core stiffness is also an important factor when assessing plaque vulnerability, where a mild stenosis with a lipid-filled core presents higher stress levels than a severe stenosis with a calcified plaque. A shorter lipid core gives rise to an increase in the stress levels. However, the fibrous cap stiffness does not influence the stress distributions for the range of values considered in this work. Based on these mechanical analyses, we identify potential sites of rupture in the axial direction for each case: the midpoints of the upstream and downstream regions of the stenosis (for severe, lipid-filled plaques), the ends of the lipid core (for short cores), and the middle of the stenosis (for mild stenoses with positive remodelling of the arterial wall).


Assuntos
Estenose das Carótidas/complicações , Metabolismo dos Lipídeos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/metabolismo , Estresse Mecânico , Fenômenos Biomecânicos , Análise de Elementos Finitos , Placa Aterosclerótica/fisiopatologia
3.
Eur Radiol ; 29(7): 3647-3657, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30903334

RESUMO

OBJECTIVES: The present study aimed to compare the diagnostic performance of a machine learning (ML)-based FFRCT algorithm, quantified subtended myocardial volume, and high-risk plaque features for predicting if a coronary stenosis is hemodynamically significant, with reference to FFRICA. METHODS: Patients who underwent both CCTA and FFRICA measurement within 2 weeks were retrospectively included. ML-based FFRCT, volume of subtended myocardium (Vsub), percentage of subtended myocardium volume versus total myocardium volume (Vratio), high-risk plaque features, minimal lumen diameter (MLD), and minimal lumen area (MLA) along with other parameters were recorded. Lesions with FFRICA ≤ 0.8 were considered to be functionally significant. RESULTS: One hundred eighty patients with 208 lesions were included. The lesion length (LL), diameter stenosis, area stenosis, plaque burden, Vsub, Vratio, Vratio/MLD, Vratio/MLA, and LL/MLD4 were all significantly longer or larger in the group of FFRICA ≤ 0.8 while smaller minimal lumen area, MLD, and FFRCT value were noted. The AUC of FFRCT + Vratio/MLD was significantly better than that of FFRCT alone (0.935 versus 0.873, p < 0.001). High-risk plaque features failed to show difference between functionally significant and insignificant groups. Vratio/MLD-complemented ML-based FFRCT for "gray zone" lesions with FFRCT value ranged from 0.7 to 0.8 and the combined use of these two parameters yielded the best diagnostic performance (86.5%, 180/208). CONCLUSIONS: ML-based FFRCT simulation and Vratio/MLD both provide incremental value over CCTA-derived diameter stenosis and high-risk plaque features for predicting hemodynamically significant lesions. Vratio/MLD is more accurate than ML-based FFRCT for lesions with simulated FFRCT value from 0.7 to 0.8. KEY POINTS: • Machine learning-based FFR CT and subtended myocardium volume both performed well for predicting hemodynamically significant coronary stenosis. • Subtended myocardium volume was more accurate than machine learning-based FFR CT for "gray zone" lesions with simulated FFR value from 0.7 to 0.8. • CT-derived high-risk plaque features failed to correctly identify hemodynamically significant stenosis.


Assuntos
Estenose Coronária/diagnóstico , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Aprendizado de Máquina , Isquemia Miocárdica/diagnóstico , Placa Aterosclerótica/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Angiografia Coronária/métodos , Estenose Coronária/complicações , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/fisiopatologia , Estudos Retrospectivos
4.
Biomed Res Int ; 2019: 3793840, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863777

RESUMO

Background: The safety of cervical rotatory manipulation (CRM) is still controversial, especially in patients with carotid artery atherosclerosis (CAS). The study aimed to investigate the effects of CRM on carotid plaques in vulnerability. Methods: 50 rabbits were randomly divided into four groups: model rabbits with CRM [CAS-CRM (n=15)]; model rabbits without CRM [CAS (n=15)]; normal rabbits with CRM [Normal-CRM (n=10)]; and Blank-control group (n=10). CAS disease models were induced by carotid artery balloon injury combined with a high-fat diet for 12 weeks. Then, CRM technique was performed in CAS-CRM and Normal-CRM groups for 3 weeks. In the end, determination of serum level of hs-CRP and Lp-PLA2, histological analysis under HE and Masson trichromic staining, and immunohistochemical analysis with CD34 and CD68 antibody were completed in order. Results: Carotid stenosis rates on successful model rabbits ranged from 70% to 98%. The CAS-CRM group had an increased level of hs-CRP (P<0.05), in comparison with the CAS group, whereas effects were not significant between the Normal-CRM group and Blank-control group. In comparison with the CAS group, the positive expression of CD34 and CD68 in the CAS-CRM group increased significantly (P<0.05). Conclusion: CRM therapy may increase the vulnerability of carotid plaque in rabbits with severe CAS.


Assuntos
Oclusão com Balão/efeitos adversos , Proteína C-Reativa/genética , Doenças das Artérias Carótidas/cirurgia , Manipulação da Coluna/efeitos adversos , Placa Aterosclerótica/cirurgia , Animais , Antígenos CD34/genética , Proteína C-Reativa/metabolismo , Artérias Carótidas/metabolismo , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Lesões das Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/fisiopatologia , Lesões das Artérias Carótidas/cirurgia , Dieta Hiperlipídica , Modelos Animais de Doenças , Regulação da Expressão Gênica/genética , Humanos , Placa Aterosclerótica/sangue , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/fisiopatologia , Coelhos
5.
Comput Methods Biomech Biomed Engin ; 22(4): 396-408, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30712373

RESUMO

The goal of this study was to develop a pragmatic approach to build patient-specific models of the peripheral artery that are aware of plaque inhomogeneity. Patient-specific models using element-specific material definition (to understand the role of plaque composition) and homogeneous material definition (to understand the role of artery diameter and thickness) were automatically built from intravascular ultrasound images of three artery segments classified with low, average, and high calcification. The element-specific material models had average surface stiffness values of 0.0735, 0.0826, and 0.0973 MPa/mm, whereas the homogeneous material models had average surface stiffness values of 0.1392, 0.1276, and 0.1922 MPa/mm for low, average, and high calcification, respectively. Localization of peak lumen stiffness and differences in patient-specific average surface stiffness for homogeneous and element-specific models suggest the role of plaque composition on surface stiffness in addition to local arterial diameter and thickness.


Assuntos
Artérias/fisiopatologia , Placa Aterosclerótica/fisiopatologia , Idoso , Artérias/diagnóstico por imagem , Fenômenos Biomecânicos , Simulação por Computador , Doença da Artéria Coronariana , Feminino , Análise de Elementos Finitos , Humanos , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Estresse Mecânico , Ultrassonografia
6.
Clin Calcium ; 29(2): 199-205, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30679401

RESUMO

Acute coronary syndromes are caused by sudden luminal thrombosis due to plaque rupture, plaque erosion, or calcified nodule in coronary atherosclerotic lesions. Coronary calcification is a well-known marker of atherosclerotic plaque burden. Accurate evaluation of coronary calcification is critical for percutaneous coronary intervention(PCI)strategy. Optical coherence tomography(OCT)is a high-resolution(10~20 µm)intravascular imaging technique that uses near infrared light to create images. OCT allows us to identify the details of coronary calcification and assess the effect of cutting balloon angioplasty and rotational atherectomy. Then, OCT is a useful technique to guide PCI in the severe calcified lesions.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Placa Aterosclerótica , Tomografia de Coerência Óptica/métodos , Calcificação Vascular , Doença da Artéria Coronariana/fisiopatologia , Humanos , Placa Aterosclerótica/fisiopatologia , Calcificação Vascular/fisiopatologia
7.
Med Biol Eng Comput ; 57(3): 731-740, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30374700

RESUMO

Stiffness of the arterial wall and atherosclerotic plaque components is a determinant of the stress field within plaques, which has been suggested to be an indicator of plaque vulnerability. The diversity and inhomogeneous structure of atherosclerotic lesions complicate the characterization of plaque components. In the present study, stiffness of the arterial wall and atherosclerotic plaque components in human coronary arteries was examined in early and developed atherosclerotic lesions. The force-spectroscopy mode of the atomic force microscope and histological examination were used for determination of elastic moduli at specified locations within samples. Fibrous cap (E = 14.1 ± 3.8 kPa) showed lower stiffness than the fibrous tissue beneath the lipid pool (E = 17.6 ± 3.2 kPa). Calcification zones (E = 96.1 ± 18.8 kPa) and lipid pools (E = 2.7 ± 1.8 kPa) were the stiffest and softest components of atherosclerotic lesions, respectively. The increase of media stiffness (%44.8) and reduction of the elastic modulus of the internal elastic lamina (%28.9) was observed in coronary arteries. Moreover, significant differences were observed between the stiffness of medial layer in diseased parts and free-plaque segments in incomplete plaques of coronary arteries. Our results can be used for better understanding of remodeling mechanisms of the arterial wall with plaque development. Graphical abstract Stiffness alteration of the arterial wall and atherosclerotic plaque components with plaque development in coronary arteries.


Assuntos
Vasos Coronários/fisiopatologia , Módulo de Elasticidade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/fisiopatologia , Calcinose/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Microscopia de Força Atômica
8.
Eur Heart J Acute Cardiovasc Care ; 8(1): 54-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29952633

RESUMO

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome with different causes, characterised by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography. Its prevalence ranges between 5% and 25% of all myocardial infarction. The prognosis is extremely variable, depending on the cause of MINOCA. The key principle in the management of this syndrome is to clarify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, cardiac enzymes, echocardiography, coronary angiography and left ventricular angiography represent the first level diagnostic investigations to identify the causes of MINOCA. Regional wall motion abnormalities at left ventricular angiography limited to a single epicardial coronary artery territory identify an 'epicardial pattern'whereas regional wall motion abnormalities extended beyond a single epicardial coronary artery territory identify a 'microvascular pattern'. The most common causes of MINOCA are represented by coronary plaque disease, coronary dissection, coronary artery spasm, coronary microvascular spasm, Takotsubo cardiomyopathy, myocarditis, coronary thromboembolism, other forms of type 2 myocardial infarction and MINOCA of uncertain aetiology. This review aims at summarising the diagnosis and management of MINOCA, according to the underlying physiopathology.


Assuntos
Doença da Artéria Coronariana , Circulação Coronária/fisiologia , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio , Placa Aterosclerótica , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Eletrocardiografia , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/fisiopatologia , Prognóstico , Fatores de Risco
9.
Med Biol Eng Comput ; 57(3): 715-729, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30357605

RESUMO

The hemodynamics conditioned by coronary geometry may play an important role in the creation of a pro-atherogenic environment in specific locations of the coronary tree. The aim of this study is to identify how several geometric parameters of the left coronary artery - cross-section areas, proximal left anterior descending artery length, angles between the branches and the septum, curvature and tortuosity - can be related with hemodynamic descriptors, using a computational fluid-structure interaction method. It is widely accepted that the hemodynamic indicators play an important role in identifying possible pro-atherogenic locations. A statistical study, using Pearson correlation coefficient and P value, was performed for a population study of 8 normal human left coronary arteries presenting right-dominant circulation. Within the study cases, arteries with high caliber (r = 0.88), high angles LMS-LAD (r = 0.49), LAD-LCx (r = 0.57) and LAD-Septum (r = 0.52), and high tortuosity LMS-LCx (r = 0.63) were correlated with a hemodynamic behavior propitious to plaque formation in the left anterior descending artery. In contrast, high proximal left anterior descending artery length (r = -0.41), high angle LMS-LCx (r = -0.59), high tortuosity LMS-LAD (r = -0.56) and LAD-LCx (r = -0.55) and high curvature of LMS (r = -0.60) and LCx (r = -0.56) can lead to non-favorable hemodynamic conditions for atheroma formation. Graphical abstract.


Assuntos
Aterosclerose/fisiopatologia , Vasos Coronários/anatomia & histologia , Modelos Cardiovasculares , Adulto , Angiografia por Tomografia Computadorizada/métodos , Simulação por Computador/estatística & dados numéricos , Vasos Coronários/fisiologia , Vasos Coronários/fisiopatologia , Feminino , Hemodinâmica , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/fisiopatologia
10.
World Neurosurg ; 121: e262-e276, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30261386

RESUMO

PURPOSE: Carotid atherosclerotic plaque occurs predominantly at the outer wall of the carotid sinus, and computational fluid dynamics (CFD) plays an important role in explaining plaque formation. The present study investigated the hemodynamic factors affecting carotid atherosclerotic stenosis. METHODS: Sixteen patients with normal carotid arteries and 16 with symptomatic stenotic carotid sinus underwent 3-dimensional angiographic imaging evaluations and were studied with CFD to simulate the complete 3-dimensional blood flow and hemodynamic parameter distribution in the carotid bifurcations. The hemodynamic parameters, including wall shear stress (WSS), dynamic and total pressure, total pressure gradient, strain rate, velocity, and velocity angle, were investigated. RESULTS: The atherosclerosis-prone outer lateral walls of the carotid sinus and the external carotid artery at its start had significantly (P < 0.05) low dynamic pressure, WSS, strain rate, and total pressure gradient but high static pressure. The blood flow near these walls with flow separation had significantly (P < 0.05) decreased velocity and dynamic pressures but a high velocity angle. The carotid divider had significantly (P < 0.05) elevated dynamic and total pressure, WSS, strain rate, and total pressure gradient but reduced static pressure. Additional stenosis occurred at the downstream area of stenosis with significantly (P < 0.05) decreased dynamic pressure, WSS, strain rate, and total pressure gradient similar to the wall at the sinus and the start of the external carotid artery. CONCLUSION: Significantly decreased vascular WSS, dynamic pressure, strain rate, and total pressure gradient are key to atherosclerotic plaque formation at the carotid sinus.


Assuntos
Doenças das Artérias Carótidas/fisiopatologia , Estenose das Carótidas/fisiopatologia , Hemodinâmica/fisiologia , Idoso de 80 Anos ou mais , Artéria Carótida Externa/fisiologia , Artéria Carótida Interna/fisiologia , Seio Carotídeo/fisiologia , Humanos , Hidrodinâmica , Angiografia por Ressonância Magnética , Masculino , Placa Aterosclerótica/fisiopatologia , Estresse Fisiológico/fisiologia
11.
Ann Biomed Eng ; 47(2): 425-438, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30488307

RESUMO

Arterial hemodynamics is markedly characterized by the presence of helical flow patterns. Previous observations suggest that arterial helical blood flow is of physiological significance, and that its quantitative analysis holds promise for clinical applications. In particular, it has been reported that distinguishable helical flow patterns are potentially atheroprotective in the carotid bifurcation as they suppress flow disturbances. In this context, there is a knowledge gap about the physiological significance of helical flow in coronary arteries, a prominent site of atherosclerotic plaque formation. This study aimed at the quantitative assessment of helical blood flow in coronary arteries, and to investigate its possible associations with vascular geometry and with atherogenic wall shear stress (WSS) phenotypes in a representative sample of 30 swine coronary arteries. This study demonstrates that in coronary arteries: (1) the hemodynamics is characterized by counter-rotating bi-helical flow structures; (2) unfavorable conditions of WSS are strongly and inversely associated with helicity intensity (r = - 0.91; p < 0.001), suggesting an atheroprotective role for helical flow in the coronary tree; (3) vascular torsion dictates helical flow features (r = 0.64; p < 0.001). The findings of this work support future studies on the role of helical flow in atherogenesis in coronary arteries.


Assuntos
Aterosclerose/fisiopatologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Modelos Cardiovasculares , Placa Aterosclerótica/fisiopatologia , Animais , Aterosclerose/prevenção & controle , Velocidade do Fluxo Sanguíneo , Modelos Animais de Doenças , Placa Aterosclerótica/prevenção & controle , Resistência ao Cisalhamento , Suínos , Porco Miniatura
12.
Ann Biomed Eng ; 47(2): 439-452, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30488310

RESUMO

We propose a multiphysical mathematical model by fully coupling lipid deposition, monocytes/macrophages recruitment and angiogenesis to investigate the pathophysiological responses of an atherosclerotic plaque to the dynamic changes in the microenvironment. The time evolutions of cellular (endothelial cells, macrophages, smooth muscle cells, etc.) and acellular components (low density lipoprotein, proinflammatory cytokines, extravascular plasma concentration, etc.) within the plaque microenvironment are assessed quantitatively. The thickening of the intima, the distributions of the lipid and inflammatory factors, and the intraplaque hemorrhage show a qualitative consistency with the MRI and histology data. Models with and without angiogenesis are compared to demonstrate the important role of neovasculature in the accumulation of blood-borne components in the atherosclerotic lesion by extravasation from the leaky vessel wall, leading to the formation of a lipid core and an inflammatory microenvironment, which eventually promotes plaque destabilization. This model can serve as a theoretical platform for the investigation of the pathological mechanisms of plaque progression and may contribute to the optimal design of atherosclerosis treatment strategies, such as lipid-lowering or anti-angiogenetic therapies.


Assuntos
Metabolismo dos Lipídeos , Imagem por Ressonância Magnética , Modelos Cardiovasculares , Neovascularização Patológica , Placa Aterosclerótica , Animais , Humanos , Inflamação/diagnóstico por imagem , Inflamação/metabolismo , Inflamação/fisiopatologia , Inflamação/terapia , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/metabolismo , Neovascularização Patológica/fisiopatologia , Neovascularização Patológica/terapia , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/metabolismo , Placa Aterosclerótica/fisiopatologia , Placa Aterosclerótica/terapia
13.
Eur Radiol ; 29(5): 2378-2387, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30523456

RESUMO

OBJECTIVES: We sought to investigate the diagnostic performance of coronary CT angiography (cCTA)-derived plaque markers combined with deep machine learning-based fractional flow reserve (CT-FFR) to identify lesion-specific ischemia using invasive FFR as the reference standard. METHODS: Eighty-four patients (61 ± 10 years, 65% male) who had undergone cCTA followed by invasive FFR were included in this single-center retrospective, IRB-approved, HIPAA-compliant study. Various plaque markers were derived from cCTA using a semi-automatic software prototype and deep machine learning-based CT-FFR. The discriminatory value of plaque markers and CT-FFR to identify lesion-specific ischemia on a per-vessel basis was evaluated using invasive FFR as the reference standard. RESULTS: One hundred three lesion-containing vessels were investigated. 32/103 lesions were hemodynamically significant by invasive FFR. In a multivariate analysis (adjusted for Framingham risk score), the following markers showed predictive value for lesion-specific ischemia (odds ratio [OR]): lesion length (OR 1.15, p = 0.037), non-calcified plaque volume (OR 1.02, p = 0.007), napkin-ring sign (OR 5.97, p = 0.014), and CT-FFR (OR 0.81, p < 0.0001). A receiver operating characteristics analysis showed the benefit of identifying plaque markers over cCTA stenosis grading alone, with AUCs increasing from 0.61 with ≥ 50% stenosis to 0.83 with addition of plaque markers to detect lesion-specific ischemia. Further incremental benefit was realized with the addition of CT-FFR (AUC 0.93). CONCLUSION: Coronary CTA-derived plaque markers portend predictive value to identify lesion-specific ischemia when compared to cCTA stenosis grading alone. The addition of CT-FFR to plaque markers shows incremental discriminatory power. KEY POINTS: • Coronary CT angiography (cCTA)-derived quantitative plaque markers of atherosclerosis portend high discriminatory power to identify lesion-specific ischemia. • Coronary CT angiography-derived fractional flow reserve (CT-FFR) shows superior diagnostic performance over cCTA alone in detecting lesion-specific ischemia. • A combination of plaque markers with CT-FFR provides incremental discriminatory value for detecting flow-limiting stenosis.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Diagnóstico por Computador/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Aprendizado de Máquina , Placa Aterosclerótica/diagnóstico , Estenose Coronária/etiologia , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Placa Aterosclerótica/fisiopatologia , Curva ROC , Estudos Retrospectivos
14.
Med Hypotheses ; 122: 106-110, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30593390

RESUMO

Atherosclerosis is a common disease whose complications, such as myocardial infarction, are a leading cause of mortality worldwide. Therefore, ideas which try to explain the circumstances of atherosclerotic plaque initiation and progression are warranted. We hypothesize that low-grade inflammation in early life (especially an imbalance between pro- and anti-inflammatory macrophages) triggers a "butterfly effect" within the arterial wall by initiating a sequence of processes that finally leads to atherosclerotic plaque development and progression. Therefore, pharmacological and non-pharmacological interventions aimed to prevent atherosclerosis development should be applied not only in the adult population over 40 years old (according to current American and European guidelines) but should start in early life.


Assuntos
Aterosclerose/fisiopatologia , Inflamação/patologia , Placa Aterosclerótica/fisiopatologia , Adolescente , Adulto , Idoso , Artérias/patologia , Aterosclerose/etiologia , Criança , Progressão da Doença , Europa (Continente) , Humanos , Macrófagos/metabolismo , Pessoa de Meia-Idade , Modelos Teóricos , Placa Aterosclerótica/etiologia , Fatores de Risco , Estados Unidos , Adulto Jovem
16.
Circ J ; 83(1): 101-109, 2018 12 25.
Artigo em Inglês | MEDLINE | ID: mdl-30404973

RESUMO

BACKGROUND: Cardiac rehabilitation (CR) is an established multidisciplinary secondary preventive program. We investigated the effects of CR involving intensive physical activity (PA) on coronary plaque volume and components in patients with acute coronary syndrome (ACS).Methods and Results:We enrolled 32 consecutive patients with ACS in early phase II CR and randomly assigned them to an intensive CR group (n=18; CR participation ≥twice/week, daily PA ≥9,000 steps) or a standard CR group (n=14; CR participation ≥once/2weeks, daily PA ≥6,000 steps). Serial integrated backscatter intravascular ultrasound was performed for non-culprit lesions at baseline and after 8 months. Baseline clinical data were identical between the 2 groups. Unexpectedly, CR participation and PA did not differ significantly between the 2 groups, and there was no significant difference in plaque volume (PV) or components between the 2 groups. Subsequently, we classified the patients into 2 groups according to median PA (7,000 steps). There were significant differences in percent change of PV and of lipid volume between these 2 groups. In addition, these changes were negatively and independently correlated with PA. CONCLUSIONS: No significant difference was observed in PV or components between the intensive CR and the standard CR groups. Intensive PA, however, may retard coronary PV and ameliorate lipid component in patients with ACS participating in late phase II CR.


Assuntos
Síndrome Coronariana Aguda , Reabilitação Cardíaca , Doença da Artéria Coronariana , Exercício , Placa Aterosclerótica , Ultrassonografia de Intervenção , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/patologia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/reabilitação , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Placa Aterosclerótica/fisiopatologia , Placa Aterosclerótica/reabilitação , Estudos Prospectivos
17.
Curr Opin Cardiol ; 33(6): 638-644, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30303854

RESUMO

PURPOSE OF REVIEW: The natural history of coronary atherosclerosis is complex and atherosclerotic plaques exhibit large morphologic and functional variability within the same individual as well as over time. The purpose of this article is to review the role of blood flow patterns and shear stress on the development of microvascular and epicardial endothelial dysfunction and atherosclerosis progression. RECENT FINDINGS: Recent breakthroughs in cardiovascular imaging have facilitated in-vivo characterization of the anatomic and functional characteristics of atherosclerotic plaques and have highlighted the role of endothelial shear stress and epicardial and microvascular endothelial dysfunction in the natural history of coronary atherosclerosis. SUMMARY: There is an important need to identify individual lesions which may progress to vulnerable plaque in order to provide early therapeutic management. Evaluation of endothelial shear stress, local blood flow patterns, epicardial and microvascular endothelial dysfunction, as well as their complex associations might indicate those patients who have microvascular endothelial dysfunction and increased risk for upstream epicardial endothelial dysfunction and plaque progression. Such high-risk patients could potentially be targeted for more intensive therapeutic strategies to prevent the progression of both microvascular and epicardial atherosclerotic manifestations.


Assuntos
Doença da Artéria Coronariana/etiologia , Circulação Coronária/fisiologia , Endotélio Vascular/fisiopatologia , Microcirculação/fisiologia , Placa Aterosclerótica/etiologia , Fluxo Sanguíneo Regional/fisiologia , Resistência ao Cisalhamento/fisiologia , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Progressão da Doença , Humanos , Placa Aterosclerótica/fisiopatologia
18.
Curr Opin Cardiol ; 33(6): 645-652, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30307412

RESUMO

PURPOSE OF REVIEW: Prior investigations have shown the close association between coronary artery calcification (CAC) and total atherosclerotic plaque burden as well as the risk of cardiovascular and all-cause mortality. However, recent pathologic and imaging-based studies suggested that massive dense calcifications are usually associated with stable plaque; whereas, micro calcifications, especially in the thin fibrous cap, are related to vulnerable characteristics. Further, the molecular mechanisms for initiation/progression of vascular calcification are highly complex and still need to be elucidated. In this manuscript, we discuss recent advancement in our understanding of CAC from the basic, pathologic, and clinical perspectives. RECENT FINDINGS: Research on the relationship between genetic polymorphisms and CAC has been growing and may potentially lead to future precision-based medicine. In basic research field, more attention has been focused on the relationship between inflammation and vascular calcification. Large-scale imaging based studies support the association between statin and calcification progression, maybe one of the ways by which statins prevent cardiovascular events. Nevertheless, the mechanism responsible for this effect is still not fully understood. Optical coherence tomography has improved resolution to detect CAC over traditional CT and may be especially promising for the detection of calcified nodules. SUMMARY: A better understanding of CAC in all of its forms will advance our understanding of its natural history of atherosclerosis. More work is needed to understand the basic molecular mechanisms responsible for the initiation/progression of CAC, which may eventually lead to the development of effective treatments for atherosclerosis.


Assuntos
Doença da Artéria Coronariana/patologia , Circulação Coronária/fisiologia , Vasos Coronários/patologia , Placa Aterosclerótica/patologia , Tomografia de Coerência Óptica/métodos , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Progressão da Doença , Humanos , Placa Aterosclerótica/fisiopatologia
19.
BMJ Open ; 8(10): e022757, 2018 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-30297348

RESUMO

OBJECTIVE: The aim of this study was to explore the relationship between low-density lipoprotein cholesterol:high-density lipoprotein cholesterol (LDL-C:HDL-C) ratio and common carotid atherosclerotic plaque (CCAP) among obese adults of Uygur community in Xinjiang, China. DESIGN: A hospital-based cross-sectional study. SETTING: First Affiliated Hospital of Xinjiang Medical University. PARTICIPANTS: A total of 1449 obese adults of Uygur population who were free of coronary artery disease were included in our study from 1 January 2014 to 31 December 2016. METHODOLOGY: Lipid profiles, other routine laboratory parameters and intima-media thickness of the common carotid artery were measured in all participants. Multivariate logistic regression analysis was used to examine the association between LDL-C:HDL-C ratio and CCAP. RESULTS: Four hundred and fifteen (28.64%) participants had CCAP. Participants with CCAP had significantly higher LDL-C:HDL-C ratio compared with those without CCAP (3.21 [2.50, 3.88] vs 2.33 [1.95, 2.97], p<0.001). Multivariate logistic regression analysis showed high LDL-C:HDL-C ratio as independent predictor of CCAP after adjusting for conventional cardiovascular risk factors. The top LDL-C:HDL-C ratio quartile (≥3.25) had an OR of 9.355 (95% CI 6.181 to 14.157) compared with the bottom quartile (<2.07) of LDL-C:HDL-C ratio (p<0.001) after adjustment for age, body mass index, smoking, diabetes mellitus and serum level of total cholesterol. CONCLUSION: CCAP is highly prevalent in Uygur obese adults. A high LDL-C:HDL-C ratio is an independent predictor of CCAP. It may help identify obese individuals who are at high risk of CCAP and who may benefit from intensive LDL-lowering therapy.


Assuntos
Dislipidemias/fisiopatologia , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Obesidade/fisiopatologia , Placa Aterosclerótica/fisiopatologia , Adulto , Idoso , Espessura Intima-Media Carotídea , China/epidemiologia , Estudos Transversais , Dislipidemias/sangue , Dislipidemias/epidemiologia , Feminino , Humanos , Metabolismo dos Lipídeos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/epidemiologia , Placa Aterosclerótica/sangue , Placa Aterosclerótica/epidemiologia , Prevalência , Fatores de Risco
20.
Biol Res ; 51(1): 33, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30185234

RESUMO

BACKGROUND: New evidence demonstrates that aging and dyslipidemia are closely associated with oxidative stress, DNA damage and apoptosis in some cells and extravascular tissues. However, in monocytes, which are naturally involved in progression and/or resolution of plaque in atherosclerosis, this concurrence has not yet been fully investigated. In this study, we evaluated the influence of aging and hypercholesterolemia on serum pro-inflammatory cytokines, oxidative stress, DNA damage and apoptosis in monocytes from apolipoprotein E-deficient (apoE-/-) mice compared with age-matched wild-type C57BL/6 (WT) mice. Experiments were performed in young (2-months) and in old (18-months) male wild-type (WT) and apoE-/- mice. RESULTS: Besides the expected differences in serum lipid profile and plaque formation, we observed that atherosclerotic mice exhibited a significant increase in monocytosis and in serum levels of pro-inflammatory cytokines compared to WT mice. Moreover, it was observed that the overproduction of ROS, led to an increased DNA fragmentation and, consequently, apoptosis in monocytes from normocholesterolemic old mice, which was aggravated in age-matched atherosclerotic mice. CONCLUSIONS: In this study, we demonstrate that a pro-inflammatory systemic status is associated with an impairment of functionality of monocytes during aging and that these parameters are fundamental extra-arterial contributors to the aggravation of atherosclerosis. The present data open new avenues for the development of future strategies with the purpose of treating atherosclerosis.


Assuntos
Envelhecimento/fisiologia , Apoptose/fisiologia , Aterosclerose/sangue , Dano ao DNA/fisiologia , Monócitos/patologia , Estresse Oxidativo/fisiologia , Espécies Reativas de Oxigênio/sangue , Envelhecimento/sangue , Animais , Aterosclerose/fisiopatologia , Biomarcadores/sangue , Modelos Animais de Doenças , Hiperlipidemias/sangue , Hiperlipidemias/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Placa Aterosclerótica/sangue , Placa Aterosclerótica/fisiopatologia
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