scholarly journals Correlation of Serum Uric Acid Levels with Nonculprit Plaque Instability in Patients with Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Donghui Zhang ◽  
Ruoxi Zhang ◽  
Ning Wang ◽  
Lin Lin ◽  
Bo Yu
Keyword(s):  
Optical Coherence Tomography ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Elevated Serum ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Instability ◽  
Coronary Syndrome ◽  
Fibrous Cap ◽  
Coronary Syndromes

Elevated serum uric acid (SUA) level is known to be a prognostic factor in patients with acute coronary syndrome (ACS). However, the correlation between SUA level and coronary plaque instability has not been fully evaluated. The aim of this study was to investigate the association between SUA level and plaque instability of nonculprit lesions in patients with ACS using optical coherence tomography. A total of 150 patients with ACS who underwent 3-vessel optical coherence tomography were selected. Patients were classified into 3 groups according to tertiles of SUA level. There was a trend towards a thinner fibrous cap (0.15 ± 0.06 versus 0.07 ± 0.01 versus 0.04 ± 0.01 mm2, p<0.001) and a wider mean lipid arc (169.41 ± 33.16 versus 177.22 ± 37.76 versus 222.43 ± 47.65°, p<0.001) with increasing SUA tertile. The plaques of the high and intermediate tertile groups had a smaller minimum lumen area than the low tertile group (6.02 ± 1.11 versus 5.38 ± 1.28 mm2, p<0.001). In addition, thin-cap fibroatheromas, microvessels, macrophages, and cholesterol crystals were more frequent in the high tertile group than the low and intermediate groups. Multivariate analysis showed SUA level to be a predictor of plaque instability.

scholarly journals Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Sebastian Reith ◽  
Andrea Milzi ◽  
Enrico Domenico Lemma ◽  
Rosalia Dettori ◽  
Kathrin Burgmaier ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Optical Coherence Tomography ◽  
Finite Elements ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Finite Elements Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. Methods Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA. Results Minimal (139.8 ± 32.8° vs. 165.6 ± 21.6°, p < 0.001) and mean ICA (164.1 ± 14.3° vs. 176.0 ± 8.4°, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797–0.882, p < 0.001, optimal cut-off 175.9°); younger age (OR 0.95 per year, 95% CI 0.92–0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41–3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68–0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47–25.64, p < 0.001) were determinants of ICA < 175.9°. A lower ICA predicted ACS (OR for 10°-variation 0.25, 95% CI 0.13–0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion’s fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. Conclusion Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.

Impact of Accumulated Serum Uric Acid on Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes in Patients with Acute Coronary Syndrome

Cardiology ◽  
2018 ◽  
Vol 141 (4) ◽  
pp. 190-198 ◽  
Author(s):  
Nobuaki Kobayashi ◽  
Kuniya Asai ◽  
Masafumi Tsurumi ◽  
Yusaku Shibata ◽  
Hirotake Okazaki ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Plaque Morphology ◽  
Optical Coherence ◽  
Cardiac Mortality ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
Very High

Objectives: We aimed to examine the relations of very high levels of serum uric acid (sUA) with features of culprit lesion plaque morphology determined by optical coherence tomography (OCT) and adverse clinical outcomes in patients with acute coronary syndrome (ACS). Methods: We retrospectively compared ACS patients according to sUA levels of > 8.0 mg/dL (n = 169), 7.1–8.0 mg/dL (n = 163), 6.1–7.0 mg/dL (n = 259), and ≤6.0 mg/dL (n = 717). Angiography and OCT findings were analyzed in patients with preintervention OCT and the 4 sUA groups (> 8.0 mg/dL, n = 61; 7.1–8.0 mg/dL, n = 72; 6.1–7.0 mg/dL, n = 131; and ≤6.0 mg/dL, n = 348) were compared. Results: Cardiogenic shock was more prevalent in ACS patients with sUA > 8.0 mg/dL (22% vs. 19% vs. 10% vs. 6%, p < 0.001). Plaque rupture was observed more prevalently by OCT in patients with sUA > 8.0 mg/dL (67% vs. 47% vs. 56% vs. 45%, p = 0.027). At the 2-year follow-up, Kaplan-Meier estimates showed higher cardiac mortality in patients with sUA > 8.0 mg/dL (25% vs. 12% vs. 5% vs. 5%, p < 0.001). After adjusting for traditional cardiovascular risk factors and creatinine levels, patients with sUA > 8.0 mg/dL showed a 4.5-fold increased risk in 2-year cardiac death by multivariate Cox proportional hazard analysis (hazard ratio 4.54, 95% confidence interval 2.98–6.91; p < 0.001). Conclusions: Very high sUA levels like > 8.0 mg/dL are the primary predictor of 2-year cardiac mortality and could partly be caused by adverse effects of accumulated sUA on plaque morphology in patients with ACS.

scholarly journals Potential relationship between high wall shear stress and plaque rupture that cause acute coronary syndrome: insights from optical coherence tomography based computational fluid dynamic simulation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Fukuyama ◽  
H Otake ◽  
F Seike ◽  
H Kawamori ◽  
T Toba ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Shear Stress ◽  
Acute Coronary Syndrome ◽  
Wall Shear Stress ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Lumen Area ◽  
Segmental Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background The direct relationship between plaque rupture (PR) that cause acute coronary syndrome (ACS) and wall shear stress (WSS) remains uncertain. Methods From the Kobe University ACS-OCT registry, one hundred ACS patients whose culprit lesions had PR documented by optical coherence tomography (OCT) were enrolled. Lesion-specific 3D coronary artery models were created using OCT data. Specifically, at the ruptured portion, the tracing of the luminal edge of the residual fibrous cap was smoothly extrapolated to reconstruct the luminal contour before PR. Then, WSS was computed from computational fluid dynamics (CFD) analysis by a single core laboratory. Relationships between WSS and the location of PR were assessed with 1) longitudinal 3-mm segmental analysis and 2) circumferential analysis. In the longitudinal segmental analysis, each culprit lesion was subdivided into five 3-mm segments with respect to the minimum lumen area (MLA) location at the centered segment (Figure. 1). In the circumferential analysis, we measured WSS values at five points from PR site and non-PR site on the cross-sections with PR. Also, each ruptured plaque was categorized into the lateral type PR (L-PR), central type PR (C-PR), and others according to the relation between the site of tearing and the cavity (Figure. 2). Results In the longitudinal 3-mm segmental analysis, the incidences of PR at upstream (UP1 and 2), MLA, and downstream (DN1 and 2) were 45%, 40%, and 15%, respectively. The highest average WSS was located in UP1 in the upstream PR (UP1: 15.5 (10.4–26.3) vs. others: 6.8 (3.3–14.7) Pa, p&lt;0.001) and MLA segment in the MLA PR (MLA: 18.8 (6.0–34.3) vs. others: 6.5 (3.1–11.8) Pa, p&lt;0.001), and the second highest WSS was located at DN1 in the downstream PR (DN1: 5.8 (3.7–11.5) vs. others: 5.5 (3.7–16.5) Pa, p=0.035). In the circumferential analysis, the average WSS at PR site was significantly higher than that of non-PR site (18.7 (7.2–35.1) vs. 13.9 (5.2–30.3) Pa, p&lt;0.001). The incidence of L-PR, C-PR, and others were 51%, 42%, and 7%, respectively. In the L-PR, the peak WSS was most frequently observed in the lateral site (66.7%), whereas that in the C-PR was most frequently observed in the center site (70%) (Figure. 3). In the L-PR, the peak WSS value was significantly lower (44.6 (19.6–65.2) vs. 84.7 (36.6–177.5) Pa, p&lt;0.001), and the thickness of broken fibrous cap was significantly thinner (40 (30–50) vs. 80 (67.5–100) μm, p&lt;0.001), and the lumen area at peak WSS site was significantly larger than those of C-PR (1.5 (1.3–2.0) vs. 1.4 (1.1–1.6) mm2, p=0.008). Multivariate analysis demonstrated that the presence of peak WSS at lateral site, thinner broken fibrous cap thickness, and larger lumen area at peak WSS site were independently associated with the development of the L-PR. Conclusions A combined approach with CFD simulation and morphological plaque evaluation by using OCT might be helpful to predict future ACS events induced by PR. Funding Acknowledgement Type of funding source: None

scholarly journals Renal Allograft-Related Inflammation and Accelerated Coronary-Artery Disease: A Case Report

2021 ◽  
Author(s):  
Rainer Ullrich Pliquett ◽  
Andrea Tannapfel ◽  
Sait Sebastian Daneschnejad
Keyword(s):  
Kidney Transplant ◽  
Systemic Inflammation ◽  
Renal Allograft ◽  
Active Role ◽  
Coronary Plaque ◽  
Plaque Instability ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Artery Disease

Background: Although persistent systemic inflammation is considered to be predictive for future cardiovascular events, it remains unclear whether or not C-reactive protein (CrP) plays an active role in coronary-plaque instability. Here, we report a case of a patient with failed and super-infected renal allograft as a source for systemic inflammation presenting with repeat acute coronary syndromes. Case presentation: A 52-years-old male type-2 diabetic with a failed kidney transplant who was hospitalized for acute urinary-tract infection. In the presence of other, classic cardiovascular risk factors, peak values of CrP coincided with episodes of unstable angina treated by cardiologic interventions. Besides pyelonephritis, the histological examination of the kidney transplant revealed signs of chronic rejection and the presence of a renal cell carcinoma in situ. Once the renal allograft has been removed, systemic inflammation was attenuated, the patient was not rehospitalized for acute-coronary syndrome within the next 12 months. Conclusion: In this case, systemic inflammation was paralleled by instability of coronary plaques as documented by repeat coronary angiograms.

scholarly journals Using optical coherence tomography and intravascular ultrasound imaging to quantify coronary plaque cap thickness and vulnerability: a pilot study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Rui Lv ◽  
Akiko Maehara ◽  
Mitsuaki Matsumura ◽  
Liang Wang ◽  
Qingyu Wang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intravascular Ultrasound ◽  
Coronary Plaque ◽  
Mean Value ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Fibrous Cap ◽  
Vulnerable Plaques ◽  
The Mean ◽  
Thickness Measurements

Abstract Background Detecting coronary vulnerable plaques in vivo and assessing their vulnerability have been great challenges for clinicians and the research community. Intravascular ultrasound (IVUS) is commonly used in clinical practice for diagnosis and treatment decisions. However, due to IVUS limited resolution (about 150–200 µm), it is not sufficient to detect vulnerable plaques with a threshold cap thickness of 65 µm. Optical Coherence Tomography (OCT) has a resolution of 15–20 µm and can measure fibrous cap thickness more accurately. The aim of this study was to use OCT as the benchmark to obtain patient-specific coronary plaque cap thickness and evaluate the differences between OCT and IVUS fibrous cap quantifications. A cap index with integer values 0–4 was also introduced as a quantitative measure of plaque vulnerability to study plaque vulnerability. Methods Data from 10 patients (mean age: 70.4; m: 6; f: 4) with coronary heart disease who underwent IVUS, OCT, and angiography were collected at Cardiovascular Research Foundation (CRF) using approved protocol with informed consent obtained. 348 slices with lipid core and fibrous caps were selected for study. Convolutional Neural Network (CNN)-based and expert-based data segmentation were performed using established methods previously published. Cap thickness data were extracted to quantify differences between IVUS and OCT measurements. Results For the 348 slices analyzed, the mean value difference between OCT and IVUS cap thickness measurements was 1.83% (p = 0.031). However, mean value of point-to-point differences was 35.76%. Comparing minimum cap thickness for each plaque, the mean value of the 20 plaque IVUS-OCT differences was 44.46%, ranging from 2.36% to 91.15%. For cap index values assigned to the 348 slices, the disagreement between OCT and IVUS assignments was 25%. However, for the OCT cap index = 2 and 3 groups, the disagreement rates were 91% and 80%, respectively. Furthermore, the observation of cap index changes from baseline to follow-up indicated that IVUS results differed from OCT by 80%. Conclusions These preliminary results demonstrated that there were significant differences between IVUS and OCT plaque cap thickness measurements. Large-scale patient studies are needed to confirm our findings.

scholarly journals Optical Coherence Tomography Analysis of Attenuated Plaques Detected by Intravascular Ultrasound in Patients with Acute Coronary Syndromes

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Takashi Kubo ◽  
Yoshiki Matsuo ◽  
Yasushi Ino ◽  
Takashi Tanimoto ◽  
Kohei Ishibashi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intravascular Ultrasound ◽  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Ultrasound Attenuation ◽  
Coronary Syndromes ◽  
Tomography Analysis ◽  
Important Marker

Background. Recent intravascular ultrasound (IVUS) studies have demonstrated that hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium is common in acute coronary syndrome. Such “attenuated plaque” may be an IVUS characteristic of unstable lesion.Methods. We used optical coherence tomography (OCT) in 104 patients with unstable angina to compare lesion characteristics between IVUS-detected attenuated plaque and nonattenuated plaque.Results. IVUS-detected attenuated plaque was observed in 41 (39%) patients. OCT-detected lipidic plaque (88% versus 49%, ), thin-cap fibroatheroma (48% versus 16%, ), plaque rupture (44% versus 11%, ), and intracoronary thrombus (54% versus 17%, ) were more often seen in IVUS-detected attenuated plaques compared with nonattenuated plaques.Conclusions. IVUS-detected attenuated plaque has many characteristics of unstable coronary lesion. The presence of attended plaque might be an important marker of lesion instability.

scholarly journals Level of Serum Uric Acid Along with Other Demographic Parameters in Patients with Acute Coronary Syndrome : A Study of 55 Cases from Chittagong

2014 ◽  
Vol 13 (2) ◽  
pp. 55-58
Author(s):  
Hasan Murad ◽  
Rajiv Dey ◽  
Md Atiquel Islam Chowdhury ◽  
Hridi Hedayet Ullah ◽  
Md Abdur Rouf
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Uric Acid ◽  
Unstable Angina ◽  
Serum Uric Acid ◽  
Troponin I ◽  
Elevated Serum ◽  
Common Finding ◽  
Coronary Syndrome

The association between serum uric acid and ischemic heart disease remains controversial and it has been difficult to identify the specific role of elevated serum uric acid because of its association with established cardiovascular risk factors such as hypertension, diabetes mellitus, hyperlipidaemia and obesity. Our objective was to study the association of serum uric acid level with confirmed cases of Acute Coronary Syndrome i.e. Unstable Angina, Acute Myocardial Infarction(AMI). The study was conducted in Chittagong Medical College (CMC) & University of Science and Technology(USTC) and nearby diagnostic centre. The study was based on Patients with Acute Coronary Syndrome proved by ECG and/or raised serum Troponin I. The aim of the study was to determine the relationship between serum uric acid and Unstable angina or myocardial infacrtion. There were 35% males & 5% females. The mean age of respondent was 50 years and age ranges from 35 to 70 years. In this study 50 cases of diagnosed myocardial infarction were selected and subsequently investigated with ECG, Radiological and Echocardiographic investigations. Increased serum uric acid levels are a common finding in patients with high blood pressure, insulin resistance, obesity and Cardiovascular disease. The clinical findings, chest X-ray and ECG findings of patients with risk factors for myocardial infarction were extensively studied and the findings are consistent with findings stated in textbooks.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21070

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