scholarly journals Epicardial Adipose Tissue Volume Is Associated with High Risk Plaque Profiles in Suspect CAD Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Dongkai Shan ◽  
Guanhua Dou ◽  
Junjie Yang ◽  
Xi Wang ◽  
Jingjing Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
High Risk ◽  
Atherosclerotic Plaque ◽  
Plaque Burden ◽  
Multivariable Logistic Regression Analysis ◽  
Plaque Composition ◽  
Coronary Syndrome ◽  
Risk Predictor ◽  
Noncalcified Plaque

Objective. To explore the association between EAT volume and plaque precise composition and high risk plaque detected by coronary computed tomography angiography (CCTA). Methods. 101 patients with suspected coronary artery disease (CAD) underwent CCTA examination from March to July 2019 were enrolled, including 70 cases acute coronary syndrome (ACS) and 31 cases stable angina pectoris (SAP). Based on CCTA image, atherosclerotic plaque precise compositions were analyzed using dedicated quantitative software. High risk plaque was defined as plaque with more than 2 high risk features (spotty calcium, positive remolding, low attenuation plaque, napkin-ring sign) on CCTA image. The association between EAT volume and plaque composition was assessed as well as the different of correlation between ACS and SAP was analyzed. Multivariable logistic regression analysis was used to explore whether EAT volume was independent risk factors of high risk plaque (HRP). Results. EAT volume in the ACS group was significantly higher than that of the SAP group ( 143.7 ± 49.8  cm3 vs. 123.3 ± 39.2  cm3, P = 0.046 ). EAT volume demonstrated a significant positive correlation with total plaque burden ( r = 0.298 , P = 0.003 ), noncalcified plaque burden ( r = 0.245 , P = 0.013 ), lipid plaque burden ( r = 0.250 , P = 0.012 ), and homocysteine ( r = 0.413 , P ≤ 0.001 ). In ACS, EAT volume was positively correlated with total plaque burden ( r = 0.309 , P = 0.009 ), noncalcified plaque burden ( r = 0.242 , P = 0.044 ), and lipid plaque burden ( r = 0.240 , P = 0.045 ); however, no correlation was observed in SAP. Patients with HRP have larger EAT volume than those without HRP ( 169 ± 6.2  cm3 vs. 130.6 ± 5.3  cm3, P = 0.002 ). After adjustment by traditional risk factors and coronary artery calcium score (CACS), EAT volume was an independent risk predictor of presence of HRP (OR: 1.018 (95% CI: 1.006-1.030), P = 0.004 ). Conclusions. With the increasing EAT volume, more dangerous plaque composition burdens increase significantly. EAT volume is a risk predictor of HRP independent of convention cardiovascular risk factors and CACS, which supports the potential impact of EAT on progression of coronary atherosclerotic plaque.

Abstract 1985: Increased Plaque Mass, but not Relative Plaque Composition, Distinguishes Culprit Coronary Artery Lesions in Patients with Acute Coronary Syndrome: A Lesion Analysis by Intravascular Ultrasound Histology

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Andrew Frutkin ◽  
Sameer K Mehta ◽  
Justin R McCrary ◽  
John House ◽  
Steven P Marso
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Atherosclerotic Plaque ◽  
Obstructive Coronary Artery Disease ◽  
Plaque Burden ◽  
Lumen Area ◽  
Coronary Artery Lesions ◽  
Plaque Composition ◽  
Artery Disease

INTRODUCTION Intravascular ultrasound Virtual Histology (IVUS-VH) uses radiofrequency analysis to measure coronary artery plaque geometry and classify plaque components into one of four categories: fibrous, fibrofatty, necrotic or calcified. We hypothesized that patients with acute coronary artery syndrome (ACS) would have atherosclerotic plaque geometry and composition that differs from patients with stable, obstructive coronary artery disease. METHODS In a crossectional study we used IVUS-VH to image 38 culprit lesions of 28 ACS patients and 104 lesions of 71 non-ACS patients prior to intervention. In both ACS and non-ACS patients, culprit lesions were defined as the site of percutaneous coronary intervention with at least 3 contiguous frames of > 40% percent plaque burden (100 × [external elastic membrane (EEM ) area − lumen area]/EEM area ) and a neointimal thickness > 600 um subtending an arc of > 10% vessel circumference. Plaque geometry and composition were measured with IVUS-VH software (pcVH v.2.2, Volcano Corp). A remodeling index was calculated as the ratio of the EEM area at the frame of the minimal lumen area to the EEM area of a reference frame (within 10 mm of MLA). RESULTS Lesions of ACS patients were longer and had greater plaque volume than non-ACS patients (Table ). The proportions of IVUS-derived plaque components were similar in both ACS and non-ACS culprit lesions (Table ). CONCLUSION Culprit coronary artery lesions in ACS patients have greater plaque mass than in non-ACS patients, but relative plaque composition is similar between these patient populations. Measurements of atherosclerotic plaque mass may discriminate better than plaque composition as to which patients with severe, obstructive coronary artery disease are at greatest risk of coronary artery thrombosis. Longitudinal studies using IVUS-VH will best resolve which IVUS-VH measurements of plaque geometry and composition have greatest predictive value.

Abstract 685: Atherosclerotic Plaque Composition Among patients with Stenotic Coronary Artery Disease on Non Invasive Coronary CT Angiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Gudrun Feuchtner ◽  
Daniel Jodocy ◽  
Ricardo C Cury ◽  
Guy Friedrich ◽  
Roger S Blumenthal ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Atherosclerotic Plaque ◽  
Coronary Ct Angiography ◽  
Mixed Type ◽  
Plaque Burden ◽  
Plaque Composition ◽  
Non Invasive ◽  
Coronary Ct ◽  
Artery Disease

Coronary CT angiography (CCTA) has emerged as a promising non-invasive tool to rule out significant coronary artery disease (CAD) as well provides additional information about atherosclerotic plaque composition. In this study we aim to assess the whether differences in plaque composition exist across patients with varying degree of stenotic CAD disease. The study population consisted of 548 subjects (58±11 years, 45% women) referred for 64-slice multi-detector CCTA for assessment of underlying degree of coronary artery disease. We analyzed plaque characteristics on a per-segment basis according to the modified AHA classification. Plaques types were classified as non-calcified, calcified, mixed type 1 (predominantly non-calcified) or mixed type 2 (predominantly non-calcified). Overall 194 (35%) had normal coronaries without evidence of plaque. In the remaining 354 patients, 187 (34%) and 167 (31%) were found to have luminal narrowing of <50% and ≥70% in at-least one coronary artery segment, respectively. Those with a higher degree of stenotic CAD demonstrated significantly more coronary segments with exclusively calcified and mixed plaques (table ). Among those with significant CAD, the overall proportion of plaque burden was more likely to be mixed predominantly calcified (18% vs. 38% vs. 44%) as well as mixed predominantly non-calcified in nature; whereas were less likely to be exclusively non-calcified (39% vs. 20% vs. 16%). Only 3/208 (1.3%) patients without any underlying calcification had significant CAD (stenosis ≥50%). In summary, significant differences in plaque composition according to severity of CAD were observed in our study with a higher mixed plaque and lesser non-calcified plaque burden among those with stenotic CAD. These findings should stimulate further investigations to assess the prognostic value of plaque according to their underlying composition.

scholarly journals Deficiency of MMP1a (Matrix Metalloprotease 1a) Collagenase Suppresses Development of Atherosclerosis in Mice

2021 ◽  
Author(s):  
Elizabeth K. Fletcher ◽  
Yanling Wang ◽  
Laura K. Flynn ◽  
Susan E. Turner ◽  
Jeffrey J. Rade ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Atherosclerotic Plaque ◽  
Disease Burden ◽  
Oxidized Ldl ◽  
Plaque Burden ◽  
Matrix Metalloprotease ◽  
Coronary Syndrome ◽  
Artery Disease

Objective: Destruction of arterial collagen allows monocyte and macrophage infiltration leading to atherosclerotic plaque formation, but it is not clear what role the MMP1 (matrix metalloprotease 1) collagenase plays in this process in vivo. To define the specific contribution of MMP1 to atherosclerotic plaque burden and pathogenesis, we generated ApoE −/− mice deficient in the human MMP1 ortholog, MMP1a. Approach and Results: After 12 to 16 weeks of Western diet, genetic loss of MMP1a resulted in a significant 50% reduction in total aortic plaque burden compared with control ApoE −/− mice. MMP1a deficiency led to significant reductions in plaque monocytes/macrophages, SMCs, and necrosis, with increases in collagen content. Collagen invasion of oxidized-LDL (low-density lipoprotein) activated peripheral blood mononuclear cells from MMP1a-deficient mice was markedly attenuated and was similar to suppressive effects with pharmacological inhibitors of MMP1 and its receptor, PAR1 (protease-activated receptor 1). Patients with coronary artery disease and acute coronary syndrome undergoing cardiac catheterization in the TRIP-PCI trial were evaluated for circulating levels of all 3 major secreted collagenases, MMP1, MMP8, and MMP13 and total number of coronary lesions with ≥50% stenosis (coronary artery disease burden). MMP1 was significantly ( P <0.001) higher by 19-fold and 5.7-fold relative to MMP13 and MMP8, respectively. MMP1 correlated with stenotic coronary artery disease burden, TNFα (tumor necrosis factor alpha) levels, and was co-expressed with PAR1 on monocytes. Treatment of patients with the PAR1 inhibitor, PZ-128, prevented a drop in monocytes following coronary catheterization, an acute protective effect that was reproduced in mice undergoing cardiac ischemia reperfusion. Conclusions: These data provide evidence for an important role for the MMP1a collagenase in atherosclerotic lesion development and leukocyte behavior and validate MMP1 as a compelling target in patients with coronary artery disease/acute coronary syndrome. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02561000.

scholarly journals Coronary Artery Microcalcification: Imaging and Clinical Implications

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 125 ◽  
Author(s):  
Federico Vancheri ◽  
Giovanni Longo ◽  
Sergio Vancheri ◽  
John S. H. Danial ◽  
Michael Y. Henein
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Disease Activity ◽  
Atherosclerotic Plaque ◽  
Coronary Artery Calcification ◽  
Early Stage ◽  
Significant Coronary Artery Disease ◽  
Necrotic Core ◽  
Plaque Burden ◽  
Clinical Implications

Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification.

Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
S Boldueva ◽  
V Feoktistova ◽  
D Evdokimov
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Atherosclerotic Plaque ◽  
St Elevation ◽  
Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.  The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

scholarly journals Clinical Relevance of Coronary Computed Tomography Angiography Beyond Coronary Artery Stenosis

2021 ◽  
Author(s):  
Mohammed Nooruddin Meah ◽  
Michelle C. Williams
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
High Risk ◽  
Atherosclerotic Plaque ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Calcium Score ◽  
Coronary Plaque ◽  
Coronary Computed Tomography ◽  
Low Attenuation Plaque

Background The capabilities of coronary computed tomography angiography (CCTA) have advanced significantly in the past decade. Its capacity to detect stenotic coronary arteries safely and consistently has led to a marked decline in invasive diagnostic angiography. However, CCTA can do much more than identify coronary artery stenoses. Method This review discusses applications of CCTA beyond coronary stenosis assessment, focusing in particular on the visual and quantitative analysis of atherosclerotic plaque. Results Established signs of visually assessed high-risk plaque on CT include positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, which correlate with the histological thin-cap fibroatheroma. Recently, quantification of plaque subtypes has further improved the assessment of coronary plaque on CT. Quantitatively assessed low-attenuation plaque, which correlates with the necrotic core of the thin-cap fibroatheroma, has demonstrated superiority over stenosis severity and coronary calcium score in predicting subsequent myocardial infarction. Current research aims to use radiomic and machine learning methods to further improve our understanding of high-risk atherosclerotic plaque subtypes identified on CCTA. Conclusion Despite rapid technological advances in the field of coronary computed tomography angiography, there remains a significant lag in routine clinical practice where use is often limited to lumenography. We summarize some of the most promising techniques that significantly improve the diagnostic and prognostic potential of CCTA. Key Points:  Citation Format

Abstract 681: Characteristics of Atherosclerotic Plaque Burden in Patients With and Without Acute Coronary Syndrome Presenting With Acute Chest Pain to the Emergency Department

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Fabian Bamberg ◽  
Maros Ferecik ◽  
Quynh Truong ◽  
Ian Rogers ◽  
Michael Shapiro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Coronary Arteries ◽  
Atherosclerotic Plaque ◽  
Acute Chest Pain ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Calcified Plaque

Background: Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS). Methods: The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded. Results : Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31). Conclusions: The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.

Spontaneous coronary artery dissection in association with cabergoline therapy

2021 ◽  
Vol 14 (2) ◽  
pp. e240022
Author(s):  
Zia Saleh ◽  
Susan Koshy ◽  
Vaninder Sidhu ◽  
Andrea Opgenorth ◽  
Janek Senaratne
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

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