scholarly journals The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation

Cells ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 1196
Author(s):  
Jeremy Yuvaraj ◽  
Kevin Cheng ◽  
Andrew Lin ◽  
Peter J. Psaltis ◽  
Stephen J. Nicholls ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Randomized Clinical Trials ◽  
Vascular Inflammation ◽  
Large Body ◽  
Surrogate Marker ◽  
Vulnerable Atherosclerotic Plaque ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Coronary Events ◽  
Artery Disease

A large body of evidence arising from recent randomized clinical trials demonstrate the association of vascular inflammatory mediators with coronary artery disease (CAD). Vascular inflammation localized in the coronary arteries leads to an increased risk of CAD-related events, and produces unique biological alterations to local cardiac adipose tissue depots. Coronary computed tomography angiography (CTA) provides a means of mapping inflammatory changes to both epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) as independent markers of coronary risk. Radiodensity or attenuation of PCAT on coronary CTA, notably, provides indirect quantification of coronary inflammation and is emerging as a promising non-invasive imaging implement. An increasing number of observational studies have shown robust associations between PCAT attenuation and major coronary events, including acute coronary syndrome, and ‘vulnerable’ atherosclerotic plaque phenotypes that are associated with an increased risk of the said events. This review outlines the biological characteristics of both EAT and PCAT and provides an overview of the current literature on PCAT attenuation as a surrogate marker of coronary inflammation.

scholarly journals Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease

Cells ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 1143
Author(s):  
Jeremy Yuvaraj ◽  
Andrew Lin ◽  
Nitesh Nerlekar ◽  
Ravi K. Munnur ◽  
James D. Cameron ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Adipose Tissue ◽  
Coronary Artery ◽  
High Risk ◽  
Stable Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Artery Disease ◽  
Stable Cad

Background: High-risk plaques (HRP) detected on coronary computed tomography angiography (CTA) confer an increased risk of acute coronary syndrome (ACS). Pericoronary adipose tissue attenuation (PCAT) is a novel biomarker of coronary inflammation. This study aimed to evaluate the association of PCAT with HRP and subsequent ACS development in patients with stable coronary artery disease (CAD). Methods: Patients with stable CAD who underwent coronary CTA from 2011 to 2016 and had available outcome data were included. We studied 41 patients with HRP propensity matched to 41 controls without HRP (60 ± 10 years, 67% males). PCAT was assessed using semi-automated software on a per-patient basis in the proximal right coronary artery (PCATRCA) and a per-lesion basis (PCATLesion) around HRP in cases and the highest-grade stenosis lesions in controls. Results: PCATRCA and PCATLesion were higher in HRP patients than controls (PCATRCA: −80.7 ± 6.50 HU vs. −84.2 ± 8.09 HU, p = 0.03; PCATLesion: −79.6 ± 7.86 HU vs. −84.2 ± 10.3 HU, p = 0.04), and were also higher in men (PCATRCA: −80.5 ± 7.03 HU vs. −86.1 ± 7.08 HU, p < 0.001; PCATLesion: −79.6 ± 9.06 HU vs. −85.2 ± 7.96 HU, p = 0.02). Median time to ACS was 1.9 years, within a median follow-up of 5.3 years. PCATRCA alone was higher in HRP patients who subsequently presented with ACS (−76.8 ± 5.69 HU vs. −82.0 ± 6.32 HU, p = 0.03). In time-dependent analysis, ACS was associated with HRP and PCATRCA. Conclusions: PCAT attenuation is increased in stable CAD patients with HRP and is associated with subsequent ACS development. Further investigation is required to determine the clinical implications of these findings.

scholarly journals Angiographic profile of NSTEMI patients with or without metabolic syndrome

2016 ◽  
Vol 15 (4) ◽  
pp. 511-516
Author(s):  
Md Aminul Haque ◽  
Nazir Ahmed ◽  
Fazila Tun Nesa Malik ◽  
Tawfiq Shahriar Huq ◽  
Md Kalimuddin ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Medical Science ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Triple Vessel Disease ◽  
Increased Risk ◽  
Significant Difference ◽  
Artery Disease ◽  
Considerable Morbidity ◽  
Vessel Score

Background: Metabolic syndrome (MS) constitutes the clustering of clinical and biochemical risk factors, which are associated with increased risk of cardiovascular events. Non ST elevation myocardial infarction (NSTEMI) accounts for the important part of acute coronary syndrome (ACS) with considerable morbidity and mortality. The aim of this study was to investigate the association of MS with angiographic severity of coronary artery disease (CAD) in patients with NSTEMI.Methods: This study included 192 prospectively enrolled NSTEMI patients. The patients underwent coronary angiography (CAG). CAG were evaluated via Sullivan’s method.Results: Statistically significant difference in vessel score observed, such that higher triple vessel disease (TVD) in MS patients (42.7% vs. 15.6%, p<0.001) and single vessel disease (SVD) in patients without MS (45.8% vs. 21.9%, p<0.001). Patients with MS had higher mean total stenosis score (9.26±4.29 vs. 6.06±3.07, p<0.001) and mean extension score (53.70±18.11 vs. 39.11±17.59, p<0.001). Correlation analysis found direct correlation between angiographic scores and MS scores, total cholesterol, LDL-C, HDL-C, TG and waist circumference. Individual components of MS were independent predictors of high total stenosis score and extension score on multivariate linear regression analysis.Conclusion: Metabolic syndrome, as well as, individual components of MS was independently associated with angiographically severe CAD.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.511-516

scholarly journals Association between the Non-high-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio and the Risk of Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jiayin You ◽  
Zhenhao Wang ◽  
Guoping Lu ◽  
Zhenyue Chen
Keyword(s):  
Coronary Artery Disease ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Artery Disease

Background. The purpose of this study was to evaluate the association between the non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio and the risk of coronary artery disease (CAD). We also explored the potential role of non-HDL-C/HDL-C in the prognosis of CAD. Methods. We analyzed 930 consecutive patients with chest discomfort who underwent coronary angiography. Of these, 680 were diagnosed with CAD; the remaining 250 patients were normal. Multivariate logistic regression and receiver operating characteristic (ROC) curves were employed to evaluate the association between non-HDL-C/HDL-C and CAD. The effect of non-HDL-C/HDL-C on the progression of major adverse cardiovascular events (MACEs) was also explored. Results. Increased non-HDL-C/HDL-C was associated with an increased risk of CAD (OR: 1.291; 95% CI: 1.039-1.561; P=0.013). The results of stratified analyses by CAD subtype showed a correlation between high non-HDL-C/HDL-C and increased risk of acute coronary syndrome (OR: 1.661; 95% CI: 1.259-2.207; P<0.001), high Gensini score (OR: 1.408; 95% CI: 1.021-1.935; P=0.039), and multivessel disease (OR: 1.487; 95% CI: 1.128-1.992; P=0.007). Moreover, the areas under the ROC for the predictive value of non-HDL-C/HDL-C for CAD, acute coronary syndrome, high Gensini score, and multivessel disease were 0.604, 0.658, 0.642, and 0.636, respectively. Non-HDL-C/HDL-C in CAD patients was significantly correlated with the risk of long-term MACEs (P=0.004). Conclusions. The findings of this study indicated that non-HDL-C/HDL-C plays an important role in the risk and progression of CAD. These findings need verification by further large-scale prospective studies.

scholarly journals How should the ticagrelor be used? The point after the TWILIGHT and THEMIS-PCI studies

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L72-L76
Author(s):  
Laura Gatto ◽  
Francesco Prati
Keyword(s):  
Clinical Trials ◽  
Heart Attack ◽  
Randomized Clinical Trials ◽  
Stable Coronary Artery Disease ◽  
Diabetic Patients ◽  
Increased Risk ◽  
The Face ◽  
Risk Patients ◽  
History Of ◽  
Artery Disease

Abstract The ticagrelor represents a cornerstone of antiplatelet therapy and its use has been supported, over the years, by several clinical trials that have enrolled thousands of patients; while the PLATO study initially demonstrated its effectiveness in the immediate treatment of acute coronary syndromes, the PEGASUS study documented the benefit of prolonging this treatment beyond 12 months from the heart attack. Over the past few months, two new randomized clinical trials have been published that have seen the use of ticagrelor in different clinical settings. The TWILIGHT study showed that in high-risk patients who completed 3 months of double antiplatelet drugs after coronary angioplasty, ticagrelor monotherapy is associated with a 44% reduction in the risk of clinically relevant bleeding in the absence of an increase in the ischaemic risk. The THEMIS study instead concluded that in the population of diabetics with stable coronary artery disease, but without a history of heart attack or stroke, a strategy that involves the addition of ticagrelor to the acetylsalicylic acid is not advisable as in the face of a benefit in the prevention of events ischaemic an increased risk of bleeding has been observed. Only in the subgroup of diabetic patients with a history of previous angioplasty would a more powerful antithrombotic therapy seem to be advantageous.

scholarly journals DAPT plus anticoagulant therapy: The difficult coexistence post-ACS in older patients with atrial fibrillation

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Mauro Di Bari ◽  
Alessandra Pratesi ◽  
Francesca M. Nigro ◽  
Irene Marozzi ◽  
Stefano Fumagalli
Keyword(s):  
Atrial Fibrillation ◽  
Triple Therapy ◽  
Older Patients ◽  
Randomized Clinical Trials ◽  
Treatment Guidelines ◽  
Coronary Intervention ◽  
Current Treatment ◽  
Difficult Problem ◽  
Coronary Syndrome ◽  
Artery Disease

Atrial fibrillation (AF) and coronary artery disease requiring percutaneous coronary intervention (PCI) and stenting often coexist in older patients. This poses the difficult problem of concurrent anticoagulant and double antiplatelet therapy (triple therapy). Current treatment guidelines do recommend triple therapy, especially in the course of acute coronary syndrome (ACS), with limitations due to an excessive risk of bleeding associated with this therapeutic regimen. This review summarizes randomized clinical trials and observational studies that compared triple therapy with a variety of different therapeutic options. Although the available evidence is not completely satisfactory and other studies are urgently needed, alternative regimens to triple therapy in AF patients undergoing PCI and stenting are promising, at least in terms of safety.

scholarly journals Agatston score of the descending aorta is independently associated with coronary events in a low-risk population

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000893 ◽  
Author(s):  
Elton A M P Dudink ◽  
Frederique E C M Peeters ◽  
Sibel Altintas ◽  
Luuk I B Heckman ◽  
Rutger J Haest ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Ct ◽  
Significant Coronary Artery Disease ◽  
Low Risk ◽  
Agatston Score ◽  
Descending Aorta ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Artery Disease

ObjectivesA standard coronary artery calcium scan includes part of the aorta. This additional information is often not included in routine analyses. We aimed to determine the feasibility of assessing the Agatston score of the descending aorta calcification (DAC) on standard coronary calcium scans and the association of this score with coronary events in a low-risk study population.MethodsBetween January 2008 and March 2011, 390 consecutive patients who were referred for cardiac CT as part of work-up for pulmonary vein isolation (n=115) or assessment of presence of coronary artery disease (n=275) were included. At baseline, all patients were free of a history of cardiovascular disease. Two independent observers determined the Agatston score of the ascending aorta and descending aorta.ResultsA total of 16 patients (4.1%) developed coronary events (acute coronary syndrome (n=6) and symptomatic significant coronary artery disease requiring treatment (n=10)) during a follow-up of 67±12 months, with more events in patients with calcifications in the descending aorta than in those without (8.4% vs 3.7 %; p=0.08). Multivariable Cox regression, corrected for Framingham Risk Score (FRS) and coronary Agatston score (CAC), revealed that DAC was independently associated with coronary events (per 100 units; HR: 1.06, 95% CI 1.02 to 1.09; p=0.001). DAC furthermore increased the identification of patients that will experience a coronary event (area under the curve: 0.68 for FRS only, 0.75 for FRS+CAC and 0.78 for FRS+CAC+DAC).ConclusionsThe Agatston score of the descending aorta could be included in the standard analysis of cardiac CT scans of low-risk patients since it holds valuable information for the prediction of coronary events.

Abstract 17283: De-Escalation of Antiplatelet Therapy in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Clinical Trials

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Babikir Kheiri ◽  
Mohammed Osman ◽  
Ahmed Abdalla ◽  
Sahar Ahmed ◽  
Khansa Osman ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Percutaneous Coronary Intervention ◽  
Randomized Clinical Trials ◽  
Maintenance Phase ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Safety And Efficacy ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Percutaneous Coronary

Introduction: Potent P2Y 12 -receptor inhibitors are recommended in the management of acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). As the risk of thrombotic complications from an ACS event is highest in the early “ischemic phase,” the greatest benefit of potent P2Y 12 blockade occurs early. However, the risk of bleeding from such therapy tends to occur with chronic treatment during the “maintenance phase.” Therefore, a stage-adapted strategy with the early use of potent P2Y 12 blockade in acute treatment, followed by de-escalation to clopidogrel during the maintenance phase is common. Nevertheless, clinical outcomes supporting this strategy are lacking. Hypothesis: This study aimed to evaluate the safety and efficacy of antiplatelet de-escalation compared with continuation in patients with ACS treated with PCI. Methods: Electronic databases search were conducted for all randomized clinical trials (RCTs) that evaluated the safety and efficacy of antiplatelet de-escalation compared with continuation in patients with ACS treated with PCI. A random-effects model was used to calculate the pooled summary estimates. Results: We included 3 RCTs with 3,391 total patients (median follow-up 12 months). The net clinical outcome (composite of thrombotic or bleeding events) was significantly reduced in the switched group compared with the continued group (8.7% vs 12.1%; risk ratio (RR): 0.64; 95% confidence interval (CI): 0.43-0.97; P=0.03). However, there were no significant differences between groups in major adverse cardiovascular events (RR: 0.78; 95% CI: 0.55-1.11; P=0.17), all BARC (Bleeding Academic Research Consortium) types bleeding (RR: 0.61; 95% CI: 0.33-1.11; P=0.10), or BARC types ≥2 bleeding (RR: 0.49; 95% CI: 0.19-1.26; P=0.14). Conclusions: Our results suggest a net clinical benefit of de-escalation therapy shortly after PCI in ACS patients, without increased risk of MACE or bleeding, though further adequately powered trials are needed to confirm this finding.

Abstract 13434: Chronic Total Occlusions in Refractory Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ales Kral ◽  
Jan Belohlavek ◽  
Daniel Rob ◽  
Jana Smalcova
Keyword(s):  
Cardiac Arrest ◽  
Study Cohort ◽  
Chronic Total Occlusions ◽  
Neurologic Recovery ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Increased Risk ◽  
High Prevalence ◽  
Artery Disease ◽  
Long Term Prognosis

Introduction: Coronary artery disease (CAD) is the most frequent cause of cardiac arrest (CA) in adults. Coronary chronic total occlusions (CTOs) are associated with an increased risk CA and predict future malignant arrhythmias in CA survivors. Nevertheless, the prevalence of CTOs in patients with CA and especially refractory CA is poorly characterized. We sought to evaluate the frequency and characteristics of CTOs in refractory CA patients included in the Prague-OHCA study. Methods: From 256 patients with refractory CA randomized in the Prague-OHCA study, coronary angiography (CAG) was performed in 181 subjects. Of the 128 patients with significant CAD (defined as more than 50% diameter stenosis in at least one major coronary vessel), 14 had a different primary cause of CA, leading to a study cohort of 114 patients with CAD as the primary cause of CA. 41 patients had at least one coronary CTO, whereas 73 patients had significant CAD without CTOs. Clinical, angiographic parameters, initial management and outcome was compared between the CTO and non-CTO groups. Results: Patients in the CTO cohort were older (59 ±12 versus 54 ±11 years, p = 0.015) and had shorter CA durations (45 ± 25 versus 55 ± 24 minutes, p = 0.03) as compared to patients in the non-CTO cohort. The CTO cohort presented less frequently with an acute coronary syndrome (ACS) (51 versus 89%, p < 0.0001) and had a higher prevalence of multi-vessel disease (89 versus 51%, p < 0.0001), as compared to the non-CTO cohort. Acute index PCI was performed less frequently in the CTO group (61 versus 86%, p = 0.002). Patients in the CTO group experienced more frequent neurologic recovery (51 versus 32%, p = 0.04), whereas cardiac recovery (63 versus 51%, p = 0.19) and six month mortality (51 versus 59%, p = 0.43) did not differ between the CTO and non-CTO group. Conclusions: CTOs represent a frequent cause of refractory CA. Patients with refractory CA due to CTOs were older with a high prevalence of multi-vessel disease and presented less frequently with an ACS, as compared to patients with significant CAD without CTOs. The observed more frequent neurologic recovery in the CTO cohort is presumably due to shorter CA durations in these patients. Mid- and long-term prognosis did not differ between the CTO and non-CTO cohort.

scholarly journals 246 Air pollution and coronary plaque vulnerability and instability: an optical coherence tomography study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rocco Antonio Montone ◽  
Massimiliano Camilli ◽  
Michele Russo ◽  
Giulia La Vecchia ◽  
Giulia Iannaccone ◽  
...  
Keyword(s):  
Air Pollution ◽  
Optical Coherence Tomography ◽  
Particulate Matter ◽  
Air Pollutants ◽  
Vulnerable Plaque ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Coronary Events

Abstract Aims Air pollution is an emerging key player in determining the residual risk of coronary events. However, pathophysiological mechanisms linking air pollution and coronary events have been not adequately investigated. We aimed at assessing the relationship between exposure to air pollutants and mechanisms of coronary instability evaluated by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS). Methods and results ACS patients undergoing OCT imaging were retrospectively selected. Mechanism of culprit lesion instability was classified as plaque rupture (PR) or intact fibrous cap (IFC) by OCT, and the presence of macrophage infiltrates (M&Oslash;I) and thin-cap fibroatheroma (TCFA) at the culprit site was also assessed. Based on each case’s home address, exposure to several pollutants was evaluated, including particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), and carbon monoxide (CO). Only patients with &gt;2 years of available data on air pollution exposure prior to ACS were enrolled. We included 126 patients [median age 67.0 years (55.5–76.0), 97 (77.0%) male]. Sixty-six patients (52.4%) had PR as mechanism of plaque instability. Patients with PR were exposed to significantly higher PM2.5 levels compared to IFC, and PM2.5 was independently associated with PR [odds ratio per unit = 1.194, 95% CI: (1.036–1.377), P = 0.015]. Moreover, exposure to higher levels of PM2.5 was independently associated with the presence of TCFA and of M&Oslash;I at the culprit site. Interestingly, PM2.5, PM10, and CO levels were positively and significantly correlated with serum levels of C-reactive protein. ROC curves were constructed to assess the ability of PM2.5 to predict the presence of plaque rupture, TCFA or M&Oslash;I. The AUC for PM2.5 to predict plaque rupture was 0.62 (95% CI: 0.52–0.71, P = 0.018), for TCFA was 0.71 (95% CI: 0.61–0.80, P &lt;0.001) and for M&Oslash;I was 0.80 (95% CI: 0.71–0.88, P &lt;0.001). Using a PM2.5 cut-off value of 13.40 μg/m3, the sensitivity and specificity for M&Oslash;I were 81% and 66%, respectively. Conclusions We provide novel insights into the missing link between air pollution and increased risk of coronary events. In particular, exposure to higher concentrations of air pollutants is a risk factor for vulnerable plaque features and for plaque rupture as mechanism of coronary instability mediated by systemic and local plaque inflammation. Of importance, the thresholds of air pollutants that predicted the presence of vulnerable plaque features are far lower than commonly accepted safety thresholds used to start preventive measures for public health, suggesting that further efforts are needed in order to reduce the adverse effects on the cardiovascular system.

Sign in / Sign up

Export Citation Format

Share Document