scholarly journals Persistent Dysfunction of Coronary Endothelial Vasomotor Responses is Related to Atheroma Plaque Progression in the Infarct-Related Coronary Artery of AMI Survivors

2019 ◽  
Vol 26 (12) ◽  
pp. 1062-1074 ◽  
Author(s):  
Takeo Horikoshi ◽  
Jun-ei Obata ◽  
Takamitsu Nakamura ◽  
Daisuke Fujioka ◽  
Yosuke Watanabe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Plaque Progression ◽  
Vasomotor Responses ◽  
Atheroma Plaque

P2706Persistent impairment of coronary endothelial vasomotor responses is related to atheroma plaque progression in the infarct-related coronary artery of AMI survivors

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Horikoshi ◽  
K Kugiyama ◽  
T Nakamura ◽  
J E Obata ◽  
T Yoshizaki ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Atheromatous Plaque ◽  
Plaque Progression ◽  
Vasomotor Response ◽  
Vasomotor Responses ◽  
Vasomotor Function ◽  
Atheroma Volume ◽  
Atheroma Plaque ◽  
Vasomotor Dysfunction

Abstract Background Although coronary endothelial vasomotor dysfunction predicts future coronary events, there are few human studies showing the relationship between endothelial vasomotor dysfunction and atheroma plaque progression in the same coronary artery. Purpose This study examined whether endothelial vasomotor dysfunction is related with atheroma plaque progression in the infarct-related coronary artery of ST-segment elevation myocardial infarction (STEMI) survivors using serial assessment of coronary plaque size with intravascular ultrasound (IVUS) and coronary vasomotor responses to acetylcholine (ACh). Methods This study included 50 patients with a first acute STEMI due to occlusion of left anterior descending coronary artery (LAD) and successful reperfusion therapy with percutaneous coronary intervention (PCI). IVUS and vasomotor response to ACh in the LAD were measured within 2 weeks after AMI (1st test) and repeated 6 months (2nd test) after AMI under optimal anti-atherosclerotic therapies. The impairment of vasomotor response to ACh was defined as <10% of the responses to ACh in 25 control subjects. Results Percent atheroma volume (PAV) and total atheroma volume (TAV) in the LAD progressed over 6 months of follow-up in 18 and 14 patients, respectively. Epicardial coronary artery dilation and coronary blood flow increase in response to ACh were persistently impaired at both the 1st and 2nd tests in 18 and 19 patients. In logistic regression analysis, the progression of PAV and TAV was significantly associated with patients with the persistent impairment of epicardial coronary diameter and blood flow response to ACh (PAV, OR, 6.2 [95% CI, 1.4–28], P=0.02 and 4.3 [1.2–16], P=0.03, respectively. TAV, 6.0 [1.4–26], P=0.02 and 5.5 [1.4–21], P=0.01, respectively). The progression of PAV and TAV had no significant association with the coronary vasomotor responses to ACh at the 1st test, traditional risk factors, PCI-related variables, medications, and the coronary vasomotor responses to sodium nitroprusside, an endothelium-independent vasodilator. Conclusions Persistent impairment of endothelial vasomotor function in the conduit arterial segment and the resistance arteriole was related to atheromatous plaque progression in the infarct-related coronary arteries of STEMI survivors despite optimized anti-atherosclerotic therapies. Acknowledgement/Funding None

Abstract 1165: Impact of Gender on Serial Atherosclerotic Changes in Response to Established Medical Therapies

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Srinivasa R Kalidindi ◽  
Amy Hsu ◽  
Keon-Woong Moon ◽  
E. Murat Tuzcu ◽  
Steven E Nissen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Arterial Wall ◽  
Elastic Membrane ◽  
Single Coronary Artery ◽  
Plaque Progression ◽  
Ultrasound Evaluation ◽  
External Elastic Membrane ◽  
Remodeling Index ◽  
Medical Therapies ◽  
The Impact

Background: While the importance of coronary artery disease in females has become increasingly recognized, little is known regarding the impact of gender with regard to changes in arterial wall dimensions with progression and regression of atherosclerosis. This study investigated the remodeling response of the artery wall accompanying changes in atheroma burden in response to use of medical therapies, stratified according to gender. Methods: 1533 patients (27.5% female) underwent serial intravascular ultrasound evaluation of a single coronary artery in the context of clinical trials that assess the impact of medical therapies on plaque progression. The relationship between gender and remodeling of the arterial wall at baseline and its serial change in association with plaque progression and regression were studied. Results: Females were older (59 v 57 years, p<0.01), had a higher body mass index (31.5 v 29.5 kg/m 2 , p<0.01), were more likely to have hypertension (86 v 71.5%, p<0.01) and metabolic syndrome (57 v 49%, p<0.01) and less likely to have a history of smoking (57.5 v 73.5%, p=0.01) and myocardial infarction (27.5 v 35.5%, p<0.01). After adjusting for body surface area, females demonstrated a trend towards smaller external elastic membrane (EEM) (226.3 v 234.3 mm 3 , p=0.09) and larger lumen (143.7 v 137.7 mm 3 , p=0.01) volumes. The remodeling index at the most diseased site did not differ between genders (0.95 v 0.95, p=0.95). No differences were observed between genders with regard to changes in EEM (−5.6 v −6.2 mm 3 , p=0.29) and lumen (−4.9 v −4.5 mm 3 , p=0.82) volumes and remodeling index (−0.02 v −0.03, p=0.43) in response to use of medical therapies. Similarly, there were no differences between genders with regard to the percentage of patients undergoing expansion (34.7 v 35.5%, p=0.86) or contraction (20.4 v 21.8%, p=0.69) of lumen volume in association with regression of atherosclerotic plaque. Conclusion: A similar pattern of remodeling of the arterial wall was observed between genders in association with serial changes in atheroscle-rotic plaque. This further highlights our understanding of the pathological interactions between atherosclerosis and the arterial wall in females.

Plaque Progression in a Human Coronary Artery is Associated With Low Wall Shear Stress and Extended Particle Residence Time

2010 ◽  
Author(s):  
Jin Suo ◽  
Michael McDaniel ◽  
Parham Eshtehardi ◽  
Saurabh Dhawan ◽  
Ravi Prasad Avati Nanjundappa ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Residence Time ◽  
Vigorous Physical Activity ◽  
Region Of Interest ◽  
Reconstruction Technique ◽  
Plaque Progression ◽  
Human Coronary Artery ◽  
Wall Shear

Intravascular ultrasound (IVUS) evaluation was performed in the coronary arteries of a 45-year-old patient with stable angina during vigorous physical activity. Concurrent angiography demonstrated a mild plaque in the proximal left anterior descending artery (LAD), with obvious lumen dilatation immediately distal to the plaque. Blood velocity was measured by a catheter Doppler transducer at proximal and distal segments of the left coronary artery, and the left main artery (LM) and LAD were reconstructed using a 3D-IVUS reconstruction technique based on biplanar angiography and IVUS images, enabling simulation of the flow field in the artery employing computational fluid dynamics (CFD). Wall shear stress (WSS) and particle path lines were determined from the CFD studies. The patient returned for a follow up evaluation after 6 months, and plaque progression during this period was evaluated from the IVUS data. Results showed that low WSS, less than 5 dynes/cm2, which occurs in the region immediately distal to the plaque, correlates with localized progression of the lesion over the 6 month interval. The path line tracking computations showed that particles near the vessel surface where plaque progression was observed resided near the artery wall longer than one complete cardiac cycle, whereas in other areas particles were flushed through the region of interest rapidly. These observations in a specific individual are consistent with the hypothesis that plaque progression is related to low WSS and relatively long residence time of atherogenic blood-borne substances.

Correlation of Longitudinal Intravascular Ultrasound Data for the Clinical Assessment of Coronary Artery Disease Progression

2012 ◽  
Author(s):  
Lucas H. Timmins ◽  
Jonathan D. Suever ◽  
Parham Eshtehardi ◽  
Michael C. McDaniel ◽  
Habib Samady ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Disease Progression ◽  
Intravascular Ultrasound ◽  
Atherosclerotic Lesion ◽  
Plaque Progression ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Artery Disease ◽  
The Impact

Virtual histology-intravascular ultrasound (VH-IVUS) has gained increasing utility in the cardiac catheterization laboratory, not only in determining underlying atherosclerotic lesion composition prior to stent placement, but also in clinical studies assessing the natural history of coronary artery disease (CAD) [1]. Furthermore, VH-IVUS has provided an excellent means of quantifying disease progression by comparing data sets collected over time (i.e., longitudinal studies) and potentially identifying rapidly progressing and potentially vulnerable plaques. One difficulty, however, in analyzing VH-IVUS derived CAD progression is the accurate co-registration of image sets collected over a period of time. Commonly, an expert VH-IVUS image reader reviews these image sets side-by-side on a display and co-registers images along the vessel main axis, herein axially co-registered, by identifying image locations relative to fiduciary anatomical markers (e.g., branches). Despite this method being the standard for analyzing CAD progression, it is limited by the inability to accurately co-register VH-IVUS data in the circumferential direction (i.e., rotating images such that their cylindrical coordinate bases coincide; herein circumferentially co-registered). Thus, a significant amount of information on focal plaque progression is lost that could provide a greater understanding of the natural evolution of CAD, the effects of various pharmaceutical agents (e.g., statins) on lesion composition changes, and the impact of local mechanical factors that induce plaque progression/regression and transformation.

scholarly journals Serial coronary computed tomography angiography-verified coronary plaque progression: comparison of stented patients with or without diabetes

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Rui Shi ◽  
Ke Shi ◽  
Zhi-gang Yang ◽  
Ying-kun Guo ◽  
Kai-yue Diao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Diabetic Patients ◽  
Plaque Progression ◽  
Coronary Computed Tomography ◽  
Number Of Patients ◽  
The Impact

Abstract Background Patients with Diabetes mellitus (DM) are susceptible to coronary artery disease (CAD). However, the impact of DM on plaque progression in the non-stented segments of stent-implanted patients has been rarely reported. This study aimed to evaluate the impact of DM on the prevalence, characteristics and severity of coronary computed tomography angiography (CCTA) verified plaque progression in stented patients. A comparison between diabetic and non-diabetic patients was performed. Methods A total of 98 patients who underwent clinically indicated serial CCTAs arranged within 1 month before and at least 6 months after percutaneous coronary intervention (PCI) were consecutively included. All the subjects were categorized into diabetic group (n = 36) and non-diabetic groups (n = 62). Coronary stenosis extent scores, segment involvement scores (SIS), segment stenosis scores (SSS) at baseline and follow-up CCTA were quantitatively assessed. The prevalence, characteristics and severity of plaque progression was evaluated blindly to the clinical data and compared between the groups. Results During the median 1.5 year follow up, a larger number of patients (72.2% vs 40.3%, P = 0.002), more non-stented vessels (55.7% vs 23.2%, P < 0.001) and non-stented segments (10.3% vs 4.4%, P < 0.001) showed plaque progression in DM group, compared to non-DM controls. More progressive lesions in DM patients were found to be non-calcified plaques (31.1% vs 12.8%, P = 0.014) or non-stenotic segments (6.6% vs 3.0%, p = 0.005) and were more widely distributed on left main artery (24.2% vs 5.2%, p = 0.007), the right coronary artery (50% vs 21.1%, P = 0.028) and the proximal left anterior artery (33.3% vs 5.1%, P = 0.009) compared to non-DM patients. In addition, DM patients possessed higher numbers of progressive segments per patient, ΔSIS and ΔSSS compared with non-DM individuals (P < 0.001, P = 0.029 and P < 0.001 respectively). A larger number of patients with at least two progressive lesions were found in the DM group (P = 0.006). Multivariate logistic regression analysis demonstrated that DM (OR: 4.81; 95% CI 1.64–14.07, P = 0.004) was independently associated with plaque progression. Conclusions DM is closely associated with the prevalence and severity of CCTA verified CAD progression. These findings suggest that physicians should pay attention to non-stent segments and the management of non-stent segment plaque progression, particularly to DM patients.

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