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Intravascular ultrasound (IVUS) pull-back in a symptomatic, diabetic female patient with a critical left main stenosis (A, right panel: IVUS frame corresponding to the dotted line A, left panel). Left anterior descending (LAD) presents the diffuse disease with calcific eccentric lesion (triangle arrows B and C right panel, corresponding to the dotted lines B and C left panel). Behind calcifications, shadow does not allow us to obtain complete vessel contours.
Source publication
Identifying patients at increased risk of coronary artery disease, before the atherosclerotic complications become clinically evident, is the aim of cardiovascular prevention. Imaging techniques provide direct assessment of coronary atherosclerotic burden and pathological characteristics of atherosclerotic lesions which may predict the progression...
Context in source publication
Context 1
... and OCT allow direct cross-sectional visualization of the coronary wall and are now considered the gold standard for in vivo imaging of coronary calcification. [79,100,103] IVUS imaging is based on ultrasound reflection by coronary calcification and is more sensitive and specific than angiography ( Figure 5). Compared to OCT, IVUS has lower spatial resolution and greater penetration depth, thus provide good assessment of the entire arterial wall. ...
Citations
... The difference in extension found in older patients (an excess of almost 200 mm 3 on average in non-LVV patients) may be not irrelevant. 19 Abdominal vessels showed an excess in prevalence and extension of calcification only in non-newly diagnosed LVV patients. ...
Objectives
The aim of this study was to compare the prevalence, entity and local distribution of arterial wall calcifications evaluated on CT scans in patients with large vessel vasculitis (LVV) and patients with lymphoma as reference for the population without LVV.
Methods
All consecutive patients diagnosed with LVVs with available baseline positron emission tomography-CT (PET-CT) scan performed between 2007 and 2019 were included; non-LVV patients were lymphoma patients matched by age (±5 years), sex and year of baseline PET-CT (≤2013; >2013). CT images derived from baseline PET-CT scans of both patient groups were retrospectively reviewed by a single radiologist who, after setting a threshold of minimum 130 Hounsfield units, semiautomatically computed vascular calcifications in three separate locations (coronaries, thoracic and abdominal arteries), quantified as Agatston and volume scores.
Results
A total of 266 patients were included. Abdominal artery calcifications were equally distributed (mean volume 3220 in LVVs and 2712 in lymphomas). Being in the LVVs group was associated with the presence of thoracic calcifications after adjusting by age and year of diagnosis (OR 4.13, 95% CI 1.35 to 12.66; p=0.013). Similarly, LVVs group was significantly associated with the volume score in the thoracic arteries (p=0.048). In patients >50 years old, calcifications in the coronaries were more extended in non-LVV patients (p=0.027 for volume).
Conclusion
When compared with patients without LVVs, LVVs patients have higher calcifications in the thoracic arteries, but not in coronary and abdominal arteries.
... The commonest presentation of coronary atherosclerosis is plaque formation at the site of bifurcation, although not always exclusively, as plaques may also develop at mid-arterial segments. These atherosclerotic coronary manifestations are identified based on conventional angiographic examination [44,45]. Additional atherosclerosis manifestations in the segments that look normal on angiography can be detected by the presence of atherosclerotic plaques on CT examination [46]. ...
(1) Background and Aim: Conflicting evidence exists regarding the benefits of percutaneous coronary intervention (PCI) on survival and symptomatic relief of patients with chronic coronary syndrome (CCS) compared with optimal medical therapy (OMT). This meta-analysis is to evaluate the short- and long-term clinical benefit of PCI over and above OMT in CCS. (2) Methods: Main endpoints were major adverse cardiac events (MACEs), all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), urgent revascularization, stroke hospitalization, and quality of life (QoL). Clinical endpoints at very short (≤3 months), short- (<12 months), and long-term (≥ 12 months) follow-up were evaluated. (3) Results: Fifteen RCTs with a total of 16,443 patients with CCS (PCI n = 8307 and OMT n = 8136) were included in the meta-analysis. At mean follow-up of 27.7 months, the PCI group had similar risk of MACE (18.2 vs. 19.2 %; p < 0.32), all-cause mortality (7.09 vs. 7.88%; p = 0.56), CV mortality (8.74 vs. 9.87%; p = 0.30), MI (7.69 vs. 8.29%; p = 0.32), revascularization (11.2 vs. 18.3%; p = 0.08), stroke (2.18 vs. 1.41%; p = 0.10), and hospitalization for anginal symptoms (13.5 vs. 13.9%; p = 0.69) compared with OMT. These results were similar at short- and long-term follow-up. At the very short-term follow-up, PCI patients had greater improvement in the QoL including physical limitation, angina frequency, stability, and treatment satisfaction (p < 0.05 for all) but such benefits disappeared at the long-term follow-up. (4) Conclusions: PCI treatment of CCS does not provide any long-term clinical benefit compared with OMT. These results should have significant clinical implications in optimizing patient’s selection for PCI treatment.
... Recently, radiogenomics studies of atherosclerosis have been increasing to understand the gaps in our knowledge of the disease pathogenesis, genotypes, and phenotypes without direct atherosclerotic plaque sampling [16]. To define atherosclerosis radiophenotypes, characteristics of the atherosclerotic plaque interior have been studied using multimodal imaging techniques [17,18]. However, greater detail is required to interrogate radiophenotypes that define the composition and activity of individual atherosclerotic plaques [17,18]. ...
... To define atherosclerosis radiophenotypes, characteristics of the atherosclerotic plaque interior have been studied using multimodal imaging techniques [17,18]. However, greater detail is required to interrogate radiophenotypes that define the composition and activity of individual atherosclerotic plaques [17,18]. Although stenosis radiophenotypes reveal the presence and severity of atherosclerotic tissues without compositional information via magnetic resonance angiography (MRA) and carotid duplex ultrasonography (CDU), this technique has been used for medical or interventional management of cardiovascular diseases in patients [10]. ...
Background
Changes in gene-specific promoter methylation may result from aging and environmental influences. Atherosclerosis is associated with aging and environmental effects. Thus, promoter methylation profiling may be used as an epigenetic tool to evaluate the impact of aging and the environment on atherosclerosis development. However, gene-specific methylation changes are currently inadequate epigenetic markers for predicting atherosclerosis and cardiovascular disease pathogenesis.
Results
We profiled and validated changes in gene-specific promoter methylation associated with atherosclerosis using stenosis radiophenotypes of cranial vessels and blood inflammatory cells rather than direct sampling of atherosclerotic plaques. First, we profiled gene-specific promoter methylation changes using digital restriction enzyme analysis of methylation (DREAM) sequencing in peripheral blood mononuclear cells from eight samples each of cranial vessels with and without severe-stenosis radiophenotypes. Using DREAM sequencing profiling, 11 tags were detected in the promoter regions of the ACVR1C, ADCK5, EFNA2, ENOSF1, GLS2, KNDC1, MTNR1B, PACSIN3, PAX8-AS1, TLDC1, and ZNF7 genes. Using methylation evaluation, we found that EFNA2, ENOSF1, GLS2, KNDC1, MTNR1B, PAX8-AS1, and TLDC1 showed > 5% promoter methylation in non-plaque intima, atherosclerotic vascular tissues, and buffy coats. Using logistic regression analysis, we identified hypomethylation of MTNR1B as an independent variable for the stenosis radiophenotype prediction model by combining it with traditional atherosclerosis risk factors including age, hypertension history, and increases in creatinine, lipoprotein (a), and homocysteine. We performed fivefold cross-validation of the prediction model using 384 patients with ischemic stroke (50 [13%] no-stenosis and 334 [87%] > 1 stenosis radiophenotype). For the cross-validation, the training dataset included 70% of the dataset. The prediction model showed an accuracy of 0.887, specificity to predict stenosis radiophenotype of 0.940, sensitivity to predict no-stenosis radiophenotype of 0.533, and area under receiver operating characteristic curve of 0.877 to predict stenosis radiophenotype from the test dataset including 30% of the dataset.
Conclusions
We identified and validated MTNR1B hypomethylation as an epigenetic marker to predict cranial vessel atherosclerosis using stenosis radiophenotypes and blood inflammatory cells rather than direct atherosclerotic plaque sampling.
... Heavily calcified coronary plaques, particularly those with deep calcium deposits, are commonly resistant to the standard plaque modification techniques, including the conventional balloon angioplasty. This is of particular note due to the fact that profound calcium deposits are prone to be underestimated during classical coronary angiography (CA) [23], especially in the urgent subset of acute coronary syndromes (ACS). As a result, ad hoc decisions regarding percutaneous revascularization are made during the coronary angiography, with no time left for well-balanced planning. ...
Background:
Heavily calcified lesions in acute coronary syndrome (ACS) still represent a challenging subset for percutaneous coronary intervention (PCI). Rota-lithotripsy-a marriage of rotational atherectomy and intravascular lithotripsy-has recently been introduced to clinical practice as a novel therapeutic option.
Methods:
This study is among the to present the 6-month clinical outcomes of rota-lithotripsy when performed in the ACS setting. The study cohort consisted of 15 consecutive ACS patients who underwent a rota-lithotripsy-PCI due to the presence of a highly calcified, undilatable lesion.
Results:
The procedural success ratio reached 100%. During the 6-month follow-up, in two of the patients, instances of MACE (major adverse cardiac events) occurred, including one fatal event. Additionally, during the observation period, one target lesion failure, due to subacute stent thrombosis, was identified.
Conclusions:
Rotational atherectomy with the subsequent use of shockwave intravascular lithotripsy appears to be a safe and effective therapeutic bail-out option for the management of highly calcified coronary artery lesions. Despite, these initial favorable outcomes, carrying out a large number of studies with long-term observations is still necessary in order to establish the potential benefits and shortcomings of rota-lithotripsy.
... Внутривенное введение контрастного вещества позволяет оценить наличие АСБ и степень стеноза коронарных артерий. Отрицательный результат КТA связан с очень низким риском коронарных событий (отрицательная прогностическая ценность около 99%) [20]. Тест подходит для исключения ИБС, что снижает потребность в инвазивных тестах. ...
Сердечно-сосудистые заболевания остаются ведущей причиной заболеваемости и смертности во всем мире и в системе здравоохранения обуславливают самую высокую долю затрат. Патоморфологической основой ишемической болезни сердца в подавляющем большинстве клинических ситуаций является атеросклероз коронарных артерий. В последнее время множество исследований посвящено изучению ранней стадии атеросклероза – субклинического атеросклероза. Дестабилизация гемодинамически незначимых, бессимптомных атеросклеротических бляшек может привести к развитию инфаркта миокарда. В статье обсуждается распространенность, клиническая значимость необструктивного атеросклероза коронарных артерий. Отдельное внимание уделено шкалам стратификации сердечно-сосудистого риска. Обозначены современные методы диагностики коронарного атеросклероза, методы визуализации «нестабильных» атеросклеротических бляшек. В реальной клинической практике оценить «нестабильность» атеросклеротической бляшки не представляется возможным, поэтому сам факт наличия субклинического атеросклероза коронарных артерий позволяет отнести пациента к категории высокого и очень высокого риска.
Cardiovascular diseases remain the leading cause of mortality and morbidity worldwide and represent the highest proportion of costs in healthcare systems. In the vast majority of cases, the pathomorphological basis of coronary heart disease is coronary artery atherosclerosis. Many of the recent research have been devoted to the study of the early stage of atherosclerosis – subclinical atherosclerosis. Destabilization of hemodynamically insignificant, asymptomatic atherosclerotic plaques can lead to the development of myocardial infarction. The article discusses the prevalence and clinical significance of non- obstructive atherosclerosis of the coronary arteries. Special attention is devoted to the scales of cardiovascular risk stratification. Modern methods of coronary atherosclerosis diagnosis, methods of visualization of unstable atherosclerotic plaques are outlined. Considering that it is impossible to assess the instability of atherosclerotic plaque in real clinical practice, the presence of subclinical coronary atherosclerosis itself allows the patient to be classified as high and very high risk.
... After the data in the storage system is processed by the computer, the irradiated microscope image can be displayed on the TV screen, or the microscope image can be photographed with an organ camera and multiple cameras [3]. Henein et al. believe that, with the development of science and technology, the number of detectors has gradually changed from the original 1 to 4800, and the capacity of the computer has become larger and the calculation speed has been accelerated, so that the imaging of the injected contrast agent in angiography is clearer and then displays, according to the microscope image, information to more clearly identify the underlying condition [4]. Christian and Loewe believe that, in coronary CT examination, the examination process is very tedious and complicated, and there are many things that patients should pay attention to before examination, and there are still many patients who are not suitable for CT examination. ...
The aim is to study the benefits of using advanced medical services for coronary CT angiography. From August 2019 to August 2020, 50 patients who underwent CT angiography were selected and divided into control groups and study groups, with 25 patients in each group. The monitoring team provides basic support, and the training team provides maximum support. Experimental results showed that the positive microscopic image of the study group after the intervention was better than that of the control group, and the stress score was lower than that of the control group (P<0.05 s and30.73±9.57 min) and are short (58.32±13.15seconds and53.17±11.84minutes) between control groups, with significant differences. The significance is (P<0.05. Patient care is relevant to patients with coronary CT angiography, which has been shown to improve heart rate, reduce stress, improve microscopic imaging, and provide relevant liver function tests. It is recommended to promote the show.
... It is a catheter-based imaging modality capturing real-time pullback sequences of transverse and volumetric scanning images of arterial vessels with high resolution [1]. It provides detailed information regarding morphological structures and microstructures of vessel wall and atherosclerotic plaques based on backscattering of the incident near-infrared (NIR) laser in a spectral range of 1250-1350 nm [2]. Figure 1 shows the physical overview of a spectral-domain IVOCT system. ...
Catheter-based intravascular optical coherence tomography (IVOCT) is a powerful imaging modality for visualization of atherosclerosis with high resolution. Quantitative characterization of various tissue types by attenuation coefficient (AC) extraction has been proven to be a potentially significant application of OCT attenuation imaging. However, existing methods for AC extraction from OCT suffer from the challenge of variability in complex tissue types in IVOCT pullback data such as healthy vessel wall, mixed atherosclerotic plaques, plaques with a single component and stent struts, etc. This challenge leads to the ineffectiveness in the tissue differentiation by AC representation based on single scattering model of OCT signal. In this paper, we propose a novel method based on multiple scattering model for parametric imaging of optical attenuation by AC retrieval from IVOCT images conventionally acquired during cardiac catheterization. The OCT signal characterized by the AC is physically modeled by Monte Carlo simulation. Then, the pixel-wise AC retrieval is achieved by iteratively minimizing an error function regarding the modeled and measured backscattered signal. This method provides a general scheme for AC extraction from IVOCT without the premise of complete attenuation of the incident light through the imaging depths. Results of computer-simulated and clinical images demonstrate that the method can avoid overestimation at the end of the depth profile in comparison with the approaches based on the depth-resolved (DR) model. The energy error depth and structural similarity are improved by about 30% and 10% respectively compared with DR. It provides a useful way to differentiate and characterize arterial tissue types in IVOCT images.
... As the original data, 2D CTCA images are essentially more accurate than other reconstructed images. Therefore, the 2D CTCA images are still widely used in some recent studies (19). The reconstructed 2D images, including the coronal, sagittal, and curved planar reformation images, also play an important role in clinical diagnosis (20). ...
Background: Atherosclerotic plaques are the major cause of coronary artery disease (CAD). Currently, computed tomography (CT) is the most commonly applied imaging technique in the diagnosis of CAD. However, the accurate extraction of coronary plaque geometry from CT images is still challenging.
Summary of Review: In this review, we focused on the methods in recent studies on the CT-based coronary plaque extraction. According to the dimension of plaque extraction method, the studies were categorized into two-dimensional (2D) and three-dimensional (3D) ones. In each category, the studies were analyzed in terms of data, methods, and evaluation. We summarized the merits and limitations of current methods, as well as the future directions for efficient and accurate extraction of coronary plaques using CT imaging.
Conclusion: The methodological innovations are important for more accurate CT-based assessment of coronary plaques in clinical applications. The large-scale studies, de-blooming algorithms, more standardized datasets, and more detailed classification of non-calcified plaques could improve the accuracy of coronary plaque extraction from CT images. More multidimensional geometric parameters can be derived from the 3D geometry of coronary plaques. Additionally, machine learning and automatic 3D reconstruction could improve the efficiency of coronary plaque extraction in future studies.
... In contrast, with CABG coronary flow is guaranteed through the LIMA, known to be strikingly resistant to the development of obstructive atherosclerosis [21]. Secondly, atherosclerosis is a progressive disease [22]; therefore, despite repairing the LMCA stenosis, the underlying pathology may progress in some patients over the course of the follow-up period, even despite efforts to control the risk factors. With CABG, unless the progressive disease is distal to the graft site or in another major branch, patients are expected to maintain good coronary circulation. ...
Background and aim:
Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG.
Methods:
PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke.
Results:
Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94 to 1.36; p = 0.19), myocardial infarction (RR: 1.48; 95% CI: 0.97 to 2.25; p = 0.07) and stroke (RR: 0.87; 95% CI: 0.62 to 1.23; p = 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI: 0.89 to 1.28; p = 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95% CI: 0.89 to 1.43; p = 0.31) were not different. However, the risk of any repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15; p < 0.00001) was higher in patients assigned to PCI.
Conclusions:
The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization.
Aim: To investigate the effect of ivabradine on the hemodynamics and contractility of the myocardium and the features of NT-pro-BNP production in patients with stable ischemic heart disease after endovascular revascularization of the myocardium depending on the number of affected coronary arteries during 12 months of therapy. Materials and Methods: The object of the study was 120 patients with stable coronary artery disease: angina pectoris of functional class III with heart failure IIA FC III with preserved and moderately reduced ejection fraction of the left ventricle, who underwent coronary artery stenting. The examined patients were randomized according to the number of affected coronary vessels and the method of treatment. Results: Ivabradine in patients with stable ischemic heart disease after 12 months of therapy had a significant beneficial effect on the structural and functional parameters of the myocardium (contributed to the reverse remodeling of the left ventricle), which did not depend on the number of stented coronary arteries (p<0.05). In patients with stented one coronary artery, all structural and functional indicators of the heart after 12 months of treatment reached the values of practically healthy individuals from the control group. The use of ivabradine in patients with stable ischemic heart disease with heart failure with preserved and intermediate ejection fraction of the left ventricle after coronary stenting made it possible to ensure the correction of a number of clinical and pathogenetic links of the disease, which generally contributed to the improvement of metric and volumetric parameters of the heart. Conclusions: Ivabradine made it possible to significantly increase the effectiveness of standard therapy, which was manifested by a faster recovery of the geometry and contractility of the left ventricle. Therefore, the use of ivabradine along with standard therapy was appropriate for such a contingent of patients. The management of patients with stable coronary heart disease should combine adequate (surgical and pharmacological) treatment of the underlying disease, further individual medication correction of symptoms and circulatory disorders inherent in coronary heart disease and heart failure.
