IVUS-based Fluid-structure Interaction Models for Novel Plaque Vulnerability Indices: A Study in Patients with Coronary Artery Disease

Abstract Background Intracoronary polarimetry with polarization-sensitive (PS-) optical frequency domain imaging (OFDI) measures polarization properties, including birefringence and depolarization, in parallel with structural features of conventional OFDI (Figure 1A). Collagen, which imparts mechanical integrity to fibrous caps, and collagen-synthesizing smooth muscle cells exhibit elevated birefringence. Depolarization is increased by the presence of macrophages and lipid/necrotic cores. Purpose This study aimed to compare conventional OFDI and polarimetric signatures of coronary lesions between patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Furthermore, we aimed to determine a birefringence cut-off value for identifying which fibrous caps belong to ACS culprit lesions. Methods This study consisted of 37 patients with ACS (n=23) or CCS (n=14). ACS culprit lesions (ACS-lesions) and CCS stenotic lesions (CCS-lesions) were included in the analysis (820 mm). Qualitative and quantitative conventional OFDI analysis included the presence of plaque rupture, macrophage infiltration, micro-vessels, thrombus, stenosis severity, fibrous cap thickness (FCT), lipid arc, lipid-burden and calcium-burden index. Birefringence and depolarization of the coronary lesions and fibrous caps were measured in the cross-sectional images showing the minimum FCT or minimum luminal area. Predictors of ACS-lesions were investigated by multivariate regression analysis. Receiver operating characteristic (ROC) analysis was used to determine the birefringence cut-off value identifying ACS fibrous caps (ACS-caps). Results There were no significant differences in clinical characteristics between the two groups, except for previous history of coronary artery disease. Compared to CCS-lesions, ACS-lesions featured higher lipid-burden index and maximum lipid arc (both p<0.05). ACS-lesions featured lower birefringence and higher depolarization than CCS-lesions (p<0.05). Multivariable regression demonstrated an independent association of birefringence with ACS-lesions (p<0.05), even after adjusting for the conventional OFDI findings. Limiting the analysis to the fibrous caps, ACS-caps exhibited significantly lower birefringence (p<0.05) and higher depolarization (p<0.05) that CCS-caps. ROC analysis for differentiating ACS-caps from CCS-caps found that a birefringence value of 0.0004 results in a sensitivity and specificity of 88% and 82%, respectively (Figure 1B, AUC = 0.82). Conclusions Intracoronary polarimetry provides quantitative assessment of coronary lesions related to their composition. Birefringence was an independent robust predictor of ACS-lesions. Decreased birefringence and pronounced depolarization within the ACS-caps may indicate increased collagenolytic activity and macrophage infiltration, respectively. These results suggest that polarization properties may serve as quantitative imaging markers for assessing plaque vulnerability. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the National Institutes of Health and by Terumo Corporation.

Download Full-text

THE IMPACT OF SERUM TRANS FATTY ACIDS CONCENTRATION ON PLAQUE VULNERABILITY IN PATIENTS WITH CORONARY ARTERY DISEASE UNDER MANAGEMENT OF CONVENTIONAL RISK FACTORS: ASSESSMENT VIA OPTICAL COHERENCE TOMOGRAPHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30362-x ◽

2016 ◽

Vol 67 (13) ◽

pp. 361

Author(s):

Yoshinori Nagasawa ◽

Toshiro Shinke ◽

Ryuji Toh ◽

Hiromasa Otake ◽

Tomofumi Takaya ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Fatty Acids ◽

Optical Coherence Tomography ◽

Coronary Artery ◽

Trans Fatty Acids ◽

Plaque Vulnerability ◽

Artery Disease ◽

The Impact ◽

Conventional Risk Factors

Download Full-text

Plasma Pentraxin3 Level Is Associated With Plaque Vulnerability Assessed by Optical Coherence Tomography in Patients With Coronary Artery Disease

International Heart Journal ◽

10.1536/ihj.15-248 ◽

2016 ◽

Vol 57 (1) ◽

pp. 18-24 ◽

Cited By ~ 7

Author(s):

Ryunosuke Tazaki ◽

Jun Tanigawa ◽

Tomohiro Fujisaka ◽

Kensaku Shibata ◽

Yoshihiro Takeda ◽

...

Keyword(s):

Coronary Artery Disease ◽

Optical Coherence Tomography ◽

Coronary Artery ◽

Optical Coherence ◽

Plaque Vulnerability ◽

Artery Disease

Download Full-text

Achilles tendon thickening is associated with disease severity and plaque vulnerability in patients with coronary artery disease

Journal of Clinical Lipidology ◽

10.1016/j.jacl.2018.10.007 ◽

2019 ◽

Vol 13 (1) ◽

pp. 194-200 ◽

Cited By ~ 4

Author(s):

Takuya Hashimoto ◽

Yoshiyasu Minami ◽

Ryota Kakizaki ◽

Teruyoshi Nemoto ◽

Kazuhiro Fujiyoshi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Achilles Tendon ◽

Disease Severity ◽

Plaque Vulnerability ◽

Artery Disease

Download Full-text

Efficacy of alirocumab for reducing plaque vulnerability: Study protocol for ALTAIR, a randomized controlled trial in Japanese patients with coronary artery disease receiving rosuvastatin

Journal of Cardiology ◽

10.1016/j.jjcc.2018.11.012 ◽

2019 ◽

Vol 73 (3) ◽

pp. 228-232 ◽

Cited By ~ 2

Author(s):

Hiromasa Otake ◽

Yoichiro Sugizaki ◽

Takayoshi Toba ◽

Yuichiro Nagano ◽

Yoshiro Tsukiyama ◽

...

Keyword(s):

Coronary Artery Disease ◽

Randomized Controlled Trial ◽

Coronary Artery ◽

Study Protocol ◽

Controlled Trial ◽

Japanese Patients ◽

Plaque Vulnerability ◽

Randomized Controlled ◽

Artery Disease

Download Full-text

A Spatiotemporal Analysis of a Fluid Structure Interaction Model of the Left Coronary Artery

The FASEB Journal ◽

10.1096/fasebj.2021.35.s1.05079 ◽

2021 ◽

Vol 35 (S1) ◽

Author(s):

Marina Fandaros ◽

Yulee Li ◽

Jie Jane Cao ◽

Wei Yin

Keyword(s):

Coronary Artery ◽

Left Coronary Artery ◽

Fluid Structure Interaction ◽

Interaction Model ◽

Spatiotemporal Analysis ◽

Fluid Structure ◽

Structure Interaction

Download Full-text

P5508Impact of CD14++CD16+ monocytes on coronary plaque vulnerability assessed by optical coherence tomography in coronary artery disease patients

European Heart Journal ◽

10.1093/eurheartj/ehz746.0458 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Yamamoto ◽

H Otake ◽

T Shinke ◽

T Yamashita ◽

H Kawamori ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Plaque ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Plaque Vulnerability ◽

Glucose Fluctuation ◽

Fibrous Cap ◽

Lipid Rich Plaque ◽

Artery Disease

Abstract Background Diabetes mellitus has been known as an important factor of coronary artery disease (CAD) progression despite of widespread with lipid-lowering therapy. Although we have reported that large glucose fluctuation is associated with the development of cardiovascular disease in both diabetes mellitus (DM) and non-DM patients, the underlying mechanisms remain unclear. Monocytes play a key role for atherosclerotic plaque formation. Monocytes in human peripheral blood are divided into three subsets: CD14++CD16− monocytes, CD14++CD16+ monocytes, and CD14+CD16++ monocytes. The CD14++CD16+ monocyte subset has recently received attention because it is reported to be associated with future cardiovascular events such as acute myocardial infarction. However, their impact on coronary plaque vulnerability in coronary artery disease (CAD) patients with or without DM remains unclear. Purpose The aim of this study was to investigate the impact of CD14++CD16+ monocyte levels on coronary plaque vulnerability and glucose fluctuation in stable CAD patients with well-regulated lipid levels. Methods This prospective observational study included 50 consecutive patients with CAD (DM [n=22], Non-DM [n=28]), receiving lipid-lowering therapy and undergoing coronary angiography and optical coherence tomography (OCT). Patients were divided into 3 tertiles according to the CD14++CD16+ monocyte percentages assessed by flow cytometry. Standard OCT parameters including lipid arc, lipid length, fibrous cap thickness (FCT) on lipid rich plaque, were assessed for 97 angiographically intermediate lesions (diameter stenosis: 30–70%). The presence of thin-cap fibroatheroma (TCFA), defined as a thin fibrous cap (<65μm) overlying a lipid-rich plaque (>90°), was also assessed. Daily glucose fluctuation assessed by using continuous glucose monitoring system was analyzed by measuring the mean amplitude of glycemic excursion (MAGE). Results CD14++CD16+ monocytes negatively correlated with FCT on lipid rich plaque (r=0.508, p<0.01) (Figure. 1). The presence of thin-cap fibroatheroma (TCFA) was increased stepwise according to the tertile of CD14++CD16+ monocytes (0 [tertile 1] vs. 5 [tertile 2] vs. 10 [tertile 3], p<0.01). CD14++CD16+ monocytes were a significant determinant of TCFA (OR 1.279, p=0.001). Although CD14++CD16+ monocytes were not significantly correlated with MAGE in DM patients (r=0.259, p=0.244), a significant relationship was found between CD14++CD16+ monocytes and MAGE in non-DM patients (r=0.477, p=0.018) (Figure 2). Conclusions CD14++CD16+ monocytes were associated with coronary plaque vulnerability in CAD patients with well-regulated lipid levels both in DM and non-DM patients. Cross-talk between glucose fluctuation and CD14++CD16+ monocytes may enhance plaque vulnerability, particularly in non-DM patients. CD14++CD16+ monocytes could be a possible therapeutic target for coronary plaque stabilization.

Download Full-text