Predictors of rapid plaque progression: an optical coherence tomography study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Araki ◽  
T Yonetsu ◽  
O Kurihara ◽  
A Nakajima ◽  
H Lee ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Multivariable Analysis ◽  
Morphological Characteristics ◽  
Critical Threshold ◽  
Rapid Progression ◽  
Plaque Progression ◽  
Plaque Disruption ◽  
Lipid Rich Plaque ◽  
Oct Imaging

Abstract Background Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former will cause stable angina when the narrowing reaches a critical threshold, while the latter may lead to acute coronary syndromes or sudden cardiac death. Purpose The aim of the study was to identify morphologic predictors for rapid plaque progression. Methods Patients who had OCT imaging during the index procedure and follow-up angiography with a minimum of 6-month interval were selected. Non-culprit lesion was defined as a plaque with a diameter stenosis ≥30% on index angiogram. Lesion progression was defined as the decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of the plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with progression, morphological changes from baseline to follow-up were assessed. Results Among 517 lesions, 50 lesions showed progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%), layered plaque (60.0% vs. 34.0%), macrophage accumulation (62.0% vs. 42.4%), microvessel (46.0% vs. 29.1%), plaque rupture (12.0% vs. 4.7%), and thrombus (6.0% vs. 1.1%), compared to those without progression. The multivariable analysis identified lipid-rich plaque [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.02–4.62, p=0.045], TCFA (OR 5.85, 95% CI 2.01–17.03, p=0.001), and layered plaque (OR 2.19, 95% CI 1.03–4.17, p=0.040) as predictors of subsequent lesion progression. In a subgroup with follow-up OCT, a new layer was detected in 14/41 (34.1%) plaques. Conclusions Lipid-rich plaque, TCFA, and layered plaque were predictors of subsequent rapid plaque progression. A new layer, a signature of rapid progression through plaque disruption and healing, was detected in 1/3 of the cases. Funding Acknowledgement Type of funding source: None

Predictors for rapid progression of coronary calcification: an optical coherence tomography (OCT) study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Nakajima ◽  
M Araki ◽  
O Kurihara ◽  
Y Minami ◽  
T Soeda ◽  
...  
Keyword(s):  
Vascular Inflammation ◽  
Multivariable Analysis ◽  
Coronary Calcification ◽  
Rapid Progression ◽  
Natural Progression ◽  
Lipid Rich Plaque ◽  
Oct Imaging ◽  
High Level

Abstract Background The natural progression of coronary calcification has not been systematically studied. In vivo coronary calcium can be evaluated by OCT. Purpose To identify the incidence and predictors for rapid progression of coronary calcification. Methods Patients with serial OCT imaging at baseline and at 6 months were selected from our database. Changes in calcium index during 6-month follow-up and predictors for progression of calcification were studied. Calcium index was defined as the product of the mean calcium arc and calcium length. Rapid progression of calcification was defined as an increase in calcium index above the median value. Results Among 187 patients who had serial OCT imaging, 235 calcified plaques were identified in 108 patients (57.8%) at baseline with median calcium index of 132.0 (Interquartile range 58.5–281.2). After 6 months, the calcium index increased in 95.3% of calcified plaques from 132.0 to 178.2 (p<0.001). In multivariable analysis, diabetes mellitus (DM), chronic kidney disease (CKD), lipid-rich plaque, and macrophages were found to be independent predictors for rapid progression of coronary calcification (table). Interestingly, rapid progression of calcification was associated with a significant reduction of inflammatory features (thin-cap fibroatheroma [TCFA]; baseline 21.2% vs. follow-up 11.9%, p=0.003, macrophages; baseline 74.6% vs. follow-up 61.0%, p=0.001). Conclusions This study demonstrated that DM, CKD, lipid-rich plaque, and macrophages were independent predictors for rapid progression of coronary calcification. High level of vascular inflammation may stimulate rapid progression of calcification. Funding Acknowledgement Type of funding source: None

scholarly journals Increased Wall Enhancement During Follow-Up as a Predictor of Subsequent Aneurysmal Growth

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1868-1872 ◽  
Author(s):  
Florent Gariel ◽  
Wagih Ben Hassen ◽  
Grégoire Boulouis ◽  
Romain Bourcier ◽  
Denis Trystram ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Vessel Wall ◽  
De Novo ◽  
Morphological Changes ◽  
Multivariable Analysis ◽  
Resonance Imaging ◽  
Unruptured Intracranial Aneurysms

Background and Purpose— Absence of arterial wall enhancement (AWE) of unruptured intracranial aneurysms (UIA) has shown promise at predicting which aneurysms will not rupture. We here tested the hypothesis that increased enhancement during follow-up (increased intensity, extension, or thickness or appearance of de novo enhancement), assessed using vessel wall magnetic resonance imaging, was associated with higher rates of subsequent growth. Methods— Patients with UIA were included between 2012 and 2018. Two readers independently rated AWE modification on 3T vessel wall magnetic resonance imaging, and morphological changes on time-of-flight magnetic resonance angiography during follow-up. Results— A total of 129 patients harboring 145 UIA (mean size 4.1 mm) met study criteria, of which 12 (8.3%) displayed morphological growth at 2 years. Of them, 8 demonstrated increased AWE during follow-up before or concurrently to morphological growth, and 4 had preexisting AWE that remained stable before growth. In the remaining 133 (nongrowing) UIAs, no AWE modifications were found. In multivariable analysis, increased AWE, not size, was associated with UIA growth (relative risk, 26.1 [95% CI, 7.4–91.7], P <0.001). Sensitivity, specificity, positive predictive value, and negative predictive value for UIA growth of increased AWE during follow-up were, respectively, of 67%, 100%, 96%, and 100%. Conclusions— Increased AWE during follow-up of conservatively managed UIAs predicts aneurysm growth over a 2-year period. This may impact UIA management towards closer monitoring or preventive treatment. Replication in a different setting is warranted.

Volumetric and morphological characteristics of the hippocampus are associated with progression to schizophrenia in patients with first-episode psychosis

2017 ◽  
Vol 45 ◽  
pp. 1-5 ◽  
Author(s):  
R. Sauras ◽  
A. Keymer ◽  
A. Alonso-Solis ◽  
A. Díaz ◽  
C. Molins ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Morphological Characteristics ◽  
First Episode Psychosis ◽  
First Episode ◽  
Control Group ◽  
Subcortical Structures ◽  
Episode Psychosis ◽  
Left Hippocampus ◽  
One Year

AbstractBackground:Abnormalities in the hippocampus have been implicated in the pathophysiology of psychosis. However, it is still unclear whether certain abnormalities are a pre-existing vulnerability factor, a sign of disease progression or a consequence of environmental factors. We hypothesized that first-episode psychosis patients who progress to schizophrenia after one year of follow up will display greater volumetric and morphological changes from the very beginning of the disorder.Methods:We studied the hippocampus of 41 patients with a first-episode psychosis and 41 matched healthy controls. MRI was performed at the time of the inclusion in the study. After one year, the whole sample was reevaluated and divided in two groups depending on the diagnoses (schizophrenia vs. non-schizophrenia).Results:Patients who progressed to schizophrenia showed a significantly smaller left hippocampus volume than control group and no-schizophrenia group (F = 3.54; df = 2, 77; P = 0.03). We also found significant differences in the morphology of the anterior hippocampus (CA1) of patients with first-episode psychosis who developed schizophrenia compared with patients who did not.Conclusions:These results are consistent with the assumption of hyperfunctioning dopaminergic cortico-subcortical circuits in schizophrenia, which might be related with an alteration of subcortical structures, such as the hippocampus, along the course of the disease. According with these results, hippocampus abnormalities may serve as a prognostic marker of clinical outcome in patients with a first-episode psychosis.

scholarly journals Changes in Patellar Morphology Following Surgical Correction of Recurrent Patellar Dislocation in Children

2021 ◽  
Author(s):  
Weifeng Li ◽  
Qian Wang ◽  
Hui Li ◽  
shunyi wang
Keyword(s):  
Patellar Dislocation ◽  
Morphological Changes ◽  
Morphological Characteristics ◽  
Surgical Correction ◽  
Ct Scans ◽  
Control Group ◽  
Recurrent Patellar Dislocation ◽  
Radiological Parameters ◽  
Significant Difference

Abstract Background: The aim of this study was to evaluate the morphological changes of patella following surgical correction of recurrent patellar dislocation in children. Methods: 35 immature children aged 5 to 10 years who suffered from bilateral recurrent patellar dislocation associated with abnormal patella morphology. The knee had most frequently patellar dislocation, which was underwent medial patellar retinacular plasty, and defined as in the study group(SG). The contralateral knee was treated conservatively and defined as in the control group (CG). Computed tomography (CT) scans were performed on all children preoperatively and at the last follow-up to evaluate the patellar morphological characteristics. Results: All the radiological parameters of the patella, showed no significant difference between the two groups, Preoperatively. At the last follow-up for CT scans, no signifcant diferences were evaluable for the relative patellar width (SG, 54.61%; CG, 52.87%; p=0.086) and the relative patellar thickness (SG, 26.07% ; CG, 25.02%; p = 0.243). The radiological parameters including Wiberg-angle (SG, 136.25°; CG, 122.65°; p < 0.001), modified Wiberg-index (SG, 1.23; CG, 2.65 ; p < 0.001), and lateral patellar facet angle (SG, 23.35° ; CG, 15.26°; p < 0.001) showed statistical differences between the two groups. Conclusions: The morphology of the patella can be improved by early surgical correction in children with recurrent patellar dislocation. Early intervention for children with recurrent patellar dislocation is important.

scholarly journals Predictive value of Altmetric Score on prospective citation and bibliometric impact: rise of a new argot

2020 ◽  
Author(s):  
David BT Robinson ◽  
Arfon G Powell ◽  
Jennifer Waterman ◽  
Luke G Hopkins ◽  
Osian P James ◽  
...  
Keyword(s):  
Impact Factor ◽  
Citation Rate ◽  
Citation Count ◽  
Multivariable Analysis ◽  
Critical Threshold ◽  
Research Article ◽  
Based Medicine ◽  
Article Impact

Background Bibliometric and Altmetric analyses provide important but alternative perspectives regarding research article impact. This study aimed to establish whether Altmetric Score (AS) was associated with citation rate, independent of bibliometrics. Method Citations for a previously reported cohort of 100 most cited articles associated with the keyword Surgery (2018, Powell et al), were collected and a three year interval Citation Gain (iCG) evaluated. Previous citation count, Citation Rate Index (CRI), AS, five year Impact Factor, and Oxford Centre for Evidence Based Medicine (OCEBM) levels were used to classify citation rate prospect. Results During follow-up, the median iCG was 161 (IQR 83 to 281), with 73 and 62 articles receiving an increase in CRI and AS, respectively. Median CRI and AS increase were 2.8 (−0.1 to 7.7) and 3 (0 to 4), respectively. Receiver Operator Characteristic (ROC) analysis revealed that CRI (AUC 0.86 (95% CI 0.79 to 0.93), p<0.001) and AS (Area Under Curve (AUC) 0.65 (95% CI 0.55 to 0.76), p=0.008) were associated with higher iCG. AS critical threshold greater than or equal to 2.0 was associated with better iCG when dichotomised at iCG median (OR=4.94, 95% CI 1.99 to 12.26, p=0.001) and iCG Upper Quartile (UQ, OR=4.13, 95% CI 1.60 to 10.66, p=0.003). Multivariable analysis identified that only CRI was independently associated with iCG when dichotomised at the median (OR 18.22, 95% CI 6.70 to 49.55, p<0.001) and UQ (OR 19.30, 95% CI 4.23 to 88.15, p<0.001). Conclusion Citation Rate Indices and Altmetric Scores are important predictors of interval Citation Gain, and better at predicting future citations than the historical and established Impact Factor and OCEBM quality of evidence descriptors.

Characteristics of the course of nephritis associated with Iga-vasculitis Henoch-Schoenlein in children

2020 ◽  
Vol 24 (3) ◽  
pp. 64-71
Author(s):  
A. V. Sukalo ◽  
I. A. Kazyra
Keyword(s):  
Clinical Laboratory ◽  
Morphological Changes ◽  
Pediatric Nephrology ◽  
Morphological Characteristics ◽  
Lymphocyte Activation ◽  
Renal Tissue ◽  
Kidney Damage ◽  
Iga Vasculitis ◽  
Factors Affecting ◽  
Treatment Regimens

INTRODUCTION. Among systemic vasopathies in children, IgA vasculitis Henoch Schoenlein (HS) is the most common, according to various authors, kidney damage is noted in 25-80 % and usually determines the prognosis of the disease.THE AIM of the study was to analyze clinical, laboratory, immunological, morphological characteristics, features of the course and treatment of nephritis associated with IgA vasculitis HS in children, as well as factors affecting the prognosis.PATIENTS AND METHODS. The study included 31 patients with morphologically verified nephritis due to IgA vasculitis HS (18 – boys, 13 – girls) aged 3 to 17 years, who were monitored at the Nephrology Department of the "2nd Children's City Clinical Hospital" of the National Center for Pediatric Nephrology and Renal Replacement therapy in Minsk from 2010 to 2019 yrs.The following parameters were analyzed: the clinical variant of kidney damage, laboratory tests (including the study of BAFF, RANTES lymphocyte activation molecules, pro-inflammatory IL1β, caspase1, TNFα, growth factors VEGF, TGF), 24 hours monitoring and office blood pressure measurements, ECHO cardiography with indicescalculation, ultrasound of the carotid arteries with the thickness of intima-media complex, morphological changes in the renal tissue, as well as treatment regimens.RESULTS. The contribution of deGal-IgA1, markers of T and B lymphocytes activation, pro-inflammatory and profibrotic molecules in the development of the disease is shown. Arterial hypertension was registered in 42 % of children, signs of heart remodeling according to the calculated indices in 19,3 %. Decrease level of adiponectin, vitamin D, leptin, increase concentration of obestatin, Pro-BNP, hs-CRP, and TSAT indicator classify patients with nephritis due to IgA vasculitis HS at moderate risk for the developmentof cardio-vascular disorders, which suggests the need for timely correction.CONCLUSION. In most cases, nephritis with IgA vasculitis HS has a benign course with rare relapses and progression to the end stage of chronic kidney disease (6,5 %).

scholarly journals OCT Findings in MINOCA

2021 ◽  
Vol 10 (13) ◽  
pp. 2759
Author(s):  
Krzysztof Bryniarski ◽  
Pawel Gasior ◽  
Jacek Legutko ◽  
Dawid Makowicz ◽  
Anna Kedziora ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Imaging Modality ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Morphological Characteristics ◽  
Artery Dissection ◽  
Plaque Disruption ◽  
Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Michael A Catalano ◽  
Shahryar G Saba ◽  
Bruce Rutkin ◽  
Greg Maurer ◽  
Jacinda Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Post Intervention ◽  
Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient &gt;40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of &gt;1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

scholarly journals Skin autofluorescence predicts new cardiovascular disease and mortality in people with type 2 diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henderikus E. Boersma ◽  
Robert P. van Waateringe ◽  
Melanie M. van der Klauw ◽  
Reindert Graaff ◽  
Andrew D. Paterson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Fasting Blood Glucose ◽  
Multivariable Analysis ◽  
Oral Glucose ◽  
Skin Autofluorescence ◽  
Z Score

Abstract Background Skin autofluorescence (SAF) is a non-invasive marker of tissue accumulation of advanced glycation endproducts (AGE). Recently, we demonstrated in the general population that elevated SAF levels predict the development of type 2 diabetes (T2D), cardiovascular disease (CVD) and mortality. We evaluated whether elevated SAF may predict the development of CVD and mortality in individuals with T2D. Methods We included 2349 people with T2D, available baseline SAF measurements (measured with the AGE reader) and follow-up data from the Lifelines Cohort Study. Of them, 2071 had no clinical CVD at baseline. 60% were already diagnosed with diabetes (median duration 5, IQR 2–9 years), while 40% were detected during the baseline examination by elevated fasting blood glucose ≥7.0 mmol/l) and/or HbA1c ≥6.5% (48 mmol/mol). Results Mean (±SD) age was 57 ± 12 yrs., BMI 30.2 ± 5.4 kg/m2. 11% of participants with known T2D were treated with diet, the others used oral glucose-lowering medication, with or without insulin; 6% was using insulin alone. Participants with known T2D had higher SAF than those with newly-detected T2D (SAF Z-score 0.56 ± 0.99 vs 0.34 ± 0.89 AU, p < 0.001), which reflects a longer duration of hyperglycaemia in the former group. Participants with existing CVD and T2D had the highest SAF Z-score: 0.78 ± 1.25 AU. During a median follow-up of 3.7 yrs., 195 (7.6%) developed an atherosclerotic CVD event, while 137 (5.4%) died. SAF was strongly associated with the combined outcome of a new CVD event or mortality (OR 2.59, 95% CI 2.10–3.20, p < 0.001), as well as incidence of CVD (OR 2.05, 95% CI 1.61–2.61, p < 0.001) and death (OR 2.98, 2.25–3.94, p < 0.001) as a single outcome. In multivariable analysis for the combined endpoint, SAF retained its significance when sex, systolic blood pressure, HbA1c, total cholesterol, eGFR, as well as antihypertensive and statin medication were included. In a similar multivariable model, SAF was independently associated with mortality as a single outcome, but not with incident CVD. Conclusions Measuring SAF can assist in prediction of incident cardiovascular disease and mortality in individuals with T2D. SAF showed a stronger association with future CVD events and mortality than cholesterol or blood pressure levels.

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