103 Coronary plaque healing and diabetes: insights from optical coherence tomography imaging

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rocco Vergallo ◽  
Marco Lombardi ◽  
Matteo Betti ◽  
Alfredo Ricchiuto ◽  
Alessandro Maino ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Plaque Rupture ◽  
Thrombus Formation ◽  
Coronary Plaque ◽  
Suboptimal Control ◽  
Diabetic Patients ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
Vessel Structure

Abstract Aims Atherosclerotic plaque healing is a dynamic process developing after plaque rupture or erosion, which aims to prevent lasting occlusive thrombus formation and to promote plaque repair. We hypothesized that diabetes mellitus, one of the major conventional cardiovascular risk factors, may influence the healing capacity after plaque destabilization. Methods and results In this single-centre observational cohort study, patients with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) who underwent optical coherence tomography (OCT) imaging at Fondazione Policlinico A. Gemelli–IRCCS, Rome, were included. Patients were divided into two groups (i.e. diabetes vs. no diabetes), and stratified based on diabetes medications (i.e. insulin, vs. oral antidiabetic drugs). OCT analysis of non-culprit coronary segments was performed. 105 patients were included (44 diabetes, 61 no diabetes). Prevalence of HCPs was not significantly different between patients with and without diabetes (3.6% vs. 3.8%, P = 0.854). However, patients with diabetes on insulin showed a lower prevalence of HCPs both at patient-based (7.1% vs. 26.4%, P = 0.116) and at segment-based analysis (1.2% vs. 4.2%, P = 0.020). When comparing HbA1c levels based on the presence or absence of healed plaque at the non-culprit lesions, patients with healed plaque showed significantly lower levels of HbA1c compared to patients without healed plaques (43.5 ± 12.1% vs. 61.2 ± 10.4%, P < 0.001). At segment-based analysis, normal vessel structure, pathological intimal thickening (PIT), and spotty calcifications were significantly less prevalent in diabetic patients (2.1% vs. 5.1%, P = 0.001; 7.2% vs. 9.5%, P = 0.05; 9.9% vs. 13.6%, P = 0.02, respectively), whereas neovascularization was significantly higher (19.2% vs. 15.6%, P = 0.035). Conclusions Patients with diabetes have a distinct coronary non-culprit plaque phenotype. Healing capacity may be impaired in patients with advanced diabetes on insulin therapy and in those with a suboptimal control of the disease. Further prospective, larger scale studies are warranted to confirm these findings.

scholarly journals New Insights into the Association between Fibrinogen and Coronary Atherosclerotic Plaque Vulnerability: An Intravascular Optical Coherence Tomography Study

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Jun Wang ◽  
Lu Jia ◽  
Xing Li ◽  
Siyu Jin ◽  
Xiaomei Li ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Optical Coherence Tomography ◽  
Heart Disease ◽  
Plaque Rupture ◽  
Experimental Studies ◽  
High Body Mass Index ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Coronary Syndrome

Background. Fibrinogen levels have been associated with coronary plaque vulnerability in experimental studies. However, it has yet to be determined if serum fibrinogen levels are independently associated with coronary plaque vulnerability as detected by optical coherence tomography (OCT) in patients with coronary heart disease. Methods. Patients with coronary heart disease (CHD) who underwent coronary angiography and OCT in our department from January 2015 to August 2018 were included in this study. Coronary lesions were categorized as ruptured plaque, nonruptured with thin-cap fibroatheroma (TCFA), and nonruptured and non-TCFA. Presence of ruptured plaque and nonruptured with TCFA was considered to be vulnerable lesions. Determinants of coronary vulnerability were evaluated by multivariable logistic regression analyses. Results. A total of 154 patients were included in this study; 17 patients had ruptured plaques, 15 had nonruptured plaques with TCFA, and 122 had nonruptured plaques with non-TCFA. Results of univariate analyses showed that being male, diabetes, current smoking, high body mass index (BMI), and clinical diagnosis of acute coronary syndrome (ACS) were associated with coronary vulnerability. No significant differences were detected in patient characteristics, coronary angiographic findings, and OCT results between patients with higher and normal fibrinogen. Results of multivariate logistic analyses showed that diabetes and ACS were associated with TCFA, while diabetes, higher BMI, and ACS were associated with plaque rupture. Conclusions. Diabetes, higher BMI, and ACS are independently associated with coronary vulnerability as detected by OCT. Serum fibrinogen was not associated with coronary vulnerability in our cohort.

scholarly journals Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with acute coronary syndrome: an optical coherence tomography study

2019 ◽  
Author(s):  
Ting-yu Zhang ◽  
Qi Zhao ◽  
Ze-sen Liu ◽  
Chao-yi Zhang ◽  
Jie Yang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Coronary Plaque ◽  
Plaque Morphology ◽  
Multivariable Logistic Regression Analysis ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome

Abstract Background The importance of monocyte-to-lymphocyte ratio (MLR) has been indicated in the initiation and progression of coronary artery disease (CAD). However, few previous researches demonstrated the relationship between MLR and plaque vulnerability. We aimed to investigate coronary plaque vulnerability in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT). Methods A total of 72 ACS patients who underwent coronary angiography and OCT test in Beijing Anzhen hospital were included in this retrospective study. The plaque vulnerability and plaque morphology were assessed by OCT. Results The coronary plaque in high MLR group exhibited more vulnerable features, characterizing as thinner thickness of fibrous cap (FCT)(112.37 ± 60.24 vs 153.49 ± 73.29 μm, P = 0.013), greater maximum lipid core angle (167.36 ± 62.33 vs 138.79 ± 56.37°, P = 0.010) and longer lipid plaque length (6.34 ± 3.12 vs 4.50 ± 2.21mm, P = 0.041). A prominently negative liner relation was found between MLR and FCT (R = 0.225, P < 0.005). Meanwhile, the incidence of OCT-detected thin cap fibro-atheroma (TCFA) (44.7% vs 18.4%, P = 0.014) and plaque rupture (36.8% vs 13.2%, P = 0.017) were higher in high MLR group. Most importantly, multivariable logistic regression analysis showed MLR level was related to the presence of TCFA (OR:3.316，95%：1.448-7.593，P = 0.005). MLR level could differentiate TCFA with a sensitivity of 72.0% and a specificity of 66.1%. Conclusion Circulating MLR level has potential value in identifying the presence of vulnerable plaque in patients with ACS. MLR, as a non- invasive biomarker of inflammation, may be valuable in revealing plaque vulnerability. Key words Monocyte-to-lymphocyte ratio, Optical coherence tomography, Plaque vulnerability

scholarly journals Potential relationship between high wall shear stress and plaque rupture that cause acute coronary syndrome: insights from optical coherence tomography based computational fluid dynamic simulation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Fukuyama ◽  
H Otake ◽  
F Seike ◽  
H Kawamori ◽  
T Toba ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Shear Stress ◽  
Acute Coronary Syndrome ◽  
Wall Shear Stress ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Lumen Area ◽  
Segmental Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background The direct relationship between plaque rupture (PR) that cause acute coronary syndrome (ACS) and wall shear stress (WSS) remains uncertain. Methods From the Kobe University ACS-OCT registry, one hundred ACS patients whose culprit lesions had PR documented by optical coherence tomography (OCT) were enrolled. Lesion-specific 3D coronary artery models were created using OCT data. Specifically, at the ruptured portion, the tracing of the luminal edge of the residual fibrous cap was smoothly extrapolated to reconstruct the luminal contour before PR. Then, WSS was computed from computational fluid dynamics (CFD) analysis by a single core laboratory. Relationships between WSS and the location of PR were assessed with 1) longitudinal 3-mm segmental analysis and 2) circumferential analysis. In the longitudinal segmental analysis, each culprit lesion was subdivided into five 3-mm segments with respect to the minimum lumen area (MLA) location at the centered segment (Figure. 1). In the circumferential analysis, we measured WSS values at five points from PR site and non-PR site on the cross-sections with PR. Also, each ruptured plaque was categorized into the lateral type PR (L-PR), central type PR (C-PR), and others according to the relation between the site of tearing and the cavity (Figure. 2). Results In the longitudinal 3-mm segmental analysis, the incidences of PR at upstream (UP1 and 2), MLA, and downstream (DN1 and 2) were 45%, 40%, and 15%, respectively. The highest average WSS was located in UP1 in the upstream PR (UP1: 15.5 (10.4–26.3) vs. others: 6.8 (3.3–14.7) Pa, p&lt;0.001) and MLA segment in the MLA PR (MLA: 18.8 (6.0–34.3) vs. others: 6.5 (3.1–11.8) Pa, p&lt;0.001), and the second highest WSS was located at DN1 in the downstream PR (DN1: 5.8 (3.7–11.5) vs. others: 5.5 (3.7–16.5) Pa, p=0.035). In the circumferential analysis, the average WSS at PR site was significantly higher than that of non-PR site (18.7 (7.2–35.1) vs. 13.9 (5.2–30.3) Pa, p&lt;0.001). The incidence of L-PR, C-PR, and others were 51%, 42%, and 7%, respectively. In the L-PR, the peak WSS was most frequently observed in the lateral site (66.7%), whereas that in the C-PR was most frequently observed in the center site (70%) (Figure. 3). In the L-PR, the peak WSS value was significantly lower (44.6 (19.6–65.2) vs. 84.7 (36.6–177.5) Pa, p&lt;0.001), and the thickness of broken fibrous cap was significantly thinner (40 (30–50) vs. 80 (67.5–100) μm, p&lt;0.001), and the lumen area at peak WSS site was significantly larger than those of C-PR (1.5 (1.3–2.0) vs. 1.4 (1.1–1.6) mm2, p=0.008). Multivariate analysis demonstrated that the presence of peak WSS at lateral site, thinner broken fibrous cap thickness, and larger lumen area at peak WSS site were independently associated with the development of the L-PR. Conclusions A combined approach with CFD simulation and morphological plaque evaluation by using OCT might be helpful to predict future ACS events induced by PR. Funding Acknowledgement Type of funding source: None

Abstract 2506: Coronary Spasm Occurs in Coronary Artery with Diffuse Intima Thickeing without Lipd and/or Calcification:Evaluation with Intravascular Optical Coherence Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yoshinobu Morikawa ◽  
Shiro Uemura ◽  
Ken-ichi Ishigami ◽  
Tsunenari Soeda ◽  
Satoshi Okayama ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Coronary Spasm ◽  
Morphological Characteristics ◽  
Provocation Test ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Intravascular Optical Coherence Tomography

Coronary spasm (CS) plays an important role in the pathogenesis of many kinds of ischemic heart disease. However, morphological characteristics of coronary artery of CS remain unknown. We evaluated 37 patients with coronary spastic angina (CSA) who underwent diagnostic acetylcholine (ACh) provocation test, and 2 acute coronary syndrome patients suspected to have severe CS. The intravascular optical coherence tomography (OCT) was performed after complete dilatation of coronary artery in all patients and additionally performed during ACh-induced CS in 4 patients. Based on the ACh provocation test, 23 patients who developed CS and ischemic ECG changes were diagnosed as coronary spastic angina (CSA), and other 14 patients without CS were referred as CS-negative patients. CS-negative patients were further divided into 2 sub-groups according to the lipid and/or calcification content in coronary arterial wall by OCT findings. Intravascular OCT revealed most coronary segments with ACh-induced CS had homogenous intima thickening, and quantitative OCT analysis showed that CS-positive segments had significantly larger intima area compared with CS-negative segments without lipid and/or calcification (2.73±0.07 vs. 1.36±0.06 mm 2 , P<0.001). By contrast, CS-positive segments had significantly smaller intima area compared with CS-negative segments with lipid and/or calcification (2.73±0.07 vs. 4.51±0.17 mm 2 , P<0.001). During ACh-induced CS, lumen and total vascular area significantly decreased, whereas intima area did not change in comparison with complete vasodilatation. Furthermore, luminal surface of intimal layer formed markedly wavy configuration during CS. In CSA cases with acute coronary syndrome, we observed additional findings of intima injury as erosion and thrombus formation at spasm site. Coronary spasm occurs in coronary artery with diffuse intima thickening without lipid and/or calcification content but not in artery either without intima thickening or with lipid and/or calcification, and coronary spasm sometimes induces intimal injury by itself which may cause acute coronary event.

scholarly journals Effect of postprandial hyperglycaemia on culprit plaque rupture in diabetic patients with non-ST segment elevation acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Su ◽  
S.W Zhuang ◽  
T Zhang ◽  
H.X Yang ◽  
W.L Dai ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hemoglobin A1c ◽  
Plaque Rupture ◽  
Coronary Plaque ◽  
Postprandial Hyperglycemia ◽  
Diabetic Patients ◽  
Funding Source ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Abstract Background Postprandial hyperglycemia was reported to play a key role in established risk factors of coronary artery diseases (CAD) and cardiovascular events. Serum 1,5-anhydroglucitol (1,5-AG) levels are known to be a clinical marker of postprandial hyperglycemia and short-term glycemic excursions. Low serum 1,5-AG levels have been associated with occurrence of CAD; however, the relationship between 1,5-AG levels and coronary plaque rupture has not been fully elucidated. The aim of this study was to evaluate 1,5-AG as a predictor of coronary plaque rupture in diabetic patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods A total of 132 diabetic patients with NSTE-ACS were included in this study. All patients underwent intravascular ultrasound examination, which revealed 38 patients with plaque rupture and 94 patients without plaque rupture in the culprit lesion. Fasting blood glucose (FBS), hemoglobin A1c (HbA1c) and 1,5-AG levels were measured before coronary angiography. Fasting urinary 8-iso-prostaglandin F2α (8-iso-PGF2α) level was measured and corrected by creatinine clearance. Results Patients with ruptured plaque had significantly lower serum 1,5-AG levels and a tendency of higher hemoglobin A1c levels than patients without ruptured plaque in our study population. In multivariate analysis, low 1,5-AG levels were an independent predictor of plaque rupture (odds ratio 3.3; p=0.006) in diabetic patients with NSTE-ACS, but HbA1c was not. The area under the receiver-operating characteristic curve for 1,5-AG (0.678, p=0.001) to predict plaque rupture was superior to that for HbA1c (0.618, p=0.034). Levels of 1,5-AG were significantly correlated with urinary 8-iso-PGF2α (r=−0.224, p=0.010). Conclusions Postprandial hyperglycaemia appeared to be superior to long-term average blood glucose levels in predicting plaque rupture in culprit lesions, which may be useful to assess the cardiovascular outcomes in diabetic patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Outstanding Clinical Discipline Project of Shanghai Pudong, Beijing Health Special Foundation

scholarly journals Optical Coherence Tomography Analysis of Attenuated Plaques Detected by Intravascular Ultrasound in Patients with Acute Coronary Syndromes

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Takashi Kubo ◽  
Yoshiki Matsuo ◽  
Yasushi Ino ◽  
Takashi Tanimoto ◽  
Kohei Ishibashi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intravascular Ultrasound ◽  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Ultrasound Attenuation ◽  
Coronary Syndromes ◽  
Tomography Analysis ◽  
Important Marker

Background. Recent intravascular ultrasound (IVUS) studies have demonstrated that hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium is common in acute coronary syndrome. Such “attenuated plaque” may be an IVUS characteristic of unstable lesion.Methods. We used optical coherence tomography (OCT) in 104 patients with unstable angina to compare lesion characteristics between IVUS-detected attenuated plaque and nonattenuated plaque.Results. IVUS-detected attenuated plaque was observed in 41 (39%) patients. OCT-detected lipidic plaque (88% versus 49%, ), thin-cap fibroatheroma (48% versus 16%, ), plaque rupture (44% versus 11%, ), and intracoronary thrombus (54% versus 17%, ) were more often seen in IVUS-detected attenuated plaques compared with nonattenuated plaques.Conclusions. IVUS-detected attenuated plaque has many characteristics of unstable coronary lesion. The presence of attended plaque might be an important marker of lesion instability.

scholarly journals Correlation of Serum Uric Acid Levels with Nonculprit Plaque Instability in Patients with Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Donghui Zhang ◽  
Ruoxi Zhang ◽  
Ning Wang ◽  
Lin Lin ◽  
Bo Yu
Keyword(s):  
Optical Coherence Tomography ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Elevated Serum ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Instability ◽  
Coronary Syndrome ◽  
Fibrous Cap ◽  
Coronary Syndromes

Elevated serum uric acid (SUA) level is known to be a prognostic factor in patients with acute coronary syndrome (ACS). However, the correlation between SUA level and coronary plaque instability has not been fully evaluated. The aim of this study was to investigate the association between SUA level and plaque instability of nonculprit lesions in patients with ACS using optical coherence tomography. A total of 150 patients with ACS who underwent 3-vessel optical coherence tomography were selected. Patients were classified into 3 groups according to tertiles of SUA level. There was a trend towards a thinner fibrous cap (0.15 ± 0.06 versus 0.07 ± 0.01 versus 0.04 ± 0.01 mm2, p<0.001) and a wider mean lipid arc (169.41 ± 33.16 versus 177.22 ± 37.76 versus 222.43 ± 47.65°, p<0.001) with increasing SUA tertile. The plaques of the high and intermediate tertile groups had a smaller minimum lumen area than the low tertile group (6.02 ± 1.11 versus 5.38 ± 1.28 mm2, p<0.001). In addition, thin-cap fibroatheromas, microvessels, macrophages, and cholesterol crystals were more frequent in the high tertile group than the low and intermediate groups. Multivariate analysis showed SUA level to be a predictor of plaque instability.

scholarly journals Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Sebastian Reith ◽  
Andrea Milzi ◽  
Enrico Domenico Lemma ◽  
Rosalia Dettori ◽  
Kathrin Burgmaier ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Optical Coherence Tomography ◽  
Finite Elements ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Plaque Vulnerability ◽  
Finite Elements Analysis ◽  
Coronary Syndrome ◽  
Fibrous Cap

Abstract Background Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. Methods Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA. Results Minimal (139.8 ± 32.8° vs. 165.6 ± 21.6°, p < 0.001) and mean ICA (164.1 ± 14.3° vs. 176.0 ± 8.4°, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797–0.882, p < 0.001, optimal cut-off 175.9°); younger age (OR 0.95 per year, 95% CI 0.92–0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41–3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68–0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47–25.64, p < 0.001) were determinants of ICA < 175.9°. A lower ICA predicted ACS (OR for 10°-variation 0.25, 95% CI 0.13–0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion’s fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. Conclusion Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.

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