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.

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 Automatic Segmentation of Coronary Lumen and External Elastic Membrane in IVUS Images Using 8-layer U-Net

2020 ◽  
Author(s):  
Liang Dong ◽  
Wei Lu ◽  
Jun Jiang ◽  
Ya Zhao ◽  
Xiangfen Song ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Tissue Characterization ◽  
Data Augmentation ◽  
Automatic Segmentation ◽  
Model Performance ◽  
Single Frequency ◽  
Elastic Membrane ◽  
Cross Section Area ◽  
Golden Standard ◽  
External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane, i.e. EEM cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (mIoU) of 0.941 and 0.750 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician. Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

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.

Abstract 684: Changes in Levels of High Density Lipoprotein Cholesterol Predict the Impact of Torcetrapib on Progression of Coronary Atherosclerosis: Insights from ILLUSTRATE

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stephen J Nicholls ◽  
Danielle M Brennan ◽  
Kathy Wolski ◽  
Srinivasa R Kalidindi ◽  
Keon-Woong Moon ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Atherosclerosis ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Single Coronary Artery ◽  
Rate Of Progression ◽  
Atorvastatin Therapy ◽  
Atheroma Volume ◽  
The Impact ◽  
The Relationship

Background: Administration of the CETP inhibitor torcetrapib does not slow the rate of progression of coronary atherosclerosis. The reason for the lack of therapeutic efficacy remains unknown. This analysis investigated the relationship between changes in HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) and atheroma volume in patients treated with torcetrapib. Methods: 910 patients with angiographic coronary artery disease underwent IVUS imaging within a single coronary artery before and during 24 months of treatment with torcetrapib (n = 464) or placebo (n = 446) on a background of atorvastatin therapy. The relationship between changes in levels of HDL-C and LDL-C and both percent atheroma volume (PAV) and total atheroma volume (TAV) was evaluated in patients treated with torcetrapib. Results: Administration of torcetrapib raised HDL-C by 61% and lowered LDL-C by 20% when compared to atorvastatin alone. An inverse relationship was observed between changes in HDL-C and both PAV (r = −0.17, p < 0.001) and TAV (r = −0.17, p < 0.001). Patients with the highest level of HDL-C (> 87 mg/dL) had the lowest rate of progression of PAV (−0.7 v +0.7%, p = 0.0003) and TAV (−9.2 v −4.6 mm 3 , p = 0.09). The greatest elevation in level of HDL-C (> 80%) was associated with the lowest progression of PAV (−0.3 v +0.9%, p = 0.002) and TAV (−12.6 v −3.4 mm 3 , p = 0.0006). Patients undergoing regression (any reduction in PAV) had greater absolute levels (73 v 66 mg/dL, p = 0.02) and changes (59.5 v 48.3%, p = 0.02) of HDL-C. No difference in the impact of torcetrapib on changes in PAV (+0.3 v +0.1%, p = 0.34) and TAV (−9.1 v −9.3 mm 3 , p = 0.95) was observed in patients with baseline levels below or above 40 mg/dL. No relationship was observed between changes in LDL-C and either PAV (r = 0.06, p = 0.20) or TAV (r = 0.07, p = 0.12) in torcetrapib treated patients. On multivariate analysis, changes in levels of HDL-C independently predicted the impact of torcetrapib on progression of PAV (p = 0.007) and TAV (p = 0.004). Conclusion: Increasing levels of HDL-C from torcetrapib treatment were associated with a beneficial impact of torcetrapib on plaque progression. This is consistent with the generation of functional HDL particles and suggests other effects to be responsible for the lack of benefit of torcetrapib.

Intravascular ultrasound

2021 ◽  
pp. 60-63
Author(s):  
Lorenz Räber
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Coronary Intervention ◽  
Elastic Membrane ◽  
Arterial Grafts ◽  
Anatomical Structures ◽  
Percutaneous Coronary ◽  
External Elastic Membrane ◽  
Artery Disease ◽  
Global And Local

Intravascular ultrasound represents the most established, well-validated, and widely used intracoronary imaging technology worldwide and was introduced approximately 25 years ago. Intravascular ultrasound enables the visualization of key anatomical structures of the coronary artery and saphenous or arterial grafts including the lumen, external elastic membrane, and adventitia and thereby provides the basis for the assessment of the degree of coronary artery stenosis, extent of atherosclerosis burden (i.e. global and local disease burden), and plaque composition. All this represents key information to plan and perform percutaneous coronary intervention procedures in native coronary artery disease or graft lesions and to estimate the risk for future cardiovascular events.

scholarly journals Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net

2020 ◽  
Author(s):  
Liang Dong ◽  
Wei Lu ◽  
Jun Jiang ◽  
Ya Zhao ◽  
Xiangfen Song ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Tissue Characterization ◽  
Data Augmentation ◽  
Automatic Segmentation ◽  
Model Performance ◽  
Single Frequency ◽  
Elastic Membrane ◽  
Ultrasound Images ◽  
External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane (EEM), i.e. cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (mIoU) of 0.937 and 0.804 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician.Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

scholarly journals Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net

2021 ◽  
Author(s):  
Liang Dong ◽  
Wenbing Jiang ◽  
Wei Lu ◽  
Jun Jiang ◽  
Ya Zhao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Tissue Characterization ◽  
Data Augmentation ◽  
Automatic Segmentation ◽  
Model Performance ◽  
Single Frequency ◽  
Elastic Membrane ◽  
Ultrasound Images ◽  
External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane (EEM), i.e. cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (MIoU) of 0.937 and 0.804 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician. Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

scholarly journals Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net

2020 ◽  
Author(s):  
Liang Dong ◽  
Wei Lu ◽  
Jun Jiang ◽  
Ya Zhao ◽  
Xiangfen Song ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Tissue Characterization ◽  
Data Augmentation ◽  
Automatic Segmentation ◽  
Model Performance ◽  
Single Frequency ◽  
Elastic Membrane ◽  
Ultrasound Images ◽  
External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane, i.e. EEM cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (mIoU) of 0.941 and 0.750 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician. Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

scholarly journals Structural Thickening of Medial Layer in Coronary Artery With Spasm in Patients With Myocardial Infarction

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Takamitsu Nakamura ◽  
Takeo Horikoshi ◽  
Kiyotaka Kugiyama
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Elastic Membrane ◽  
Optical Coherence ◽  
Unique Identifier ◽  
External Elastic Membrane ◽  
Relationship Of ◽  
Medial Area

Background The underlying pathophysiology of coronary artery spasm (CAS) remains unclear. We aim to determine whether coronary artery medial layer thickness is associated with CAS using optical coherence tomography. Methods and Results A total of 50 patients with previous myocardial infarction underwent optical coherence tomography of the left anterior descending artery: 20 with CAS and 30 without CAS. Intimal and medial layer areas were measured by planimetric analysis of optical coherence tomography images. The medial area/external elastic membrane (EEM) area was significantly greater in patients with than without CAS (0.13±0.01 versus 0.09±0.01, respectively, P <0.01), whereas the intimal area/EEM area was similar in the 2 groups. In patients without CAS, the relationship of intimal area/EEM area with medial area/EEM area and coronary diameter response to intracoronary injection of acetylcholine was characterized by an inverted U‐shaped curve ( y =−1.85 x 2 +0.81 x +0.01, R 2 =0.43, P <0.001) and a U‐shaped curve ( y =2993.2 x 2 −1359.6 x +117.1, R 2 =0.53, P <0.001), respectively. Thus, the medial layer became thin and the contractile response became weak in coronary arteries with greater intimal area in the non‐CAS patients. In contrast, in patients with CAS, the intimal area/EEM area had no significant relationship with the medial area/EEM area in either linear correlation analysis or quadratic regression analysis. Thus, even when the intimal layer thickened, the medial layer did not thin in patients with CAS. Conclusions The structural thickness of the coronary medial layer was increased in patients with CAS, which may provide mechanistic insight into the pathogenesis of CAS. Registration URL: https://www.upload.umin.ac.jp ; Unique identifier: UMIN000018432.

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