Cardiovascular Imaging Techniques for Detection of Vulnerable Plaques

Abstract Various cardiovascular imaging techniques were developed for the detection of vulnerable atherosclerotic plaques, hoping to be able to predict a cardiovascular event. Plaque vulnerability results from compound pathophysiological mechanisms that lead to structural and morphological changes in lesions. The aim of this review is to present the most recent techniques for the assessment of vulnerable coronary plaques such as cardiac computed tomography angiography (CCTA), optical coherence tomography, or virtual histology intravascular ultra-sound, based on literature data from the last 3 years. CCTA permits direct visualization of the intravascular lumen, together with characterization of the arterial wall. Recent studies maintain that low-attenuation plaques, spotty calcifications, positive vessel remodeling, and the napkin-ring sign are considered main markers of plaque vulnerability and instability. Emerging analytical techniques, such as machine learning or radiomics, will probably demonstrate useful as an auxiliary diagnostic tool for vulnerable plaque detection. The data from the two imaging techniques together provide useful information, especially in patients undergoing a PCI procedure for an acute coronary syndrome. Invasive and noninvasive imaging techniques are able to deliver a large amount of scientific data to assess vulnerable coronary atheromatous plaques. Recent studies demonstrated that information defined by the two techniques is complementary, and using both methods is essential for adequate diagnosis, therapeutic strategy, and prognostic assessment.

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COVID-19 associated multisystem inflammatory syndrome in a neonate with atypical coronary artery involvement.

American Journal of Perinatology ◽

10.1055/a-1733-4163 ◽

2022 ◽

Author(s):

Simonetta Costa ◽

Angelica Bibiana Delogu ◽

Anthea Bottoni ◽

Velia Purcaro ◽

Vito D'Andrea ◽

...

Keyword(s):

Coronary Artery ◽

Imaging Techniques ◽

Cardiac Computed Tomography ◽

Correct Diagnosis ◽

Multiple Organ ◽

Organ Involvement ◽

Cardiac Computed Tomography Angiography ◽

Coronary Artery Involvement ◽

Coronary Artery Dilatation ◽

Inflammatory Syndrome

Objective The study aimed to report a COVID-19 associated multisystem inflammatory syndrome in children (MIS-C) in a neonate found to have an atypical diffuse thickening in coronary artery walls, whose diagnosis required a multi-imaging approach. Study Design A neonate presented at birth with multiple organ involvement and coronary artery anomalies. A diagnosis of MIS-C associated to COVID-19 was supported by maternal Sars-CoV-2 infection during pregnancy, and by the presence of both IgG against Sars-CoV-2 and Spike-specific memory B cells response in the neonatal blood. Other plausible causes of the multiple organ involvement were excluded. Result At admission, a severe coronary artery dilatation was identified on echocardiography, supporting the diagnosis of MIS-C Kawasaki-like disease; however, coronary artery internal diameters were found to be normal using cardiac computed tomography angiography. At discharge, comparing the two imaging techniques each other, the correct diagnosis resulted to be an abnormal thickening in coronary arterial walls. These findings suggest that the inflammatory process affecting the coronary arterial wall in MIS-C could result not only in typical coronary artery lesions such as dilatation of the lumen or aneurysms development, but also in abnormal thickening of the coronary artery wall. Conclusion. Our case provides an alert for paediatric cardiologists about the complexity to assess coronary artery involvement in MIS-C, and raises the question of whether an abnormal vascular remodeling, with normal inner diameters, is to be considered like coronary artery dilatation for risk stratification.

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Original Research. Transluminal Contrast Attenuation Gradient Is Associated with Coronary Plaque Vulnerability — a Computed Tomography Angiography-based Study

Journal Of Cardiovascular Emergencies ◽

10.1515/jce-2017-0016 ◽

2017 ◽

Vol 3 (3) ◽

pp. 121-127

Author(s):

Marius Orzan ◽

Roxana Hodas ◽

Mihaela Dobra ◽

Nora Rat ◽

Monica Chitu ◽

...

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Functional Significance ◽

Necrotic Core ◽

Original Research ◽

Fatty Tissue ◽

Plaque Vulnerability ◽

Plaque Volume ◽

Cardiac Computed Tomography Angiography ◽

Atheromatous Plaques

Abstract The aim of this study was to demonstrate that the transluminal contrast attenuation gradient (TAG), a new CT imaging-derived marker of functional significance of a coronary stenosis, is directly associated with the vulnerability degree of atheromatous coronary plaques. Material and methods: This is a prospective study on 21 patients with 30 atheromatous plaques in the coronary arteries, who underwent cardiac computed tomography angiography (CCTA) for assessment of coronary plaques. Results: Twelve plaques were classified as vulnerable (40%) and 18 plaques (60%) as non-vulnerable. Plaques associated with a TAG value above 10 HU exhibited in a significantly higher proportion CCTA markers of plaque vulnerability, as compared to plaques in which the attenuation gradient was below 10 HU. TAG values >10 HU were associated with a higher amount of plaque volume (107.4 ± 91.2 mm3 vs. 56.0 ± 37.5 mm3, p = 0.009), necrotic core (32.5 ± 36.9 mm3 vs. 3.1 ± 3.2 mm3, p = 0.0003), and fibro-fatty tissue (17.7 ± 16.3 mm3 vs. 4.0 ± 2.6 mm3, p = 0.0002), as compared to those lesions with TAG values below 10 HU. Linear regression analysis revealed a significant correlation between TAG values and CCTA features of plaque instability: necrotic core (r = −0.73, p <0.0001), fibrofatty tissue (r = −0.63, p = 0.0002), and plaque volume (r = −0.48, p = 0.006). Conclusions: In patients with coronary artery disease, contrast attenuation gradient along the coronary plaques, determined by CCTA, correlates with CT markers of plaque vulnerability. Vulnerable coronary plaques are associated with a higher functional significance than the stable ones with a similar anatomic profile.

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Cardiac Computed Tomography Assessment in Acute Coronary Syndromes — Do We Have Time for It in Emergency Settings?

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2017-0051 ◽

2017 ◽

Vol 2 (2) ◽

pp. 140-143

Author(s):

Alexandra Stănescu ◽

Elisabeta Himcinschi ◽

Mirabela Morariu ◽

Nora Rat ◽

Lehel Bordi ◽

...

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Coronary Artery ◽

Cardiac Computed Tomography ◽

High Specificity ◽

Relevant Information ◽

Percutaneous Coronary Angioplasty ◽

Cardiac Computed Tomography Angiography ◽

Coronary Syndrome ◽

Specificity And Sensitivity

AbstractThe diagnosis and treatment of acute coronary syndrome remain a challenge for clinicians in many clinical settings, especially in patients with previous low-to-intermediate risk. Due to its high specificity and sensitivity for detecting significant coronary artery stenoses, cardiac computed tomography angiography (CCTA) tends to be used more frequently in the emergency room (ER) in the last years. This technique has been associated with a higher rate of safe discharge in patients with chest pain, less time spent in the ER, and decreased costs related to further investigations. In cases positive for coronary artery stenosis, CCTA can accurately evaluate the indication for percutaneous coronary angioplasty and can offer relevant information related to the characteristics of the coronary plaques, being able to detect vulnerable coronary plaques. The aim of this manuscript is to highlight the possibility of using CCTA in the ER in the assessment of patients with chest pain and to show the benefits of the procedure regarding safety, costs, accuracy, and time.

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Appropriate utilization of cardiac computed tomography for the assessment of stable coronary artery disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01957-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Hammer ◽

Muhtashim Mian ◽

Levi Elhadad ◽

Mary Li ◽

Idan Roifman

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Imaging ◽

Cardiac Computed Tomography ◽

The United States ◽

Appropriate Use ◽

Potential Cost ◽

Cardiac Computed Tomography Angiography ◽

Artery Disease

Abstract Background Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. Methods We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. Results Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. Conclusions We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.

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Intracoronary polarimetry for characterizing coronary plaque vulnerability in patients with coronary artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0309 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Otsuka ◽

M Villiger ◽

L.J.C Van Zandvoort ◽

T Neleman ◽

A Karanasos ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Roc Analysis ◽

Macrophage Infiltration ◽

Collagenolytic Activity ◽

Funding Source ◽

Plaque Vulnerability ◽

Coronary Syndrome ◽

Coronary Lesions ◽

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.

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Coronary Centerline Extraction from CCTA Using 3D-UNet

Future Internet ◽

10.3390/fi13040101 ◽

2021 ◽

Vol 13 (4) ◽

pp. 101

Author(s):

Alexandru Dorobanțiu ◽

Valentin Ogrean ◽

Remus Brad

Keyword(s):

Computed Tomography ◽

Cardiac Computed Tomography ◽

Three Dimensional ◽

Class Imbalance ◽

Training Data ◽

Cardiac Computed Tomography Angiography ◽

Centerline Extraction ◽

Network Training ◽

Dimensional Reconstruction ◽

Coronary Centerline

The mesh-type coronary model, obtained from three-dimensional reconstruction using the sequence of images produced by computed tomography (CT), can be used to obtain useful diagnostic information, such as extracting the projection of the lumen (planar development along an artery). In this paper, we have focused on automated coronary centerline extraction from cardiac computed tomography angiography (CCTA) proposing a 3D version of U-Net architecture, trained with a novel loss function and with augmented patches. We have obtained promising results for accuracy (between 90–95%) and overlap (between 90–94%) with various network training configurations on the data from the Rotterdam Coronary Artery Centerline Extraction benchmark. We have also demonstrated the ability of the proposed network to learn despite the huge class imbalance and sparse annotation present in the training data.

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Oxidative Stress Mediates Vascular Tortuosity

Antioxidants ◽

10.3390/antiox10060926 ◽

2021 ◽

Vol 10 (6) ◽

pp. 926

Author(s):

Toshio Fumoto ◽

Shouhei Kinoshita ◽

Takao Sasaki ◽

Norihito Shimamura ◽

Hiroki Ohkuma

Keyword(s):

Oxidative Stress ◽

Basilar Artery ◽

Morphological Changes ◽

Imaging Techniques ◽

Pcr Analysis ◽

Adult Rats ◽

Vascular Tortuosity ◽

Bilateral Common Carotid Artery ◽

Stress Related Genes ◽

Underlying Mechanisms

Vascular tortuosity is associated with various disorders and is being increasingly detected through advances in imaging techniques. The underlying mechanisms for vascular tortuosity, however, remain unclear. Here, we tested the hypothesis that oxidative stress mediates the generation of tortuous vessels. We used the bilateral common carotid artery (CCA) ligation model to induce vascular tortuosity. Both young and adult rats showed basilar artery tortuous morphological changes one month after bilateral CCA ligation. These tortuous changes were permanent but more pronounced in the adult rats. Microarray and real-time PCR analysis revealed that these tortuous changes were accompanied by the induction of oxidative stress-related genes. Moreover, the indicated model in rabbits showed that tortuous morphological changes to the basilar artery were suppressed by antioxidant treatment. These results are highly suggestive of the significance of oxidative stress in the development of vascular tortuosity. Although further studies will be needed to elucidate the possible mechanisms by which oxidative stress enhances vascular tortuosity, our study also points toward possible prophylaxis and treatment for vascular tortuosity.

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Aspartame Intake Relates to Coronary Plaque Burden and Inflammatory Indices in Human Immunodeficiency Virus

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx083 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 3

Author(s):

Leangelo N. Hall ◽

Laura R. Sanchez ◽

Jane Hubbard ◽

Hang Lee ◽

Sara E. Looby ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Cardiac Computed Tomography ◽

Coronary Plaque ◽

Plaque Burden ◽

Artificial Sweetener ◽

Food Record ◽

Cvd Risk ◽

Cardiac Computed Tomography Angiography ◽

Markers Of Inflammation ◽

Immunodeficiency Virus

Abstract Background Dietary sweeteners may contribute to metabolic dysregulation and cardiovascular disease (CVD), but this has not been assessed in human immunodeficiency virus (HIV). Methods One hundred twenty-four HIV-infected and 56 non-HIV-infected participants, without history of known coronary artery disease were included. Dietary intake was assessed using a 4-day food record. Coronary plaque was determined using cardiac computed tomography angiography. Results Human immunodeficiency virus-infected participants had significantly greater intake of dietary sweeteners, including total sugar (P = .03) and added sugar (P = .009); intake of aspartame (artificial sweetener) was greater among aspartame consumers with HIV versus non-HIV consumers (P = .03). Among HIV-infected participants, aspartame intake was significantly associated with coronary plaque (P = .002) and noncalcified plaque (P = .007) segments, as well as markers of inflammation/immune activation (monocyte chemoattractant protein 1 and lipoprotein-associated phospholipase A2), which may contribute to increased atherogenesis. In multivariable regression modeling, aspartame remained an independent predictor of plaque in HIV. In contrast, among non-HIV-infected participants, no sweetener type was shown to relate to plaque characteristics. Conclusions We demonstrate increased intake of dietary sweeteners and a potential novel association between aspartame intake, plaque burden, and inflammation in HIV. Our data suggest that aspartame may contribute to CVD risk in HIV. Further studies should address potential mechanisms by which aspartame may contribute to increased plaque burden and cardiovascular benefits of dietary strategies targeting aspartame intake in HIV.

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