Reproducibility Between Three-Dimensional Turbo Spin-Echo and Two-Dimensional Dual Inversion Recovery Turbo Spin-Echo for Coronary Vessel Wall Imaging in Kawasaki Disease

Background: Magnetic resonance vessel wall imaging is desirable for evaluating Kawasaki disease (KD)-associated coronary arterial lesions. Purpose: To evaluate reproducibility of three-dimensional turbo spin-echo (3D-TSE) and two-dimensional dual inversion-recovery turbo spin-echo (2D-DIR-TSE) for coronary vessel wall imaging in KD.Methods: Ten patients were prospectively enrolled. Coronary vessel wall imaging with axial-slice orientation 3D-TSE and 2D-DIR-TSE were acquired for cross-sectional images in aneurysmal and normal regions. Lumen area (LA), wall area (WA), and normalized wall index (NWI) of cross-sectional images were measured in both regions. Reproducibility between 3D-TSE and 2D-DIR-TSE was evaluated via intraclass correlation coefficients (ICCs) and Bland-Altman plots.Results: 48 points (aneurysmal, 27; normal, 21) were evaluated. There were high ICCs between 3D-TSE and 2D-DIR-TSE in LA (0.95) and WA (0.95). In aneurysmal regions, 95% limits of agreement were LA, WA, and NWI of -29.9–30.4 mm2, -18.8–15.0 mm2, and -0.22–0.20, respectively. In normal regions, the 95% limits of agreement were LA, WA, and NWI of -4.44–4.38 mm2, -3.51–4.30 mm2, and -0.14–0.16, respectively. No fixed and proportional biases between 3D-TSE and 2D-DIR-TSE images in aneurysmal and normal regions were noted.Conclusions: 3D-TSE was reproducible with conventional 2D-DIR-TSE for coronary vessel wall assessment on KD.

Follow up coronary vessel evaluation of magnesium bioresorbable stents with coronary computed tomography angiography

Background Cardiac computed tomography angiography (CCTA) has already shown its ability to evaluate late results of polymer-based bioresorbable scaffolds (BVS) in different clinical scenarios. Recently, magnesium-based BVS (Mg-BVS) has emerged as an interesting alternative to these previous platforms due to its lower risk of thrombosis. Nonetheless, there is no systematic data about characterization of magnesium BVS with CCTA. Purpose To study the feasibility of Mg-BVS assessment with CCTA and to evaluate in-scaffold wall tissue characterization during the follow-up. Methods In this multicentre work, CCTA was performed in patients with a previously implanted Mg-BVS as a supplementary follow-up assessment. All studies were done after the theoretical resorption time of the scaffolds. A central core laboratory with an independent level 3 expert in CCTA blinded to the clinical and angiographic results analysed the studies. For this purpose, a dedicated software for coronary analysis was used to quantify coronary stenosis and evaluate coronary wall (Figure). Results Eight patients (55±6 years-old; 87.5% male) with a previously implanted Mg-BVS from 3 different centres in Spain and Italy were included. The presentation was equally distributed (2, 25%) among stable and unstable angina, NSTEMI and STEMI. Target vessels included 5 left anterior descending (62.5%), 2 left circumflex (25%) and 1 right coronary arteries (12.5%). CTCA was performed 13 [11.3–20] months after BVS implantation. In spite of the blinding, all scaffolds were accurately located through identification of proximal and distal radiopaque markers. Concordance of CCTA Mg-BVS sizing was good for diameter (ICC 0.66; p=0.09) and excellent for length (ICC 0.98; p<0,001) of the stents. Patency of all scaffolds was confirmed without significant diameter (0.14 [0–0.27]%) or area (0.39 [0.19–0.57]%) stenoses compared with proximal reference segments. Moreover, within the stent boundaries the maximum luminal diameter and area narrowing were 0.22 [0,12–0.3]% and 0.39 [0.23–0.5]% respectively, in keeping with mild in-scaffold late loss and/or underlying plaque growth. Regarding coronary wall tissue characterization of segments with BVS, there was a plaque burden of 0.37 [0.31–0.48]% and plaque volume of 87.6 [50.2–189.3] mm3. The most common component of the plaque was fibrous (69.5 [33.9–133.7]%), suggesting that Mg-BVS allows for stabilization of unstable culprit lesions (6/8 cases). Compared to the proximal and distal reference segments, there was no differences in plaque volume or composition, suggesting a good coronary vessel healing. Conclusions This short series shows for the first time the ability of CCTA to correctly locate and evaluate patency of Mg-BVS. Moreover, the lack of metal struts allows a detailed coronary plaque evaluation at treated segments. These preliminary results suggest plaque stabilization and a good coronary vessel healing with this novel scaffold. FUNDunding Acknowledgement Type of funding sources: None. Mg-BVS in LCx with mixed plaque

Heterogeneous pdgfrβ+ cells regulate coronary vessel development and revascularization during heart regeneration

ABSTRACTEndothelial cells emerge from the atrioventricular canal (AVC) to form nascent coronary blood vessels in the juvenile zebrafish heart. We found that pdgfrβ is first expressed in the epicardium around the AVC and later becomes localized mainly in the mural cells. pdgfrβ mutant fish display severe defects in mural cell recruitment and coronary vessel development. pdgfrβ+ mural cells are heterogeneous and those associated with coronary arteries also express cxcl12b. Mural cells positive for both pdgfrβ and cxcl12b transgenic reporters had elevated expression of smooth muscle cell genes. Interestingly, these mural cells were associated with coronary arteries even in the absence of Pdgfrβ, although smooth muscle gene expression was downregulated in these cells. We found that pdgfrβ expression dynamically changes in the epicardium derived cells, which we found to be a heterogeneous population. mdka was identified as a gene upregulated in subpopulations of pdgfrβ+ cells during heart regeneration. However, pdgfrβ but not mdka mutants showed defects in heart regeneration. Our results demonstrated that pdgfrβ+ cells and Pdgfrβ signaling are essential for coronary development and heart regeneration.SUMMARY STATEMENTHeterogeneous pdgfrβ positive cells are present in developing and regenerating zebrafish hearts and are required for development of mural cells and their association with the nascent coronary vessels during zebrafish heart development and regeneration.

Coronary Vessel Segmentation by Coarse-to-Fine Strategy Using U-nets

Each level of the coronary artery has different sizes and properties. The primary coronary arteries usually have high contrast to the background, while the secondary coronary arteries have low contrast to the background and thin structures. Furthermore, several small vessels are disconnected or broken up vascular segments. It is a challenging task to use a single model to segment all coronary artery sizes. To overcome this problem, we propose a novel segmenting method for coronary artery extraction from angiograms based on the primary and secondary coronary artery. Our method is a coarse-to-fine strategic approach for extracting coronary arteries in many different sizes. We construct the first U-net model to segment the main coronary artery extraction and build a new algorithm to determine the junctions of the main coronary artery with the secondary coronary artery. Using these junctions, we determine regions of the secondary coronary arteries (rectangular regions) for a secondary coronary artery-extracted segment with the second U-net model. The experiment result is 76.40% in terms of Dice coefficient on coronary X-ray datasets. The proposed approach presents its potential in coronary vessel segmentation.

Risk Factors Associated With the Extent of Coronary Vessel Involvement Across the Spectrum of Coronary Artery Disease

Background: Cardiovascular Disease (CVD) is one of the most important causes of mortality and morbidity in developed and developing countries. Objectives: This study aimed to evaluate the risk factors associated with the extent of coronary vessel involvement across the spectrum of Coronary Artery Disease (CAD) in patients referring to the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran. Methods: A cross-sectional study was conducted on 3,394 patients undergoing coronary angiography at the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran, in 2011-2015. Subjects were assigned to four groups in terms of the extent of coronary vessel involvement: Normal CAD, non-significant CAD, CAD, and non-obstructive CAD. Adjusted odds ratios and 95% confident intervals were calculated by including all variables with P values < 0.05 into the multivariate model to control for confounding factors. Data were analyzed using SPSS version 22. Results: Among male and female patients, those aged 45-65 years needed angiography more than other groups. Multiple logistic regression analysis showed that diabetes, male gender, FBS, and history of hypertension significantly increased the likelihood of coronary vessel involvement (P ≤ 0.05). Conclusions: The findings of the present study imply that age, male gender, FBS, and history of hypertension are the independent risk factors for the extent of coronary vessel involvement in CAD and non-significant CAD groups. To reduce the rates and consequences of CAD, it is paramount to control cardiovascular risk factors, screen susceptible populations at risk, and improve coronary interventional services.

VEGF-B Promotes Endocardium-Derived Coronary Vessel Development and Cardiac Regeneration

Background: Recent discoveries have indicated that, in the developing heart, sinus venosus and endocardium provide major sources of endothelium for coronary vessel growth that supports the expanding myocardium. Here we set out to study the origin of the coronary vessels that develop in response to vascular endothelial growth factor B (VEGF-B) in the heart and the effect of VEGF-B on recovery from myocardial infarction. Methods: We used mice and rats expressing a VEGF-B transgene, VEGF-B-gene–deleted mice and rats, apelin-CreERT, and natriuretic peptide receptor 3–CreERT recombinase-mediated genetic cell lineage tracing and viral vector–mediated VEGF-B gene transfer in adult mice. Left anterior descending coronary vessel ligation was performed, and 5-ethynyl-2’-deoxyuridine–mediated proliferating cell cycle labeling; flow cytometry; histological, immunohistochemical, and biochemical methods; single-cell RNA sequencing and subsequent bioinformatic analysis; microcomputed tomography; and fluorescent- and tracer-mediated vascular perfusion imaging analyses were used to study the development and function of the VEGF-B–induced vessels in the heart. Results: We show that cardiomyocyte overexpression of VEGF-B in mice and rats during development promotes the growth of novel vessels that originate directly from the cardiac ventricles and maintain connection with the coronary vessels in subendocardial myocardium. In adult mice, endothelial proliferation induced by VEGF-B gene transfer was located predominantly in the subendocardial coronary vessels. Furthermore, VEGF-B gene transduction before or concomitantly with ligation of the left anterior descending coronary artery promoted endocardium-derived vessel development into the myocardium and improved cardiac tissue remodeling and cardiac function. Conclusions: The myocardial VEGF-B transgene promotes the formation of endocardium-derived coronary vessels during development, endothelial proliferation in subendocardial myocardium in adult mice, and structural and functional rescue of cardiac tissue after myocardial infarction. VEGF-B could provide a new therapeutic strategy for cardiac neovascularization after coronary occlusion to rescue the most vulnerable myocardial tissue.