From Vulnerable Plaque to Vulnerable Patient

Naghavi, Morteza; Libby, Peter; Falk, Erling; Casscells, S. Ward; Litovsky, Silvio; Rumberger, John A.; Badimón, Juan J.; Stefanadis, Christodoulos; Moreno, Pedro R.; Pasterkamp, Gérard; Fayad, Zahi A.; Stone, Peter H.; Waxman, Sergio; Raggi, Paolo; Madjid, Mohammad; Zarrabi, Alireza; Burke, Allen; Yuan, Chun; Fitzgerald, Peter J.; Siscovick, David S.; Korte, Chris L. de; Aikawa, Masamichi; Airaksinen, Juhani; Assmann, Gerd; Becker, Christoph R.; Chesebro, James H.; Farb, Andrew; Galis, Zorina S.; Jackson, Chris; Jang, Ik‐Kyung; Köenig, Wolfgang; Lodder, Robert A.; March, Keith L.; Demirovic, Jasenka; Navab, Mohamad; Priori, Silvia G.; Rekhter, Mark D.; Bahr, Raymond D.; Grundy, Scott M.; Mehran, Roxana; Colombo, Antonio; Boerwinkle, Eric; Ballantyne, Christie M.; Insull, William; Schwartz, Robert S.; Vogel, Robert A.; Serruys, Patrick W.; Hansson, Göran K.; Faxon, David P.; Kaul, Sanjay; Drexler, Helmut; Greenland, Philip; Muller, James E.; Virmani, Renu; Ridker, Paul M.; Zipes, Douglas P.; Shah, Prediman K.; Willerson, James T.

doi:10.1161/01.cir.0000087480.94275.97

Cited by 2,187 publications

(849 citation statements)

References 103 publications

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“…Overnight polysomnography was performed at nationally accredited sleep centers, and final diagnosis with apnea-hypopnea index (AHI; measure of the severity of disease) was available in all patients included in this study. Obstructive sleep apnea was further classified as no OSA (AHI <10), mild OSA (AHI [10][11][12][13][14][15][16][17][18][19][20], and severe OSA (AHI> 20). The number of vessels involved was defined as 0 if there was no stenosis and 1 if any stenosis or plaque was present.…”

Section: Imaging Techniquementioning

confidence: 99%

“…13 -15 It is believed that the noncalcified plaques and mixed plaques are more prone to rupture and may play an important role in ACS. 16 The traditional noninvasive imaging techniques do not identify noncalcified plaques. Multidetector-row computed tomography (MDCT) recently has been demonstrated as a reliable noninvasive technique for detection and characterization of noncalcified atherosclerotic plaques.…”

Section: Introductionmentioning

confidence: 99%

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Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography

Sharma

Gebregziabher

Parker

et al. 2012

Clinical Cardiology

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Background: Coronary artery atherosclerosis has been associated with obstructive sleep apnea (OSA). However, the type and severity of plaque formation have not been characterized. This study evaluated the association of coronary noncalcified plaques and severity of stenosis in patients with OSA. Hypothesis:Methods: This study was a retrospective analysis of 81 patients, 49 with OSA and 32 without OSA, who had undergone multidetector-row helical computed tomography scanning. The board-certified radiologist was blinded to the diagnosis of OSA and reviewed the scans for plaque characterization, severity of stenosis, and number of vessels involved. Results: Of the 81 patients reviewed, the mean apnea-hypopnea index in the OSA group was 42.2 vs 7.5 in the non-OSA group. The groups did not significantly differ in the distribution of comorbid conditions. We found that among the patients with OSA, 63% had noncalcified/mixed plaques, as opposed to 16% in the non-OSA group (P< 0.0001), with unadjusted odds ratio of 9.3 (3.0, 28.4). After adjustment for other risk factors such as age, sex, race, hypercholesterolemia, and history of smoking, the association remained strong, with an odds ratio of 7.0 (1.9, 26.5; P < 0.05). Conclusions: Our study finds that the frequency of noncalcified/mixed plaques is much higher in patients with OSA than in non-OSA patients. Patients with OSA also have more severe stenosis and a higher number of vessels involved. This study adds to a growing body of data regarding our understanding of the association of OSA and atherosclerosis.

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Section: Imaging Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography

Sharma

Gebregziabher

Parker

et al. 2012

Clinical Cardiology

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“…The PROSPECT study16 of coronary atherosclerosis demonstrated that cardiac events were related to high atherosclerotic burden rather than the severity of coronary artery stenosis. It is now accepted that atherosclerotic burden in coronary arteries is more important than stenosis in predicting subsequent cardiovascular events17, 18, 19, 20, 21.…”

Section: Introductionmentioning

confidence: 99%

Carotid plaque volume in patients undergoing carotid endarterectomy

Ball

Rogers

Kanesalingam

et al. 2018

British Journal of Surgery

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BackgroundThe main indication for carotid endarterectomy (CEA) is severity of carotid artery stenosis, even though most strokes in carotid disease are embolic. The relationship between carotid plaque volume (CPV) and symptoms of cerebral ischaemia, and the measurement of CPV by minimally invasive tomographic ultrasound imaging, were investigated.MethodsThe volume of the endarterectomy specimen was measured using a validated saline suspension technique in patients undergoing CEA. Time from last symptom and severity of stenosis measured by duplex ultrasonography were recorded. Middle cerebral artery emboli were counted using transcranial Doppler imaging (TCD) in a subset of patients.ResultsSome 339 patients were included, 270 with symptomatic and 69 with asymptomatic carotid stenosis. Mean(s.d.) CPV was higher in symptomatic than in asymptomatic patients (0·97(0·43) versus 0.74(0·41) cm3; P < 0·001). CPV did not correlate with severity of carotid stenosis (P = 0·770). Mean CPV was highest at 1·03(0·46) cm3 in the 4 weeks following cerebral symptoms, declining to 0·78(0·36) cm3 beyond 8 weeks. Among 33 patients who had TCD, mean CPV was 1·00(0·48) cm3 in the 27 patients with ipsilateral cerebral emboli compared with 0·67(0·16) cm3 in those without (P = 0·142). There was excellent correlation between CPV measured by tomographic ultrasound imaging and the endarterectomy specimen in 34 patients (r = 0·93, P < 0·001).ConclusionCPV correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA.

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“…However, luminal narrowing measured by angiography usually underestimates the disease severity due to positive remodeling effect and lacking of compositional information, particularly intraplaque hemorrhage, which is critical for the assessment of plaque vulnerability 6. Transesophageal echocardiography (TEE) can be utilized for detecting atherosclerotic plaques in aortic arch but this imaging technique is invasive.…”

Section: Introductionmentioning

confidence: 99%

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

Dai

Cai

et al. 2018

Ann Clin Transl Neurol

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ObjectivesTo investigate the characteristics of atherosclerotic plaques in stroke‐related vascular beds and their relationship with stroke using three‐dimensional magnetic resonance (MR) vessel wall imaging.MethodsFifty‐two symptomatic patients (mean age: 56.3 ± 13.4 years; 38 males) were enrolled and underwent MR vessel wall imaging for stroke‐related vascular beds including intracranial and extracranial carotid arteries and aortic arch and routine MR imaging for brain. The maximum wall thickness (Max WT) and luminal stenosis of each plaque were measured. The presence/absence of atherosclerotic plaque, intraplaque hemorrhage (IPH), and severe stenosis (stenosis >50%) at each vascular bed and acute ischemic lesion (AIL) were determined. The correlation between Max WT of each vascular bed and AIL was analyzed.ResultsOf 52 patients, 24 (46.2%) had AILs, and 30 (57.7%), 34 (65.4%), and 11 (21.2%) had plaques in intracranial artery, extracranial carotid artery, and aortic arch, respectively. The prevalence of IPH and severe stenosis was 25% and 26.9% for intracranial arteries, 13.5% and 9.6% for extracranial carotid artery, and 3.8% and 0% for aortic arch, respectively. In discriminating AIL, Max WT of intracranial artery had the highest area‐under‐the‐curve (AUC = 0.84), followed by extracranial carotid artery (AUC = 0.83) and aortic arch (AUC = 0.78) after adjusted for confounding factors. The AUC of Max WT combined three stroked‐related vascular beds reached 0.87.ConclusionExtracranial carotid arteries have the highest prevalence of plaques and intraplaque hemorrhage and severe stenosis are most frequently seen in intracranial arteries in Asian symptomatic patients. The Max WT combined three stroke‐related vascular beds show stronger predictive value for AIL than each vascular bed alone.

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From Vulnerable Plaque to Vulnerable Patient

Cited by 2,187 publications

References 103 publications

Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography

Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography

Carotid plaque volume in patients undergoing carotid endarterectomy

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

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