Optical Coherence Tomography of Coronary Plaque Progression and Destabilization

Adriaenssens, Tom; Allard-Ratick, Marc; Thondapu, Vikas; Sugiyama, Tomoyo; Raffel, O.; Barlis, Peter; Poon, Eric; Araki, Makoto; Nakajima, Ayako; Minami, Yoshiyasu; Takano, Masamichi; Kurihara, Osamu; Fuster, Valentín; Kakuta, Tsunekazu; Jang, Ik‐Kyung

doi:10.1016/j.jacc.2021.07.032

Cited by 14 publications

(16 citation statements)

References 71 publications

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“…With the development of IVI in the study of coronary plaque, nCSA has received increasing attention because the MACEs caused by nCSA are comparable to culprit lesions at the 3-year follow-up 43 . Therefore, stabilizing and regressing nCSA to reduce the incidence of corresponding MACEs is our goal, especially for patients with ACS post PCI for culprit lesions 9 , 26 , 44 , 45 . Although it has been well known for a long time that DM is a coronary artery disease equivalent in clinical practice 9 , 40 , 46 , which easily causes not only coronary PP but also plaque instability 47 , 48 , early initiation of LLT with statins is targeted at such patients 39 , 40 , 46 , 49 .…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies on plaque components were mainly based on quantitative analysis of the virtual histology of intravascular ultrasound (IVUS) and showed that it was correlated with clinical outcomes 20 – 22 , the correlation between plaque components and histopathology still needs to be further explored 23 , 24 . More studies are based on semiquantitative analysis of optical coherence tomography (OCT) data, especially for lipids, calcified plaque and fibrous cap thickness, but the quantification of plaque components based on OCT is insufficient 9 , 25 , 26 . Recently, an artificial intelligence (AI) framework named the optical flow ratio (OFR) based on OCT data was used to automatically analyse the components and volume of coronary plaque precisely for clinical use (Pulse Medical Imaging Technology, Shanghai, Co., Ltd.) 18 , 27 , 28 .…”

Section: Introductionmentioning

confidence: 99%

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Morphologies and composition changes in nonculprit subclinical atherosclerosis in diabetic versus nondiabetic patients with acute coronary syndrome who underwent long-term statin therapy

Meng

Nong

et al. 2023

Sci Rep

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Although patients are undergoing similar lipid-lowering therapy (LLT) with statins, the outcomes of coronary plaque in diabetic mellitus (DM) and non-DM patients are different. Clinical data of 239 patients in this observational study with acute coronary syndrome was from our previous randomized trial were analyzed at 3 years, and 114 of them underwent OCT detection at baseline and the 1-year follow-up were re-anlayzed by a novel artificial intelligence imaging software for nonculprit subclinical atherosclerosis (nCSA). Normalized total atheroma volume changes (ΔTAVn) of nCSA were the primary endpoint. Plaque progression (PP) was defined as any increase in ΔTAVn. DM patients showed more PP in nCSA (ΔTAVn; 7.41 (− 2.82, 11.85) mm3 vs. − 1.12 (− 10.67, 9.15) mm3, p = 0.009) with similar reduction of low-density lipoprotein cholesterol (LDL-C) from baseline to 1-year. The main reason is that the lipid component in nCSA increases in DM patients and non-significantly decreases in non-DM patients, which leads to a significantly higher lipid TAVn (24.26 (15.05, 40.12) mm3 vs. 16.03 (6.98, 26.54) mm3, p = 0.004) in the DM group than in the non-DM group at the 1-year follow-up. DM was an independent predictor of PP in multivariate logistic regression analysis (OR = 2.731, 95% CI 1.160–6.428, p = 0.021). Major adverse cardiac events (MACEs) related to nCSA at 3 years were higher in the DM group than in the non-DM group (9.5% vs. 1.7%, p = 0.027). Despite a comparable reduction in LDL-C levels after LLT, more PP with an increase in the lipid component of nCSA and a higher incidence of MACEs at the 3-year follow-up was observed in DM patients.Trial registration: ClinicalTrials.gov. identifier: NCT02140801.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morphologies and composition changes in nonculprit subclinical atherosclerosis in diabetic versus nondiabetic patients with acute coronary syndrome who underwent long-term statin therapy

Meng

Nong

et al. 2023

Sci Rep

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“…Plaque topography, especially the upslope and downslope that surround a luminal obstruction (axial plaque stress), may substantially impact the proclivity, location, and nature of focal plaque disruption, which may also explain why even nonobstructive plaques may destabilize if their topographical slope is adverse . Recent OCT studies similarly demonstrate that focal areas of high ESS and, in particular, high ESS gradient (the difference in ESS values of immediately adjacent endothelial areas), which also correlates with plaque slope, contribute to the plaque destabilization process of erosion or rupture …”

Section: Vascular Pathobiology Of Coronary Atherosclerosis and The Ro...mentioning

confidence: 99%

Fundamental Pathobiology of Coronary Atherosclerosis and Clinical Implications for Chronic Ischemic Heart Disease Management—The Plaque Hypothesis

2023

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ImportanceRecent clinical and imaging studies underscore that major adverse cardiac events (MACE) outcomes are associated not solely with severe coronary obstructions (ischemia hypothesis or stenosis hypothesis), but with the plaque burden along the entire coronary tree. New research clarifies the pathobiologic mechanisms responsible for plaque development/progression/destabilization leading to MACE (plaque hypothesis), but the translation of these insights to clinical management strategies has lagged. This narrative review elaborates the plaque hypothesis and explicates the current understanding of underlying pathobiologic mechanisms, the provocative destabilizing influences, the diagnostic and therapeutic implications, and their actionable clinical management approaches to optimize the management of patients with chronic coronary disease.ObservationsClinical trials of management strategies for patients with chronic coronary artery disease demonstrate that while MACE rate increases progressively with the anatomic extent of coronary disease, revascularization of the ischemia-producing obstruction does not forestall MACE. Most severely obstructive coronary lesions often remain quiescent and seldom destabilize to cause a MACE. Coronary lesions that later provoke acute myocardial infarction often do not narrow the lumen critically. Invasive and noninvasive imaging can identify the plaque anatomic characteristics (plaque burden, plaque topography, lipid content) and local hemodynamic/biomechanical characteristics (endothelial shear stress, plaque structural stress, axial plaque stress) that can indicate the propensity of individual plaques to provoke a MACE.Conclusions and RelevanceThe pathobiologic construct concerning the culprit region of a plaque most likely to cause a MACE (plaque hypothesis), which incorporates multiple convergent plaque features, informs the evolution of a new management strategy capable of identifying the high-risk portion of plaque wherever it is located along the course of the coronary artery. Ongoing investigations of high-risk plaque features, coupled with technical advances to enable prognostic characterization in real time and at the point of care, will soon enable evaluation of the entire length of the atheromatous coronary artery and broaden the target(s) of our therapeutic intervention to include all regions of the plaque (both flow limiting and nonflow limiting).

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“…OCT is broadly used for plaque characterization, especially for the detection of TCFA and rupture [ 35 ]. OCT provides unsurpassed spatial resolution (10 times higher than IVUS) and manages to discriminate plaque elements, and also captures macrophage accumulations in the vessel wall [ 35 , 36 ]. Macrophages, in the context of a fibroatheroma, may be depicted by intravascular OCT as regions of increased signal that are more intense than the background noise [ 37 ].…”

Section: Identifying the Vulnerable Plaquementioning

confidence: 99%

Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept

Emfietzoglou

Mavrogiannis

Stamatelopoulos

et al. 2023

Life

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Despite major advances in pharmacotherapy and interventional procedures, coronary artery disease (CAD) remains a principal cause of morbidity and mortality worldwide. Invasive coronary imaging along with the computation of hemodynamic forces, primarily endothelial shear stress and plaque structural stress, have enabled a comprehensive identification of atherosclerotic plaque components, providing a unique insight into the understanding of plaque vulnerability and progression, which may help guide patient treatment. However, the invasive-only approach to CAD has failed to show high predictive value. Meanwhile, it is becoming increasingly evident that along with the “vulnerable plaque”, the presence of a “vulnerable patient” state is also necessary to precipitate an acute coronary thrombotic event. Non-invasive imaging techniques have also evolved, providing new opportunities for the identification of high-risk plaques, the study of atherosclerosis in asymptomatic individuals, and general population screening. Additionally, risk stratification scores, circulating biomarkers, immunology, and genetics also complete the armamentarium of a broader “vulnerable plaque and patient” concept approach. In the current review article, the invasive and non-invasive modalities used for the detection of high-risk plaques in patients with CAD are summarized and critically appraised. The challenges of the vulnerable plaque concept are also discussed, highlighting the need to shift towards a more interdisciplinary approach that can identify the “vulnerable plaque” in a “vulnerable patient”.

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Optical Coherence Tomography of Coronary Plaque Progression and Destabilization

Cited by 14 publications

References 71 publications

Morphologies and composition changes in nonculprit subclinical atherosclerosis in diabetic versus nondiabetic patients with acute coronary syndrome who underwent long-term statin therapy

Morphologies and composition changes in nonculprit subclinical atherosclerosis in diabetic versus nondiabetic patients with acute coronary syndrome who underwent long-term statin therapy

Fundamental Pathobiology of Coronary Atherosclerosis and Clinical Implications for Chronic Ischemic Heart Disease Management—The Plaque Hypothesis

Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept

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