Role of new imaging modalities in pursuit of the vulnerable plaque and the vulnerable patient

Raggi, Paolo; Andreini, Daniele

doi:10.1016/j.ijcard.2017.10.046

Cited by 10 publications

(8 citation statements)

References 58 publications

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“…It also makes sense of prognostic valuation. Models within genetic variants for risk stratification in order to expand "area under curve" worth further research in precision medicine era [29][30][31]. Admittedly, the study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Susceptible gene polymorphism in patients with three-vessel coronary artery disease

Liu

Song

Jiang

et al. 2020

BMC Cardiovasc Disord

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Background: Data of susceptible gene polymorphisms related to progression of coronary atherosclerosis in patients with three-vessel disease (TVD) is limited in China. This case-control study aimed to analyze the differences of variant carrier frequencies between cases and controls, and to explain the possible genetic effects on the progression of TVD. Methods: A total of 8943 TVD patients were consecutively enrolled. Major adverse cardiac and cerebrovascular events (MACCE) included all-cause death, acute myocardial infarction, repeat revascularization, readmission and stroke. Patients with 1-year MACCE in this cohort were selected as MACCE group. Blood samples from MACCE group and non-CAD control groups were collected, and a deoxyribonucleic acid library was created. A total of 34 tag or hot single nucleotide polymorphisms (SNPs) in six genes including CDKN2B-AS1, ADAMTS7, ABO, ADAMTS13, IL-18, and PECAM1 were analyzed by a SNPscan™ multi-genotyping kit. Carrier frequencies of each SNP were compared between the two groups using dominant, recessive and codominant allele model, respectively. Multivariate logistic regression model was established. Results: Variant allele frequencies of rs10757274, rs1333042, rs1333049, rs4977574, rs9632884, rs1063192 and rs3217986 on CDKN2B-AS1 gene showed significant differences between the two groups in at least one allele model. Variant allele frequency of rs3217986 was not statistically significant after adjusting for the false discovery rate using Benjamini-Hochberg procedure (Q > 0.05). Variant allele frequencies of rs1333049, rs10757274, rs4977574 on CDKN2B-AS1 gene were significantly higher in MACCE group in all dominant, recessive and codominant models. Rs1055432 on ADAMTS13 and rs8176694 on ABO gene showed threshold significance between the two groups. After multivariable adjustment, G mutant homozygous rs9632884 (GG vs. GC + CC) (OR: 0.24; 95% CI: 0.09-0.65; P = 0.005) on CDKN2B-AS1 gene were independent protective factor of MACCE in recessive model. Conclusions:In patients with TVD in China, variant alleles on CDKN2B-AS1 gene may form part of the genetic basis of coronary atherosclerosis progression, promoting or suppressing ischemic events.

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Section: Discussionmentioning

confidence: 99%

Susceptible gene polymorphism in patients with three-vessel coronary artery disease

Liu

Song

Jiang

et al. 2020

BMC Cardiovasc Disord

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“…In this scenario, the requirement for a second CTA obtained at the time of coronary PET imaging would not be practical or economically feasible, and incurs unnecessary additional radiation exposure. In carefully selected populations at exceptionally high risk of adverse events, 18 F-NaF PET could provide insight into the biology of atherosclerosis and may prove to be of importance in patient management 16,17 . It has been shown that the presence of vulnerable plaque features predicts acute coronary syndromes and in the absence of significant stenosis and coronary calcification, the likelihood of adverse events is very low 7, 18 .…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Coronary ¹⁸ F-Sodium Fluoride Positron-Emission Tomography Assessment With the Utilization of Previously Acquired Computed Tomography Angiography

Kwieciński

Adamson

Lassen

et al. 2018

Circ: Cardiovascular Imaging

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Background We assessed the feasibility of utilizing previously acquired computed tomography angiography (CTA) with a subsequent PET-only scan for the quantitative evaluation of 18F-NaF PET coronary uptake. Methods & Results Forty-five patients (age 67.1±6.9 years, 76% males) underwent CTA (CTA1) and combined 18F-NaF PET/CTA (CTA2) imaging within 14[10,21] days. We fused CTA1 from visit one with 18F-NaF PET (PET) from visit two and compared visual pattern of activity, maximal standard uptake values (SUVmax) and target to background (TBR) measurements on (PET/CTA1) fused versus hybrid (PET/CTA2). On PET/CTA2, 226 coronary plaques were identified. Fifty-eight coronary segments from 28(62%) patients had high 18F-NaF uptake (TBR>1.25), whil 168 segments had lesions with 18F-NaF TBR ≤1.25. Uptake in all lesions was categorized identically on co-registered PET/CTA1. There was no significant difference in 18F-NaF uptake values between PET/CTA1 and PET/CTA2 (SUVmax: 1.16±0.40 vs. 1.15±0.39, p=0.53; TBR:1.10±0.45 vs. 1.09±0.46, p=0.55). The intraclass correlation coefficient for SUVmax and TBR was 0.987 (95%CI 0.983 to 0.991) and 0.986 (95%CI 0.981 to 0.992). There was no fixed or proportional bias between PET/CTA1 and PET/CTA2 for SUVmax and TBR. Cardiac motion correction of PET scans improved reproducibility with tighter 95% limits of agreement (±0.14 for SUVmax and ±0.15 for TBR vs. ±0.20 and ±0.20 on diastolic imaging;p<0.001). Conclusions Coronary CTA/PET protocol with CTA first followed by PET-only allows for reliable and reproducible quantification of 18F-NaF coronary uptake. This approach may facilitate selection of high-risk patients for PET-only imaging based on results from prior CTA, providing a practical workflow for clinical application.

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“…CCTA focalizes attention on validated measures of plaque vulnerability. There is increasing interest and continuing debate on its potential role as a “noninvasive” method for (1) mapping coronary atherosclerosis, (2) better understanding the adverse features of coronary plaques, and (3) achieving potential benefits in guiding therapeutic interventions [ 58 ].…”

Section: Definition Of Vulnerable Plaque and Features By Cctamentioning

confidence: 99%

“…Using CCTA, in comparison with grayscale IVUS, calcified versus noncalcified plaque can be quantified on the basis of density cutoff values [ 61 ]. Low attenuation suggests high lipid content and has defined for attenuations below 30 Hounsfield Units (HU) [ 58 , 62 ] ( Figure 2 ). Different HU cut-off limits used in different laboratories presumably have weakened the estimated risk of ACS associated with LAP.…”

Section: Definition Of Vulnerable Plaque and Features By Cctamentioning

confidence: 99%

“…Finally, the NRS is a thin ring of high attenuation around the plaque along the outer contour of the vessel. This is typically due to the presence of a hypodense deposit of necrotic material in the center of the plaque itself [ 58 , 62 ]. Importantly, despite ex vivo comparison to histology showed the ability of CCTA to differentiate no calcified, mixed, and calcified plaques [ 63 ].…”

Section: Definition Of Vulnerable Plaque and Features By Cctamentioning

confidence: 99%

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Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review

Carità

Guaricci

Muscogiuri

et al. 2018

BioMed Research International

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Coronary stenosis severity is both a powerful and a still debated predictor of prognosis in coronary artery disease. Coronary computed tomographic angiography (CCTA) has emerged as a noninvasive technique that enables anatomic visualization of coronary artery disease (CAD). CCTA with newer applications, plaque characterization and physiologic/functional evaluation, allows a comprehensive diagnostic and prognostic assessment of otherwise low-intermediate subjects for primary prevention. CCTA measures the overall plaque burden, differentiates plaque subtypes, and identifies high-risk plaque with good reproducibility. Research in this field may also advance towards an era of personalized risk prediction and individualized medical therapy. It has been demonstrated that statins may delay plaque progression and change some plaque features. The potential effects on plaque modifications induced by other medical therapies have also been investigated. Although it is not currently possible to recommend routinely serial scans to monitor the therapeutic efficacy of medical interventions, the plaque modulation, as a part of risk modification, appears a feasible strategy. In this review we summarize the current evidence regarding vulnerable plaque and effects of lipid lowering therapy on morphological features of CAD. We also discuss the potential ability of CCTA to characterize coronary atherosclerosis, stratify prognosis of asymptomatic subjects, and guide medical therapy.

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Role of new imaging modalities in pursuit of the vulnerable plaque and the vulnerable patient

Cited by 10 publications

References 58 publications

Susceptible gene polymorphism in patients with three-vessel coronary artery disease

Susceptible gene polymorphism in patients with three-vessel coronary artery disease

Feasibility of Coronary ¹⁸ F-Sodium Fluoride Positron-Emission Tomography Assessment With the Utilization of Previously Acquired Computed Tomography Angiography

Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review

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Role of new imaging modalities in pursuit of the vulnerable plaque and the vulnerable patient

Cited by 10 publications

References 58 publications

Susceptible gene polymorphism in patients with three-vessel coronary artery disease

Susceptible gene polymorphism in patients with three-vessel coronary artery disease

Feasibility of Coronary 18 F-Sodium Fluoride Positron-Emission Tomography Assessment With the Utilization of Previously Acquired Computed Tomography Angiography

Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review

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Feasibility of Coronary ¹⁸ F-Sodium Fluoride Positron-Emission Tomography Assessment With the Utilization of Previously Acquired Computed Tomography Angiography