The Vulnerable Plaque: Recent Advances in Computed Tomography Imaging to Identify the Vulnerable Patient

Beg, Faheemullah; Rehman, Hasan; Al-Mallah, Mouaz

doi:10.1007/s11883-020-00879-z

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…The first component generated by our principal component analysis included all measured vulnerable plaque characteristics: IPH, LRNC, ulceration, TRFC and plaque volume. Calcification was found to negatively affect this component, which conforms to previous literature describing an inverse association between calcification and plaque vulnerability [ 26 ]. In patients with suspected coronary artery disease, a positive association between MPO-DNA complexes was reported with both the number of atherosclerotic coronary vessels and the occurrence of major adverse cardiac events, suggesting a relationship between NETs levels and unstable plaques [ 22 ].…”

Section: Discussionsupporting

confidence: 89%

Association between plaque vulnerability and neutrophil extracellular traps (NETs) levels: The Plaque At RISK study

et al. 2022

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Carotid atherosclerotic plaque rupture and its sequelae are among the leading causes of acute ischemic stroke. The risk of rupture and subsequent thrombosis is, among others, determined by vulnerable plaque characteristics and linked to activation of the immune system, in which neutrophil extracellular traps (NETs) potentially play a role. The aim of this study was to investigate how plaque vulnerability is associated with NETs levels. We included 182 patients from the Plaque At RISK (PARISK) study in whom carotid imaging was performed to measure plaque ulceration, fibrous cap integrity, intraplaque hemorrhage, lipid-rich necrotic core, calcifications and plaque volume. Principal component analysis generated a ‘vulnerability index’ comprising all plaque characteristics. Levels of the NETs marker myeloperoxidase-DNA complex were measured in patient plasma. The association between the vulnerability index and low or high NETs levels (dependent variable) was assessed by logistic regression. No significant association between the vulnerability index and NETs levels was detected in the total population (odds ratio 1.28, 95% confidence interval 0.90–1.83, p = 0.18). However, in the subgroup of patients naive to statins or antithrombotic medication prior to the index event, this association was statistically significant (odds ratio 2.08, 95% confidence interval 1.04–4.17, p = 0.04). Further analyses revealed that this positive association was mainly driven by intraplaque hemorrhage, lipid-rich necrotic core and ulceration. In conclusion, plaque vulnerability is positively associated with plasma levels of NETs, but only in patients naive to statins or antithrombotic medication prior to the index event.

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Section: Discussionsupporting

confidence: 89%

Association between plaque vulnerability and neutrophil extracellular traps (NETs) levels: The Plaque At RISK study

et al. 2022

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“…Maximum intensity projection, curved planar reformation (CRP), volume rendering, and other post-processing methods were used to analyze the images by radiologists. The imaging features of VPs include spotty calcification, positive reconstruction, low attenuation plaque, and napkin ring sign (NRS) ( 17 ). CCTA imaging data were analyzed and evaluated independently by two radiologists with more than 10 years of experience in cardiovascular disease imaging.…”

Section: Methodsmentioning

confidence: 99%

Predictive Value of Non-high-Density Lipoprotein Cholesterol and Neutrophil-Lymphocyte Ratio for Coronary Artery Vulnerable Plaques in Type 2 Diabetes Mellitus

Huang

Yang

Zhao

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with diabetes have an increased risk of developing vulnerable plaques (VPs), in which dyslipidemia and chronic inflammation play important roles. Non-high-density lipoprotein cholesterol (non-HDL-C) and neutrophil-lymphocyte ratio (NLR) have emerged as potential markers of both coronary artery VPs and cardiovascular prognosis. This study aimed to investigate the predictive value of non-HDL-C and NLR for coronary artery VPs in patients with type 2 diabetes mellitus (T2DM).MethodsWe retrospectively enrolled 204 patients with T2DM who underwent coronary computed tomography angiography between January 2018 and June 2020. Clinical data including age, sex, hypertension, smoking, total cholesterol, low-density lipoprotein cholesterol, HDL-C, triglyceride, non-HDL-C, glycated hemoglobin, neutrophil count, lymphocyte count, NLR, and platelet count were analyzed. Multivariate logistic regression was used to estimate the association between non-HDL-C, NLR, and coronary artery VPs. Receiver operating curve analysis was performed to evaluate the value of non-HDL-C, NLR, and their combination in predicting coronary artery VPs.ResultsIn our study, 67 patients (32.84%) were diagnosed with VPs, 75 (36.77%) with non-VP, and 62 (30.39%) with no plaque. Non-HDL-C and NLR were independent risk factors for coronary artery VPs in patients with T2DM. The areas under the ROC curve of non-HDL-C, NLR, and their combination were 0.748 [95% confidence interval (CI): 0.676–0.818], 0.729 (95% CI: 0.650–0.800), and 0.825 (95% CI: 0.757–0.887), respectively.ConclusionEither non-HDL-C or NLR could be used as a predictor of coronary artery VPs in patients with T2DM, but the predictive efficiency and sensitivity of their combination would be better.

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“…The formation of vulnerable plaques is strongly associated with the body's inflammatory response, which is involved in all stages of plaque progression. 12,13 At present, various imaging methods can be employed to evaluate the vulnerability of carotid plaque, including carotid duplex ultrasound (CDU), high-resolution magnetic resonance imaging (HRMRI), CT (computed tomography), intravascular ultrasound (IVUS), and so on. Combined with serum markers, it is of great clinical significance to identify and evaluate vulnerable plaques.…”

mentioning

confidence: 99%

“…According to the existence and severity of some histological characteristics of plaques, they can be divided into stable and vulnerable plaques. The formation of vulnerable plaques is strongly associated with the body's inflammatory response, which is involved in all stages of plaque progression 12,13 …”

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confidence: 99%

Imaging diagnosis and research progress of carotid plaque vulnerability

Zhang

Lyu

et al. 2022

J of Clinical Ultrasound

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Ischemic stroke (IS) exhibits a high disability rate, mortality, and recurrence rate, imposing a serious threat to human survival and health. Its occurrence is affected by various factors. Although the previous research has demonstrated that the occurrence of IS is mainly associated with lumen stenosis caused by carotid atherosclerotic plaque (AP), recent studies have revealed that many patients will still suffer from IS even with mild carotid artery lumen stenosis. Blood supply disturbance causes 10% of IS to the corresponding cerebral blood supply area caused by carotid vulnerable plaque. Thrombus blockage of distal branch vessels caused by rupture of vulnerable carotid plaque is the main cause of ischemic stroke. Therefore, how to accurately evaluate vulnerable plaque and intervene as soon as possible is a problem that needs to be solved in clinic. The vulnerability of plaque is determined by its internal components, including thin and incomplete fibrous cap, necrotic lipid core, intra‐plaque hemorrhage, intra‐plaque neovascularization, and ulcerative plaque formation. The development of imaging technology enables the routine detection of AP vulnerability. By analyzing the pathological changes, characteristics, and formation mechanism of carotid plaque vulnerability, this article aims to explore the modern imaging methods which can be used to identify plaque composition and plaque vulnerability to provide a reference basis for disease diagnosis and differential diagnosis.

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The Vulnerable Plaque: Recent Advances in Computed Tomography Imaging to Identify the Vulnerable Patient

Cited by 5 publications

References 34 publications

Association between plaque vulnerability and neutrophil extracellular traps (NETs) levels: The Plaque At RISK study

Association between plaque vulnerability and neutrophil extracellular traps (NETs) levels: The Plaque At RISK study

Predictive Value of Non-high-Density Lipoprotein Cholesterol and Neutrophil-Lymphocyte Ratio for Coronary Artery Vulnerable Plaques in Type 2 Diabetes Mellitus

Imaging diagnosis and research progress of carotid plaque vulnerability

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