1. 1-24 of 24
    1. Plaque Progression: Slow Linear or Rapid Stepwise?

      Plaque Progression: Slow Linear or Rapid Stepwise?

      Atherosclerosis was thought to be a disease of insidious onset and slow process, secondary to smooth muscle cell proliferation. 1 However, this concept was challenged during the past 2 decades by the theory that an alternative mode of rapid step-wise plaque progression might also exist. This sudden change in arterial lumen occurs when mural thrombus is organized after disruption of a plaque or by sudden expansion of a plaque secondary to intraplaque hemorrhage. Because of the sudden change in local geometry, this second mode is significant not only to rapid plaque progression, but also to the development of acute coronary ...

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    2. Serial 3-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated With Lesion Progression in Patients With Stable Angina Pectoris

      Serial 3-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated With Lesion Progression in Patients With Stable Angina Pectoris

      Background— Optical coherence tomographic (OCT) morphologies associated with lesion progression are not well studied. The aim of this study was to determine the morphological change for untreated lesion progression using both OCT and intravascular ultrasound (IVUS). Methods and Results— We used baseline and 8-month follow-up 3-vessel OCT and IVUS to assess 127 nonculprit lesions (IVUS plaque burden ≥40%) in 45 patients with stable angina after target lesion treatment. Lesion progression was defined as an IVUS lumen area decrease >0.5 mm 2 . A layered pattern was identified as a superficial layer that had a different optical intensity and a clear ...

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    3. Early Detection and Treatment of the Vulnerable Coronary Plaque Can We Prevent Acute Coronary Syndromes?

      Early Detection and Treatment of the Vulnerable Coronary Plaque Can We Prevent Acute Coronary Syndromes?

      Early identification and treatment of the vulnerable plaque, that is, a coronary artery lesion with a high likelihood of rupture leading to an acute coronary syndrome, have gained great interest in the cardiovascular research field. Postmortem studies have identified clear morphological characteristics associated with plaque rupture. Recent advances in invasive and noninvasive coronary imaging techniques have empowered the clinician to identify suspected vulnerable plaques in vivo and paved the way for the evaluation of therapeutic agents targeted at reducing plaque vulnerability. Local treatment of vulnerable plaques by percutaneous coronary intervention and systemic treatment with anti-inflammatory and low-density lipoprotein–lowering drugs ...

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    4. Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease

      Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease

      Background— Numerous reports suggest sex-related differences in atherosclerosis. Frequency-domain optical coherence tomography has enabled visualization of plaque microstructures associated with disease instability. The prevalence of plaque microstructures between sexes has not been characterized. We investigated sex differences in plaque features in patients with coronary artery disease. Methods and Results— Nonculprit plaques on frequency-domain optical coherence tomography imaging were compared between men and women with either stable coronary artery disease (n=320) or acute coronary syndromes (n=115). A greater prevalence of cardiovascular risk factors was observed in women. Nonculprit plaques in women with stable coronary artery disease were more likely ...

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    5. Coronary Calcification and Plaque Vulnerability An Optical Coherence Tomographic Study

      Coronary Calcification and Plaque Vulnerability An Optical Coherence Tomographic Study

      Background— Spotty superficial calcium deposits have been implicated in plaque vulnerability based on previous intravascular imaging studies. Biomechanical models suggest that microcalcifications between 5 and 65 µm in diameter can intensify fibrous cap stress, promoting plaque rupture. However, the 100- to 200-µm resolution of intravascular ultrasound limits its ability to discriminate single calcium deposits from clusters of smaller deposits, and a previous optical coherence tomographic investigation evaluated calcifications within a long segment of artery, which may not truly reflect the mechanics involved in potentiating focal plaque rupture. Methods and Results— Detailed optical coherence tomographic assessment of coronary calcification at ...

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    6. The Mystery of Spotty Calcification Can We Solve It by Optical Coherence Tomography?

      The Mystery of Spotty Calcification Can We Solve It by Optical Coherence Tomography?

      Spotty calcification has recently been introduced as a marker of plaque vulnerability in patients presenting with acute coronary syndrome undergoing invasive and noninvasive coronary imaging, 1 and it has been suggested to be of predictive value for percent atheroma volume with greater progression. 2 Several pathological and clinical studies applying computed tomography (CT) and intravascular ultrasound (IVUS) demonstrated that spotty calcification is more frequently observed in lesions with plaque rupture compared with stable plaque. 3 , 4 Recently, optical coherence tomography (OCT) has emerged as the premier intracoronary imaging technology with a higher resolution (10–20 μm) than IVUS (100–200 ...

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    7. Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma

      Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma

      Background— Although rupture of thin-cap fibroatheroma (TCFA) underlies most myocardial infarctions, reliable TCFA identification remains challenging. Virtual-histology intravascular ultrasound (VH-IVUS) and optical coherence tomography (OCT) can assess tissue composition and classify plaques. However, direct comparisons between VH-IVUS and OCT are lacking and it remains unknown whether combining these modalities improves TCFA identification. Methods and Results— Two hundred fifty-eight regions-of-interest were obtained from autopsied human hearts, with plaque composition and classification assessed by histology and compared with coregistered ex vivo VH-IVUS and OCT. Sixty-seven regions-of-interest were classified as fibroatheroma on histology, with 22 meeting criteria for TCFA. On VH-IVUS, plaque (10 ...

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    8. Optical Coherence Tomography and Virtual-Histology Intravascular Ultrasound Strange Bedfellows? … or Not?

      Optical Coherence Tomography and Virtual-Histology Intravascular Ultrasound Strange Bedfellows? … or Not?

      The ultimate goal of studies such as the one by Brown et al 1 in this issue of Circulation: Cardiovascular Imaging is to provide the clinician with a diagnostic tool that identifies high-risk plaques prospectively to treat and prevent acute events. This tool must have a high positive predictive value and negative predictive value in the clinical setting and not require specific expertise or core-laboratory analysis to determine whether a plaque is vulnerable and should be treated pre-emptively—a yes/no, treat/don’t treat tool. Optical coherence tomography (OCT) has been proposed as that tool. OCT criteria for a ...

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    9. Endothelial Shear Stress and Coronary Plaque Characteristics in Humans: A Combined Frequency-Domain Optical Coherence Tomography and Computational Fluid Dynamics Study

      Endothelial Shear Stress and Coronary Plaque Characteristics in Humans: A Combined Frequency-Domain Optical Coherence Tomography and Computational Fluid Dynamics Study

      Background —Despite the exposure of the entire vasculature to the atherogenic effects of systemic risk factors, atherosclerotic plaques preferentially develop at sites with disturbed flow. This study aimed at exploring in vivo the relationship between local endothelial shear stress (ESS) and coronary plaque characteristics in humans, using computational fluid dynamics and frequency-domain optical coherence tomography (FD-OCT). Methods and Results —Three-dimensional coronary artery reconstruction was performed in 21 patients (24 arteries) presenting with acute coronary syndrome using FD-OCT and coronary angiography. Each coronary artery was divided into sequential 3-mm segments, and analyzed for the assessment of local ESS and plaque characteristics ...

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    10. Computer-Aided Image Analysis Algorithm to Enhance In Vivo Diagnosis of Plaque Erosion by Intravascular Optical Coherence Tomography

      Computer-Aided Image Analysis Algorithm to Enhance In Vivo Diagnosis of Plaque Erosion by Intravascular Optical Coherence Tomography

      Background —Recent reports show that plaque erosion can be diagnosed in vivo using optical coherence tomography (OCT) in patients with acute coronary syndromes (ACS). However, quantitative OCT image criteria for computer-aided diagnosis of plaque erosion have not been established. Methods and Results —A total of 42 patients with ACS caused by plaque erosion were included. Plaque erosion was identified according to the previously established OCT criteria. Both optical properties and morphological features of the focal eroded region as well as erosion-adjacent region were analyzed using a custom designed computer algorithm. Non-eroded fibrous plaques remote from the erosion site within the ...

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    11. Feasibility of Optical Coherence Tomography in Children with Kawasaki Disease and Pediatric Heart Transplant Recipients

      Feasibility of Optical Coherence Tomography in Children with Kawasaki Disease and Pediatric Heart Transplant Recipients

      Background —Optical Coherence Tomography (OCT) is a high-resolution intravascular imaging technique used in adults. We tested the hypothesis that OCT could identify coronary abnormalities not seen by angiography in children with a history of Kawasaki Disease (KD) and pediatric heart transplant (TX) recipients. Methods and Results —KD patients and TX recipients were evaluated between December 2012 and October 2013 with angiography and OCT (Ilumien System, LightLabs, St Jude Medical, Westford, MA). Modifications were made to the adult OCT protocol to adapt this technique for children. Serial cross sectional area (CSA) measurements of the lumen, intima and media were made. Entire ...

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    12. Features of Coronary Plaque in Patients with Metabolic Syndrome and Diabetes Mellitus Assessed by 3-vessel Optical Coherence Tomography

      Features of Coronary Plaque in Patients with Metabolic Syndrome and Diabetes Mellitus Assessed by 3-vessel Optical Coherence Tomography

      Background —The pathophysiologic basis for the association between metabolic syndrome (MetS) and coronary artery disease is not well understood. We sought to characterize coronary plaques in patients with MetS using optical coherence tomography (OCT). Methods and Results —We identified 451 coronary plaques from 171 subjects who underwent OCT imaging in three coronary arteries. Subjects were divided into 3 groups: diabetes mellitus (DM, n=77), MetS (n=35), and a control group (C group, n=59) without DM or MetS. OCT analysis included the presence of lipid-rich plaque, maximum lipid arc, lipid-core length (LL), lipid index (LI), fibrous cap thickness (FCT ...

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    13. Nonculprit Coronary Plaque Characteristics of Chronic Kidney Disease

      Nonculprit Coronary Plaque Characteristics of Chronic Kidney Disease

      Background— Chronic kidney disease (CKD) promotes the development of atherosclerosis and increases the risk of cardiovascular disease. The aim of the present study was to compare the coronary plaque characteristics of patients with and without CKD using optical coherence tomography. Methods and Results— We identified 463 nonculprit plaques from 287 patients from the Massachusetts General Hospital (MGH) optical coherence tomography registry. CKD was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m 2 . A total of 402 plaques (250 patients) were in the non-CKD group and 61 plaques (37 patients) were in the CKD group. Compared ...

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    14. Non-Culprit Coronary Plaque Characteristics of Chronic Kidney Disease

      Non-Culprit Coronary Plaque Characteristics of Chronic Kidney Disease

      Background —Chronic kidney disease (CKD) promotes the development of atherosclerosis and increases the risk of cardiovascular disease. The aim of the present study was to compare the coronary plaque characteristics of patients with and without CKD using optical coherence tomography (OCT). Methods and Results —We identified 463 non-culprit plaques from 287 patients from the MGH OCT Registry. CKD was defined as estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m 2 . 402 plaques (250 patients) were in the non-CKD group and 61 plaques (37 patients) were in the CKD group. Compared to non-CKD plaques, plaques with CKD had a larger ...

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    15. Letter by Bourantas et al Regarding Article, "Nonculprit Plaques in Patients With Acute Coronary Syndromes Have More Vulnerable Features Compared With Those With Non-Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study"

      Letter by Bourantas et al Regarding Article, "Nonculprit Plaques in Patients With Acute Coronary Syndromes Have More Vulnerable Features Compared With Those With Non-Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study"

      We have read with great interest the report by Kato et al1 on the comparison of nonculprit plaques in patients with and without acute coronary syndromes with regards to their prevalence and optical coherence tomography (OCT) characteristics. The authors for the first time demonstrated that the nonculprit lesions of the acute coronary syndrome patients had similar prevalence and distribution , but exhibited differences in the composition of plaque by OCT. However, in order to better understand their conclusions on the prevalence and distribution, the authors should report the length of the pullback and the localization of the imaged segments. There are ...

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    16. In Search of Vulnerable Plaque

      In Search of Vulnerable Plaque

      Between 1970 and 2010, the number of cardiovascular deaths per 100 000 persons in the United States has fallen from ≈450 to ≈125, a reduction >70%.1 This marked decline in cardiovascular mortality represents one of the true success stories of modern medicine. The improving lifespan of both men and women can be attributed principally to prevention of death first from coronary artery disease (CAD) and second from stroke, with a much smaller contribution from other disease states.2 The decrease in coronary heart disease deaths may be ascribed to both treatment of acute coronary syndromes (ACS) and chronic CAD ...

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    17. Predictors for Neoatherosclerosis: A Retrospective Observational Study from the Optical Coherence Tomography Registry

      Predictors for Neoatherosclerosis: A Retrospective Observational Study from the Optical Coherence Tomography Registry

      Background—Recent studies have reported development of neoatherosclerosis (NA) inside the stents several years after stent implantation. The aim of this study was to determine the predictors for NA using optical coherence tomography (OCT). Methods and Results—From a total of 1080 patients who underwent OCT, we identified 179 stents in 151 patients in which the mean neointimal thickness was >100 μm. The presence of lipid-laden neointima or calcification inside the stents was defined as NA in the present study. Patient characteristics, stent type, and time since stent implantation (stent age) were compared between stents with or without NA. Univariable ...

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    18. Nonculprit Plaques in Patients With Acute Coronary Syndromes Have More Vulnerable Features Compared With Those With Non–Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study

      Nonculprit Plaques in Patients With Acute Coronary Syndromes Have More Vulnerable Features Compared With Those With Non–Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study

      Background—Patients with acute coronary syndrome (ACS) have a higher incidence of recurrent ischemic events. The aim of this study was to compare the plaque characteristics of non-culprit lesions between ACS and non-ACS patients using optical coherence tomography (OCT) imaging. Methods and Results—Patients who had 3-vessel OCT imaging were selected from the Massachusetts General Hospital (MGH) OCT Registry. MGH registry is a multicenter registry of patients undergoing OCT. The prevalence and characteristics of non-culprit plaques were compared between ACS and non-ACS patients. A total of 248 non-culprit plaques were found in 104 patients: 45 plaques in 17 ACS patients ...

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    19. Microvascular Obstruction Is Caused by Atherothrombosis in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

      Microvascular Obstruction Is Caused by Atherothrombosis in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

      The diagnosis of acute coronary syndrome (ACS) is primarily based on the mode of clinical presentation and is a term used for any conditions suggesting the acute induction of myocardial ischemia. The precise molecular and cellular triggers that lead to ACS remain poorly understood; however, histopathologic studies have illustrated several mechanisms that may explain the sudden onset of symptoms in ACS patients. The most common substrate underlying ACS is thought to be rupture of a vulnerable plaque that contains a necrotic core covered by a fibrous cap. The term, thin-cap fibroatheroma (TCFA) is used to describe vulnerable plaque because histomorphometric ...

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    20. Thin-Cap Fibroatheroma as High Risk Plaque for Microvascular Obstruction in Patients With Acute Coronary Syndrome

      Thin-Cap Fibroatheroma as High Risk Plaque for Microvascular Obstruction in Patients With Acute Coronary Syndrome
      Background—Plaque contents can cause microvascular impairment, which is an important determinant of clinical outcomes in patients with acute coronary syndrome (ACS). We hypothesized that percutaneous coronary intervention (PCI) for thin-cap fibroatheroma (TCFA) could easily disrupt the fibrous cap and expose the contents of plaque to coronary flow, possibly resulting in microvascular obstruction (MVO). The purpose of this study was to investigate whether TCFA was associated with MVO following PCI in patients with ACS. Methods and Results—We enrolled 115 patients with ACS who were successfully recanalized with PCI. The patients were divided into a ruptured plaque group (n=59 ...
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    21. Imaging Biomarkers in Atherosclerosis Trials

      Imaging Biomarkers in Atherosclerosis Trials
      Atherosclerosis and its thrombotic complications are the leading cause of morbidity and mortality in developed countries, and the burden of atherosclerotic disease is expected to increase even further in the coming decades due to soaring obesity rates that feed the diabetes epidemic. There is, therefore, a clear need for new drugs targeting atherosclerosis to add to our current therapeutic armamentarium. Drug approval currently is based on multicenter, randomized, placebo-controlled trials with long-term follow-up in thousands of patients to demonstrate clear benefits in mortality and cardiovascular events and to allow adequate assessment of safety. Cardiovascular drug development has become a hostage ...
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    22. First In Vivo Demonstration of Coronary Edema in Culprit Lesion of Patient With Acute Coronary Syndrome by Cardiovascular Magnetic Resonance

      First In Vivo Demonstration of Coronary Edema in Culprit Lesion of Patient With Acute Coronary Syndrome by Cardiovascular Magnetic Resonance
      Atherosclerosis is a chronic, progressive, inflammatory disease causing multiple lesions in the intima of large and medium-sized arteries. 1 A minority of atherosclerotic lesions referred to as vulnerable plaques (VPs) may suddenly precipitate thrombosis, leading to life-threatening events such as acute myocardial infarction and ischemic stroke. The most common VP is the rupture-prone type, also known as thin-cap fibroatheromas, which are characterized by a large necrotic core with a thin and inflamed fibrous cap, outward remodeling mitigating luminal obstruction, neovascularization, plaque hemorrhage, adventitial inflammation, and a “spotty” pattern of calcifications. 2 Among these features, inflammation and angiogenesis are believed to ...
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    23. Pulmonary Vascular Changes in Pulmonary Hypertension: Optical Coherence Tomography Findings

      Pulmonary Vascular Changes in Pulmonary Hypertension: Optical Coherence Tomography Findings

      A 25-year-old man presented with a 3-month history of recurrent syncope, exertional chest discomfort, and shortness of breath. On physical examination, he had right ventricular heave, loud P2, jugular venous distension, tricuspid regurgitation murmur, and lower extremity edema. D-dimer was negative. Echocardiography showed right ventricular hypertrophy with elevated right ventricular pressure. Left ventricular function was normal. Cardiac catheterization showed pulmonary artery pressure of 131/50/78 mm Hg (concurrent aortic pressure was 145/80 mm Hg). Pulmonary wedge pressure was 15 mm Hg. Pulmonary angiography showed dilation of the main pulmonary artery with peripheral tapering (Figure 1). After pulmonary angiography ...

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    24. Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease

      Both chronic and acute aortic conditions are challenges for primary care physicians and cardiac specialists. Longitudinal progression of chronic aortic diseases and appropriate timing of open or endovascular surgery are usually derived from serial noninvasive imaging studies. Rapid imaging is necessary as not to delay the diagnosis of a potentially life-threatening diagnosis. Given the frequency of missed cases of dissection, atypical presentation, and time-dependent morbidity and mortality, imaging is paramount for diagnosis and treatment of any aortic disorder. An ideal imaging modality will precisely, safely, and rapidly confirm suspected acute or chronic aortic pathology with quantitative information on aneurysm formation ...
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