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Prediction models for different plaque morphology in non-significantly stenosed regions of saphenous vein grafts assessed with optical coherence tomography
摘要： Introduction: Coronary artery bypass grafting (CABG) is a method of choice in treatment of diffuse coronary artery disease (CAD), although it has some limitations such as late saphenous vein graft (SVG) patency loss, which occurs in one fifth of all conduits at 5 years. Since atherosclerosis in SVG has diffuse characteristics, it appears that significantly and non-significantly stenosed lesions may have an equal impact on worse prognosis. Aim: To assess non-significant lesions of SVG by the use of optical coherence tomography (OCT) and investigate the clinical and laboratory findings with the potential impact on plaque composition. Material and methods: Twenty-nine patients with 43 non-significant lesions were enrolled in the study. All variables were assessed using uni- and multivariable logistic regression analysis with each plaque morphology as a dependent variable. Odds ratio (OR) and 95% confidence interval (CI) were computed. Results: Plaque rupture (PRT) was independently associated with age (OR = 1.49, 95% CI: 1.09–2.04, p = 0.015) and lower rates of high-density lipoproteins (HDL) cholesterol (OR = 0.67, 95% CI: 0.49–0.92, p = 0.016). Intimal tearing or rupture (ITR) was related to reduced GFR (OR = 0.52, 95% CI: 0.38–0.72, p = 0.0004). Lipid-rich plaque (LRP) was associated with raised platelet count (PLT) (OR = 1.51, 95% CI: 1.16–1.96, p = 0.004) and increased frequency of smoking (OR = 1.45, 95% CI: 1.12–1.89, p = 0.007). Conclusions: Atherosclerosis of SVG is not restricted to significantly stenosed lesions. Plaque composition is independently associated with different types of clinical and laboratory findings, mostly recognized as risk factors of CAD.
关键词： coronary artery disease,optical coherence tomography,saphenous vein graft coronary artery bypass grafting
更新于2025-09-23 15:22:29
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Intracoronary Imaging
摘要： Coronary angiography represents both the gold standard for diagnosis of coronary artery disease and the main guidance for percutaneous coronary intervention (PCI). Yet, coronary angiography is well known to not be optimal in appreciating the whole spectrum of lesions that may cause clinical problems in patients with coronary artery disease. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represent the 2 contemporary invasive intracoronary imaging modalities aimed at improving the detection of coronary details. Their potential is extraordinary but their use for improving coronary disease diagnosis is not standardized. Moving from diagnosis to treatment, PCI based on drug-eluting stent (DES) implantation often requires a series of manipulations with different techniques and devices. Last generation DES types have similar technical features and share a comparable ability to scaffold coronary lesions. Not surprisingly, lesion complexity is known to be associated with increased procedure challenges that may be tackled by different strategies. The selection of devices and the assessment of appropriate DES implantation may be based on either angiography or intracoronary imaging techniques like IVUS or OCT. Both techniques have evolved over time and offer the possibility to see details of coronary lesions and stent/vessel interactions that are impossible to be captured and measured by angiography. So far, thousands of studies with different designs have been performed, but they have not been able to make interventional cardiologists act in a homogeneous way. Consequently, intravascular imaging is selected on the basis of individual yield, with an impressive variability across different countries and operators. Reimbursement issues are part of the game but do not entirely explain the overall underutilization of intravascular imaging (especially in Western countries where a lot of expensive devices are routinely incorporated in interventional practice). In reality, the application of intracoronary imaging adds complexity to PCI, requires adequate technical skills, and by itself does not necessarily improve the clinical outcome. As compared with angiography guidance, IVUS and OCT are able to provide (in real time) many more coronary details. Such angiographically invisible details need to be recognized by the operator to properly react to improve the clinical outcome of treated patients. Because of the impressive amount of details and possible measures/cutoffs, the identification of both impactful features (deserving attention) and best reactions (additional technical steps with corrective efficacy) is pivotal. Yet, data collected by IVUS studies have not been concordant and this has resulted in overall limited clinical penetration: many catheterization laboratories are actually working without any access to intracoronary imaging. Furthermore, although rare, imaging catheter-related complications may occur so that a safety issue has to be considered any time the expected benefit is not well established in clinical practice. On the bases of these concepts, it is evident that the intracoronary imaging clinical impact may come from the correct identification and appropriate processing of those details that may help (1) to improve the PCI strategy (technique/device selection, that is, PCI planning) and (2) to facilitate the achievement of improved stenting result (ie, PCI optimization). As shown in the Figure, among all the information captured by intracoronary imaging, a limited series of imaging-based pre-PCI findings can be easily incorporated in the PCI planning (lesion preparation and stent selection). Similarly, some key intra-PCI findings (stent underexpansion, stent edge dissections, and strut malapposition) can be searched in order to optimize the stent implantation result. The feasibility of this approach is supported by the daily experience of many high volume centers. Yet, the overall clinical impact of image guidance in PCI is still unrecognized, and large studies in the field are needed. Recently-collected data started shedding new light on both IVUS and OCT. The large study by Maehara et al, although not randomized, allowed to run a propensity-matched comparison between thousands of IVUS-guided and angiography-guided procedures. IVUS use was associated with different procedure conduction and reduced major adverse events incidence at up to 2 years. Of note, the clinical benefit comprised significant improvements of hard end points, namely stent thrombosis, myocardial infarction, and cardiac mortality. Such results fit well with the recent ULTIMATE prospective randomized trial (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in 'All-Comers' Coronary Lesions). The ULTIMATE investigators randomized 1448 all-comer patients who required DES implantation to either IVUS guidance or angiography guidance. As compared with angiography, randomization to IVUS guidance was associated with different procedure course (higher contrast administration, larger and longer stents, and higher inflation pressures) and warranted lower target vessel failures with IVUS at 12 months. OCT, as compared with IVUS, represents a younger technique, but data are growingly been collected because it has the appeal of offering higher resolution. The specific image generation process of OCT translates into the need of dedicated experience but has the potential for shorter learning curve. The possible clinical impact of OCT use in PCI guidance has been started to be highlighted by the results of the CLI-OPCI II study (Centro per la Lotta Contro l'Infarto-Optimisation of Percutaneous Coronary Intervention II). In this large registry, specific definitions for OCT features of suboptimal stent results were found to be independently associated with adverse clinical outcome after PCI. For sure, more complex PCIs (where the risk of stent thrombosis and restenosis is higher), are expected to benefit more from PCI refinements. Thus, two large prospectively randomized trials (OCTOBER, and ILUMIEN IV, and URL: https://www.clinicaltrials.gov. Unique identifier: NCT03507777) comparing OCT and angiographic guidance are actually ongoing and have been powered to explore the benefit of OCT guidance (using rigorous OCT-based PCI optimization algorithms) in, respectively, bifurcated lesions and complex patients. In conclusion, intravascular imaging modalities are entering a new era because the recently collected data seem to show new thresholds and targets for PCI planning and optimization. Thus, IVUS and OCT are going to become the ideal glasses that interventional cardiologists should wear anytime something looks unclear before, during or after PCI. Appropriate education, standardization of operative protocols and definitions of best clinical settings for application represent the future challenges for the intravascular imaging clinical implementation.
关键词： intravascular ultrasound,angiography,myocardial infarction,Editorials,diagnosis,optical coherence tomography,coronary artery disease,percutaneous coronary intervention
更新于2025-09-23 15:22:29
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How to Utilize Coronary Computed Tomography Angiography in the Treatment of Coronary Artery Disease
摘要： Coronary computed tomography angiography (CCTA) has high negative predictive power for detecting coronary artery disease. However CCTA is limited by moderate positive predictive power in the detection of myocardial ischemia. This is not unexpected because the diameter of a stenosis is a poor indicator of myocardial ischemia and discrepancy between the severity of stenosis and noninvasive tests is not uncommon. The value of stenosis for predicting future development of acute coronary syndrome represented by plaque rupture has been questioned. CCTA identifies the characteristics of high-risk plaque including positive remodeling, low density plaque and spotty or micro-calcification. Also, additional evaluation of myocardial ischemia using computational flow dynamics, and luminal attenuation gradient are expected to increase both diagnostic performance for hemodynamically significant stenosis and the predictive power for future cardiovascular risk. Technical advances in CCTA would enable evaluation of both coronary artery stenosis and myocardial ischemia simultaneously with high predictive performance, and would improve vastly the clinical value of CCTA.
关键词： Functional ischemia,Coronary artery disease,Atherosclerosis,Prognosis,Coronary CT angiography,Myocardial mass
更新于2025-09-23 15:22:29
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P1774Effect of early pitavastatin therapy on coronary fibrous-cap thickness assessed by optical coherence tomography in patients with acute coronary syndrome: the ESCORT study
摘要： Coronary artery disease in young adults is rare, but it is in an increasing trend. However, the risk factors are largely unknown. Previous studies have shown that hyperuricemia is associated with coronary artery disease, but the relationship in young adults is unknown. In this article, we hope to explore the effect of hyperuricemia on coronary artery disease in young adults less than 35 years old. In this retrospective study,we consecutively included young adults (aged 18–35 years old) undergoing coronary angiography in our institution from January 2005 to December 2015. Patients with coronary angiography showed that luminal diameter stenosis≥50% in any of the major epicardial coronary arteries were considered as CAD. The severity of CAD was assessed by gensini score. We tested for interactions between uric acid (hyperuricemia or normouricemia) and other traditional risk factors on the coronary artery disease. The interaction effect on the presence of CAD in young adults was analyzed with multi-variate logistic regression analyses. The relationship between hyperuricemia and CAD in young adults was analyzed with multi-variate regression. 1203 patients (1129 male and 74 female) were included in this study. 790 of young adults were confirmed as having coronary artery disease. The hyperuricemia was present in 35.41% of patients. The multivariate analysis identified hyperuricemia was not independent for the presence of CAD. We furtherly found that the interaction between hyperuricemia and smoking achieved statistical significance for the present of CAD (p=0.0109).In non-smokers, hyperuricemia was an independent risk factor for the presence of CAD (odds ratio [OR]=1.85, 95% confidence interval [CI]=1.06–3.21, P=0.0293). Multivariate analysis identified hyperuricemia was an independent risk factor for the severity of CAD in young adults (odds ratio [OR]=8.45, 95% confidence interval [CI]=1.18–15.71, p=0.0231). In young adults (≤35 years old), hyperuricemia is significantly associated with the presence of CAD in non-smokers. Hyperuricemia has strong correlation with the severity of coronary artery disease in young adults (≤35 years old).
关键词： Coronary artery disease,risk factors,hyperuricemia,smoking,young adults
更新于2025-09-23 15:21:21
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Evaluation of plaque characteristics in coronary artery patients with impaired glucose tolerance through optical coherence tomography
摘要： OBJECTIVE: With the adoption of optical coherence tomography (OCT), this study targets the impacts on plaque characteristics brought about by impaired glucose tolerance (IGT) in patients with coronary artery disease. METHODS: For this study, 150 patients with coronary artery disease were recruited. Regarding glycosylated hemoglobin (HbAlc), the patients were sectioned into normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM) groups. Coronary angiography (CAG) and OCT were conducted for 150 patients. RESULTS: There were 186 plaques discovered in 150 patients (37, 40, 44, and 65 in the NGT, IFG, IGT, and DM groups, respectively). Compared to the NGT group, the lipid core size, which is presented as the average angle of the lipid arc, was markedly larger in the IFG,IGT and DM groups ( 135.7 ± 32.7 ê, 161.2 ± 55.7 ê, 162.5 ± 55.8 ê, and 170.2 ± 59.7 ê, respectively, all P values< 0.05). Meanwhile, the fibrous cap over the lipid core in the NGT group was remarkably thicker than that in the IFG, IGT, and DM groups (115.7 ± 47.7 μm vs. 77.7 ± 23.5 μm, 75.1 ± 23.2 μm, 71.2 ± 22.1 μm, all P values<0.05). CONCLUSION: Coronary plaques in coronary artery patients with NDT are more stable than in those with IGT and DM.
关键词： Diabetes Mellitus,Tomography, Optical Coherence,Coronary Artery Disease,Atherosclerosis,Coronary Disease
更新于2025-09-23 15:21:01
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[IEEE 2019 22nd International Conference on Computer and Information Technology (ICCIT) - Dhaka, Bangladesh (2019.12.18-2019.12.20)] 2019 22nd International Conference on Computer and Information Technology (ICCIT) - Enhancement of Conversion Efficiency of CdS-CdTe Photovoltaic Cell Sandwiching Intrinsic CdTe Layer between Window and Absorber Layers
摘要： Studies involving turbulent flow have been carried out in many parts of the cardiovascular system, and it has been widely reported that turbulence related to stenosis (narrowing) of arteries creates audible sounds, which may be analyzed to yield information about the nature and severity of the blockage. Results so far indicate that the high frequency content of the sounds generally increases with the degree of stenosis. In this paper, we designed and built an MEMs microphone array and a signal acquisition board to improve the detection of coronary occlusions using an approach based on the recording and analysis of isolated diastolic heart sounds associated with turbulent blood flow in occluded coronary arteries. The nonlinear dynamic analysis method based on approximate entropy has been proposed for the analysis of diastolic heart sounds from patients with single coronary occlusions, before and after stent placement procedures. The nonlinear dynamic analysis (approximate entropy) measures of the diastolic heart sounds recorded from eight patients with single coronary occlusions and two normal subjects were estimated. In addition, a spectral analysis based on the fast Fourier transform was used to estimate the energy content of the recorded signals. Results suggest the presence of high nonlinear (approximate entropy) values of diastolic heart sounds associated with coronary artery disease (p < 0.01) as well as significant differences in the energy content of the heart sound signals above and below 150 Hz (p < 0.05).
关键词： MEMs microphone array,approximate entropy,nonlinear dynamics analysis,Coronary artery disease
更新于2025-09-23 15:21:01
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Cardiac Computed Tomography 2.0
摘要： Computed tomography angiography (CTA) is now an established diagnostic option for patients with chest pain. It is a safe alternative to functional testing, provides diagnostic certainty, is a good gatekeeper for downstream invasive angiography, and increases the diagnostic yield when invasive angiography is eventually needed. CTA-driven care is associated with more relief of angina and generates optimal medical therapy associated with reduced death and myocardial infarction. However, CT angiography can lead to more cardiac catheterizations as well as more coronary revascularization. CTA shows good sensitivity, but also suffers from suboptimal specificity; thus, one cannot be sure, lacking other functional test results, that more revascularization procedures are necessary or beneficial compared to operating on lesions with demonstrated ischemia.
关键词： Fractional Flow Reserve,Myocardial Perfusion Imaging,Cardiac Computed Tomography,Coronary Artery Disease,CT Angiography
更新于2025-09-23 15:21:01
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Excimer laser coronary atherectomy prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions
摘要： This study aimed to evaluate the efficacy and safety of excimer laser coronary atherectomy (ELCA) prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. This retrospective observational study analyzed 118 eligible patients with de novo coronary artery disease whose only percutaneous coronary intervention was a drug-coated balloon angioplasty (i.e., no subsequent stent placement). Data related to our primary outcomes of interest—incidence of major adverse cardiovascular and cerebral events (MACCE), and incidence of procedural complications (bailout stenting and minor complications)—were collected and retrospectively analyzed. ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high lateral branch), normally associated with poor treatment outcomes (55.6% vs. 14.3%, p < 0.0005). However, the two groups were not different in terms of cumulative incidence as estimated by the Kaplan–Meier method (log-rank test, p = 0.603) and a causal relationship between ELCA and MACCE was not identified (OR, 2.223; 95% CI, 0.614–8.047; p = 0.223). This study confirms the safety of ELCA prior to paclitaxel DCB angioplasty to treat de novo coronary artery lesions. While difficult-to-treat lesions were significantly more prevalent in the group treated by ELCA, the study revealed similar efficiency as conventional pre-dilation methods. Our findings provide grounds for a prospective randomized trial with consistent lesion and procedural characteristics to evaluate the potential benefits of combining paclitaxel DCB angioplasty following ELCA for de novo coronary artery lesions.
关键词： Drug-coated balloon,Laser coronary atherectomy,Coronary artery disease,Angioplasty
更新于2025-09-23 15:19:57
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Extending the Use of Coronary Calcium Scanning to Clinical Rather Than Just Screening Populations
摘要： Twenty-five years after its initial development, coronary artery calcium (CAC) scanning has become a relatively inexpensive test that has been extensively validated as a potent noninvasive means for assessing the burden of coronary atherosclerosis in asymptomatic individuals. A proportional relationship between the magnitude of CAC abnormality and the frequency of subsequent cardiac events over long-term follow-up has been consistently demonstrated, including observations from large patient and population-based cohorts.1–3 Incremental prognostic value over standard clinical assessments including the Framingham Risk Score and other scores of global risk has also been consistently reported.3,4 Consequently, the application of CAC scanning for assessing asymptomatic patients with intermediate clinical risk has now become part of clinical guidelines.5,6
关键词： tomography, emission-computed, single-photon,myocardial perfusion imaging,coronary angiography,atherosclerosis,Editorials,coronary artery disease
更新于2025-09-19 17:15:36
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TCT-665 Experience With Excimer Laser in Percutaneous Coronary Intervention With Indications, Procedural Characteristics, Complications, and Outcomes in a Large University Teaching Hospital
摘要： Excimer laser coronary atherectomy (ELCA) has been around since the early 1980s. Previous studies, although documenting high complication rates and restenosis, actually predate the introduction of the smaller 0.9-mm catheter, which is now in frequent use. We established the indications, procedural characteristics, complications, and outcomes of ELCA in a contemporary coronary interventional practice.
关键词： percutaneous coronary intervention,Excimer laser coronary atherectomy,acute coronary syndromes,coronary artery disease,ELCA,cardiogenic shock
更新于2025-09-19 17:13:59