Calcified Ones Research Articles

High Inflammation and Coronary Calcification in an Acute Coronary Syndrome Successfully Treated with Cutting Balloon

Abstract Complex coronary atherosclerosis may exhibit different phenotypes of coronary plaques, from non-calcified highly vulnerable atheroma to heavily calcified ones. Computed coronary tomography angiography (CCTA) may identify these different phenotypes and the recently introduced CCTA-based techniques for mapping coronary inflammation along the coronary arteries may provide useful additional information on cardiovascular risk. Here we present the case of a 68-year-old male patient with acute coronary syndrome in whom invasive coronary angiography and CCTA revealed a severe three-vessel disease with a heavily calcified lesion. Mapping of the CT fat attenuation index along the coronary arteries identified a high level of coronary inflammation, especially associated with the non-calcified lesions. All lesions were successfully revascularized by implantation of drug-eluting stents. A cutting balloon was used for the lesion identified by CCTA as heavily calcified, followed by stent implantation, with good results. In conclusion, CCTA, in association with novel techniques for mapping coronary inflammation, may represent an extremely useful tool for preparing complex interventions in multivessel diseases, helping preprocedural planning in high-risk patients.

Association of blood lipids with coronary artery plaque among Saudi patients referred to computed tomography

BackgroundBlood lipids are strong risk factors for the progression of atherosclerotic plaques. However, data on gender-specific associations are limited.ObjectivesTo examine gender-specific associations of coronary plaque with blood lipids among a large sample of Saudi patients without CAD.MethodsRetrospective cross-sectional study was conducted among adult patients referred to (64 multidetector spiral) computed tomography (CT) for standard indications at the Prince Sultan Cardiac Centre (Riyadh, Saudi Arabia) between July 2007 and December 2017. Those with pre-existing CAD were excluded. Plaques were determined based on quantification of coronary calcium and Coronary CT angiography.ResultsA total 2421 patients (1498 males and 923 females) were included. The prevalence of any plaque was 36.6% with higher burden in males than females (41.3% versus 28.9%, p < 0.001). Approximately 78.9% of all plaques were calcified. Blood lipids (mmol/L) were 4.75 ± 1.14 for total cholesterol, 2.90 ± 0.96 for LDL cholesterol, 1.20 ± 0.36 for HDL cholesterol, and 1.64 ± 1.09 for triglycerides. Males had significantly higher triglycerides and lower HDL cholesterol compared with females. In adjusted models in males and all patients, soft and/or calcified plaques were significantly associated with lower HDL cholesterol and higher triglycerides. In females, the only significant association was between soft plaques and higher triglycerides.ConclusionsMiddle-aged patients without clinical CAD in Saudi Arabia have a high burden of plaques, specially calcified ones. The findings may impact the use of lipid lowering mediations, by underscoring the importance of assessing the risk of CAD in patients without clinical CAD even in case of lack of coronary calcification.

Spatiotemporal Complexity of the Aortic Sinus Vortex as a Function of Leaflet Calcification.

Several studies have shown the variation of aortic sinus structures' hemodynamics with different flow and geometric characteristics. They have also correlated aortic sinus hemodynamics with the progression and evolution of calcific aortic valve disease (CAVD). This study aims at visualizing aortic sinus fluid structure variations as functions of different leaflet calcification degrees and assessing their potential relationship with CAVD. A degenerated 23mm Carpentier-Edwards Perimount Magna valve extracted from a redo-surgery patient was implanted in an aortic root model and tested in a pulse duplicator left heart simulator. The valve has 3 leaflets with 3 different levels of calcium distribution: mild, moderate and severe. High-speed imaging and particle image velocimetry were performed to assess sinus vortices, leaflet tip position and velocity along with shear stress. Results have shown that (a) aortic sinus vortices initiation, entrapment and evolution varied with different calcified leaflet exposure; (b) higher velocities in the sinus were calculated with the mildly calcified leaflet compared to the moderately and severely calcified ones; (c) during systole, the mildly calcified leaflet sinus case shows the most spread-out and higher ranges of shear stress probabilities and highest magnitudes going from (- 1.5 to + 1.8Pa) compared with (- 1.0 to + 1.0Pa) for moderately and severely calcified leaflets. The higher the calcification degree the lower the shear stress range and likelihoods of having higher shear stress. This holds in diastole as well. This study shows the impact of calcification on the aortic sinus flow structures.

Prevalence and geospatial distribution of bovine cysticercosis in the state of Mato Grosso, Brazil

This study focused on estimating the prevalence and evaluating the geospatial distribution of bovine cysticercosis in the state of Mato Grosso, Brazil. To this, we used data of 6,200,497 animals slaughtered during the years of 2013 and 2014, and from 141 municipalities of the state. The prevalence observed for this period was 0.0873% (95% CI 0.0851–0.0897). Regarding the cysticerci detected, the calcified ones were the most frequent (74.43%). The high odds ratios were observed in animals reared in the Administrative Regions of Sinop, Barra do Garças, Água Boa, Cáceres, Barra do Bugres, Cuiabá, Pontes Lacerda, Rondonópolis, Matupa, São Félix do Araguaia and Lucas do Rio Verde, respectively. Furthermore, the results indicate the existence of a relation between the areas with high cysticercosis prevalence and human population density. We highlight the need of the development of a risk model based on the origin to improve cysticercosis detection in endemic areas.

Preference of the herbivorous marine teleost Siganus canaliculatus for different macroalgae

The decomposition of a large amount of unexploited macroalgal resource along the coast of China often results in heavy environmental pollution. In order to pave a way of using macroalgae as the dietary ingredient of rabbitfish Siganus canaliculatus, one of a few farmed herbivorous marine teleosts in China, its preference (feeding selectivity) for different macroalgae was determined in this study. Seven seaweed species abundantly inhabiting the coast of east Guangdong Province were exposed simultaneously to rabbitfish juveniles in laboratory (multiple-choice feeding) with their content and absolute intake assayed. It was found that the most preferred algae were Ulva prolifera, Gracilaria lemaneiformis and Chaetomorpha linum, less preferred algae were U. pertusa and Porphyra haitanensis, and least preferred ones were Sargassum fusiforme and Corallina sessilis. Such an order did not change when one to four relatively preferred seaweeds were removed. The preferred seaweeds were richer in protein and soluble sugar thus higher in energy than the least preferred. In addition, this fish was found to favor filamentous and flat algae rather than calcified ones. Accordingly, the richness of nutrients and morphological characteristics determined the preference of S. canaliculatus for tested macroalgae.

STUDY OF PLAQUE VULNERABILITY IN CORONARY ARTERY USING MOONEY–RIVLIN MODEL: A COMBINATION OF FINITE ELEMENT AND EXPERIMENTAL METHOD

Atherosclerosis is a disease in which plaque builds up inside arteries. It is also considered as one of the most serious and common forms of cardiovascular disease which can lead to heart attack and stroke. In the current research, finite element method is used to anticipate plaque vulnerability based on peak plaque stress using human samples. A total of 23 healthy and atherosclerotic human coronary arteries, including 14 healthy and 9 atherosclerotic are removed within 5 h postmortem. The samples are mounted on a uniaxial tensile test machine and the obtained mechanical properties are used in finite element models. The results, including the Mooney–Rivlin hyperelastic constants of the samples as well as peak plaque stresses, are computed. It is demonstrated that the atherosclerotic human coronary arteries have significantly (p &lt; 0.05) higher stiffness compared to healthy ones. The hypocellular plaque, in addition, has the highest stress values compared to the cellular and calcified ones and, consequently, is so prone to rupture. The calcified plaque type, nevertheless, has the lowest stress values and, remains stable. The results of this study can be used in the plaque vulnerability prediction and could have clinical implications for interventions and surgeries, such as balloon angioplasty, bypass and stenting.

RETRACTED: A comparative study on plaque vulnerability using constitutive equations

Atherosclerosis is the most serious and common form of cardiovascular disease in which plaque builds up inside the arteries. Peak plaque stress is considered as the main reason for plaque rupture, which results in heart attack and stroke. In the current research, the finite element method is used to anticipate plaque vulnerability, using human samples. A total of 23 healthy and atherosclerotic human coronary arteries (14 healthy and 9 atherosclerotic) were removed within 5 h postmortem. The samples were mounted on a uniaxial tensile test machine and the obtained mechanical properties were used in finite element models. The peak plaque stresses for the Ogden hyperelastic model were compared to the Mooney-Rivlin and Neo-Hookean outcomes. The results indicated that hypocellular plaque in all three models has the highest stress values compared to the cellular and calcified ones and, as a result, is quite prone to rupture. The calcified plaque type, in contrast, has the lowest stress values and remains stable. The results can be used in plaque vulnerability prediction and have clinical implications for interventions and surgeries such as balloon-angioplasty, cardiopulmonary bypass and stenting.

Noninvasive assessment of the carotid and cerebrovascular atherosclerotic plaques by multidetector CT in type-2 diabetes mellitus patients with transient ischemic attack or stroke

BackgroundThe cerebrovasuclar artery disease as a common complication of type-2 diabetes mellitus (T2DM) caused huge economic burden and lives threatening to patients. We evaluated the prevalence and morphology of carotid and cerebrovascular atherosclerotic plaques in T2DM patients with transient ischemic attack (TIA) or stroke using multidetector CT (MDCT).Methods64-MDCT and dual-source CT (DSCT) angiographies were performed in 195 T2DM patients with TIA or stroke (mean age 65.7+/-12.8 years; 118 men) between January 2009 to August 2011. During the process, plaque type, its distribution, extensive and obstructive natures were determined for each segment derived from the patients.ResultsAtherosclerotic plaques were detected in 183 (93.8%) patients. A total of 1056 segments with plaque were identified, of which 450 (42.6%) were non-calcified, 192 (18.2%) were mixed and 414 (39.2%) calcified ones. Among them, 562 (53.2%) resulted in mild stenosis, 291 (27.6%) moderate stenosis, 170 (16.1%) severe stenosis and 33 (3.1%) occlusion. Non-calcified plaques contributed 91.8% to non-obstructive lumen narrowing, while mixed and calcified plaques contributed 89.0% and 65.0% respectively.ConclusionsMDCT angiography detected a high prevalence of plaques in T2DM patients with TIA or stroke. A relatively high proportion of plaques were non-calcified, as well as with non-obstructive stenosis. MDCT angiography might further enhance the detection and management of carotid and cerebrovascular atherosclerosis in T2DM patients with TIA and stroke

Determination of the mechanical properties of normal and calcified human mitral chordae tendineae

The aim of the present research is to determine the influence of the calcification of human mitral valves on the mechanical properties of their marginal chordae tendineae. The study was performed on marginal chords obtained from thirteen human mitral valves, explanted at surgery, including six non-calcified, four moderately calcified and three strongly calcified valves. The mechanical response of the chords from the non-calcified and moderately calcified valves was determined by means of quasi-static tensile tests (the poor condition of the strongly calcified valves prevented them from being mechanically characterised). The material parameters that were obtained and analysed (the Young's modulus, the secant modulus, the proportional limit stress, the ultimate strength, the strain at fracture and the density of energy stored up to maximum load) revealed noticeable differences in mechanical behaviour between the two groups of mitral chordae tendineae. Large scatter was obtained in all cases, nevertheless, considering the mean values, it was observed that the normal chords are between three and seven times stiffer or more resistant than the moderately calcified ones. On the contrary, the results obtained for the strain at fracture showed a rather different picture as, in this case, no significant differences were observed between the two families of chords. A scanning electron microscopy study was conducted in order to find out the relevant features of the calcium deposits present in the calcified chordae tendineae. In addition, the general aspects appreciated in the stress vs. strain curves were correlated with the collagen morphological evidences determined microscopically. Finally, the calcium content present in the three groups of chords was quantitatively determined through atomic absorption spectroscopy; then, the relation between the mechanical properties of normal and moderately calcified chords as a function of its calcium content was obtained. This analysis confirmed the existence of a strong correlation between calcium content and stiffness or resistance whereas the influence on the ductility seems to be negligible.

Bone morphogenetic protein -7 increases thrombogenicity of lipid-rich atherosclerotic plaques via activation of tissue factor

Thrombogenicity of atherosclerotic plaques largely depends on plaque morphology. Tissue factor (TF) expression is higher in lipid-rich than in calcified lesions. Although bone morphogenetic protein (BMP) -7 is a known inhibitor of vascular calcification, the role of BMP-7 in the development of plaque thrombogenicity is uncertain. We hypothesized that increased thrombogenic potential of lipid-rich plaques is attributed to activation of TF by BMP-7. We measured levels of BMP-7 and TF proteins in lipid-rich and calcified carotid plaques, and tested the effects of BMP-7 on TF expression in human monocytes in vitro. Quantitative immunohistochemical analysis of endarterectomy specimens for TF and BMP-7 revealed that lipid-rich plaques contained more TF antigen than calcified ones (158.6 ± 25.3 vs 37.4 ± 8.8 AU, p < 0.008). Lipid-rich plaques also expressed higher levels of BMP-7 (60.7 ± 5.2 AU) than calcified lesions (31.8 ± 8.6 AU, p < 0.021). In vitro treatment of whole blood with BMP-7 markedly increased the population of TF-positive monocytes from 1.5 ± 0.6 % to 31.0 ± 7.6 % (p < 0.001). Stimulation of blood with BMP-7 was accompanied by elevated surface presentation of TF antigen in monocytes as TF-dependent fluorescence intensity increased from 5.0 ± 2.6 AU in unstimulated conditions to 15.8 ± 1.9 AU after incubation with BMP-7 (p < 0.002). Our data suggest that BMP-7 contributes to increased thrombogenicity of lipid-rich plaques via enhancement of TF expression.

Evaluation by ultrasound of traumatic rib fractures missed by radiography

Rib fractures are the most common (25%) injuries resulting from blunt chest trauma, and are usually revealed on radiographs. Radiography sometimes cannot show fractures, especially those in costal cartilages, except for densely calcified ones. Several authors have recently investigated the role of ultrasound in the detection of rib fractures. We conducted this study to investigate possible rib fractures with ultrasound, determine those overlooked on chest x-ray, and analyze the possible clinical predictors of these insidious rib fractures in minor or mild blunt chest trauma. A total of 20 patients with minor mild blunt chest trauma were enrolled into this study. All radiographs were reviewed by two radiologists who noted rib fractures or other complications. Ultrasonography was performed in the radiology department using a linear transducer by one radiologist. The costal cartilage normally appears relatively hypoechoic compared with the osseous rib. Fractures of the rib, costochondral junction, and costal cartilage were denoted by a clear disruption of the anterior echogenic margin. A total of 20 patients with normal radiological findings, but continuing symptoms were evaluated by ultrasound. The most common etiology of trauma was a fall, as seen in 60% of the patients. None of the rib fractures were identified radiographically. Sonography detected 26 rib fractures in 18 of 20 subjects at presentation. Sonography reveals more fractures than radiography and will reveal fractures in most patients presenting with suspected rib fracture.

Noncollagenous bone matrix proteins as a part of calcific aortic valve disease regulation

Clinically, calcific aortic valve disease is a progressive continuum from obstructive fibro(sclero)tic valve thickening to aortic stenosis. Recent evidence suggests that, in addition to nonbone miscellaneous mineralization, calcified valves present distinct signs of active bone remodeling; and in this context, noncollagenous bone-associated proteins are assumed to have a critical role. The expression of 5 bone matrix proteins-bone morphogenetic protein-2 and -4, bone sialoprotein II, osteopontin, and osteoprotegerin-was examined by reverse transcriptase polymerase chain reaction (n = 31) and immunolabeling (n = 83) in the clinical continuum from healthy pliable valves to heavily calcified ones. As a known structural pathologic sign, the extent of neovascularization was also examined. We observed progressive increase in the gene expression of osteopontin (7.4-fold elevation, P < .001) and bone sialoprotein II (5.8-fold elevation, P < .05), and also 1.7-fold elevation (P < .05) in osteoprotegerin gene expression during the disease course. These findings were congruent with that of immunohistochemical analysis. Surprisingly, bone morphogenetic protein-2 and -4 showed a comparable significant decrease in messenger RNA levels in calcified valves (P < .01 and P < .05, respectively). Our results support the view that aortic valve calcification is an actively regulated process. Furthermore, the results suggest that the expression of pro- and anticalcific noncollagenous bone-associated matrix proteins is altered during the disease continuum and that this imbalance may contribute to the pathology of calcific aortic valve disease.

Pinching in longitudinal and alternate osteons during cyclic loading

Pinching is a degrading phenomenon which occurs during cyclic loading of certain materials. A change in the slope of the deflection curve reveals pinching; lesions, either flexural cracks or bond degradation, cause pinching. This paper investigates pinching for 20 longitudinal and 18 alternate fully calcified osteonic samples of cylindrical shape and 500 μm length. Each sample was axially loaded beyond the proportional limit using an electromechanical device acting as a transducer of the variations in length of the sample into changes in the resonance frequency of a microwave micrometer. A cubic polynomial served as a mathematical model to investigate the stress-strain diagrams at the first and last cycles through the study of strain limits, stiffness and pinching behaviors, and energy absorption. The hysteretic behavior of the two types of osteons differs and is far from ideal. The presence of pinching may derive from the existence of longitudinal fibrils, in particular the yielding of the incompletely calcified ones. In longitudinal osteons consisting mainly of longitudinal collagen fibrils, the deformation under compression is not protected by lamellae consisting of transverse fibrils, therefore the lesions inducing pinching are magnified. In contrast, in alternate osteons, where the fibrils having a longitudinal orientation are reduced and protected by lamellae containing transversely oriented fibrils, the lesions-inducing pinching are lessened.

Critical assessment of two-dimensional echocardiographic estimation of the mitral valve area in rheumatic mitral valve disease: calcific deposits in the valve as a major determinant of the accuracy of the method.

The accuracy of two-dimensional echocardiographic estimation of the mitral valve area (MVA) and the effects which the morphological features of the valve (degree of stenosis, coexistent regurgitation, extent of calcific deposits) exert on the approximation of such a measurement have been evaluated. In 29 patients, who underwent surgical replacement of a rheumatic mitral valve, correlation was assessed between the echocardiographic values of MVA and the anatomical ones measured on excised valves by means of a sizer set to detect area differences up to 0.1 cm2 Though the correlation obtained was statistically significant (P <0.001) the percentage deviation (δ%) between the two series of measurements was appreciable (29.38 ± 20.14%, mean ± 1 s.d.). The degree of stenosis and the presence or absence of regurgitation did not affect δ%. Only the amount of calcific deposits, evaluated from the radiographs of the excised valves, influenced the discrepancy between the two methods, δ% being significantly higher (P < 0.05) in the calcified valves than in the not or minimally calcified ones. Though the two-dimensional echocardiographic estimates ofM VA in rheumatic mitral valve disease are correlated with the anatomical area, their predictive value in the estimation of the true orifice size is poor in the individual patient, in view of the large discrepancy between the echocardiographic and anatomical measurements found in our study.