Lumen Volume Research Articles

Is the Natural Anatomical Evolution of Type B Intramural Hematomas Reliable to Identify the Patients at Risk of Aneurysmal Progression?

The natural history of type B intramural hematomas is little-known. Aneurysmal progression or an aortic dissection occurs in 15 to 20% of the cases. The study of the natural anatomical evolution could help identify the patients at risk of unfavorable evolution. All the patients monitored for a type B intramural hematoma between 2009 and 2018 were included in this monocentric retrospective study. Computed tomography angiography centerline measurement of diameters was obtained in various points of aortic segmentation on day (D) 0 and at one month (M1). Aortic volumes (lumen, intramural hematoma, and total volume) were calculated. The circulating volume was calculated using the volume rendering method. The volume of the intramural hematoma was measured using a manual section-by-section segmentation tool, and the total volume was obtained by summing up the two preceding volumes. Two groups of patients were compared: group 1 (favorable anatomical evolution) and group 2 (unfavorable anatomical evolution). Between January 2008 and August 2018, 25 patients were managed for a type B intramural hematoma in our center. After an average follow-up of 15.5months (1-52), 13 patients (52%) presented a favorable evolution and 12 (48%) an unfavorable evolution. At M1, a significant increase of the luminal diameters (37mm vs. 32mm; P<0.01) and a significant reduction in the longitudinal extension (19mm vs. 26mm; P<0.01) were observed. The maximum aortic diameter evolved significantly between D0 and M1 in the unfavorable evolution group (49mm vs. 44 mm, respectively; P=0.038). Such a difference was not found in the favorable evolution group (37.4 vs. 37.1, respectively; P=0.552). An overall significant reduction in the total aortic volume (166cm3 vs. 219cm3; P<0.01), the circulating volume (124cm3 vs. 145cm3; P=0,026), and the volume of the hematoma (42cm3 vs. 39cm3; P<0.01) was observed. The circulating volume decreased significantly between D0 and M1 in the favorable evolution group (110cm3 vs. 135cm3; P=0.05), whereas no difference was noted in the unfavorable group (142cm3 vs, 157cm3; P=0.24). The progression of the maximum aortic diameter and of the circulating volume after one month of follow-up could be predictive factors of the poor long-term evolution of type B intramural hematomas.

Contrast-Enhanced High-Resolution Intracranial Vessel Wall MRI with Compressed Sensing: Comparison with Conventional T1 Volumetric Isotropic Turbo Spin Echo Acquisition Sequence.

ObjectiveCompressed sensing (CS) has gained wide interest since it accelerates MRI acquisition. We aimed to compare the 3D post-contrast T1-weighted volumetric isotropic turbo spin echo acquisition (VISTA) with CS (VISTA-CS) and without CS (VISTA-nonCS) in intracranial vessel wall MRIs (VW-MRI).Materials and MethodsFrom April 2017 to July 2018, 72 patients who underwent VW-MRI, including both VISTA-CS and VISTA-nonCS, were retrospectively enrolled. Wall and lumen volumes, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured from normal and lesion sites. Two neuroradiologists independently evaluated overall image quality and degree of normal and lesion wall delineation with a four-point scale (scores ≥ 3 defined as acceptable).ResultsScan coverage was increased in VISTA-CS to cover both anterior and posterior circulations with a slightly shorter scan time compared to VISTA-nonCS (approximately 7 minutes vs. 8 minutes). Wall and lumen volumes were not significantly different with VISTA-CS or VISTA-nonCS (interclass correlation coefficient = 0.964–0.997). SNR was or trended towards significantly higher values in VISTA-CS than in VISTA-nonCS. At normal sites, CNR was not significantly different between two sequences (p = 0.907), whereas VISTA-CS provided lower CNR in lesion sites compared with VISTA-nonCS (p = 0.003). Subjective wall delineation was superior with VISTA-nonCS than with VISTA-CS (p = 0.019), although overall image quality did not differ (p = 0.297). The proportions of images with acceptable quality were not significantly different between VISTA-CS (83.3–97.8%) and VISTA-nonCS (75–100%).ConclusionCS may be useful for intracranial VW-MRI as it allows for larger scan coverage with slightly shorter scan time without compromising image quality.

Coronary Artery Lumen Segmentation Using Location-Adaptive Threshold in Coronary Computed Tomographic Angiography: A Proof-of-Concept.

ObjectiveTo compare the lumen parameters measured by the location-adaptive threshold method (LATM), in which the inter- and intra-scan attenuation variabilities of coronary computed tomographic angiography (CCTA) were corrected, and the scan-adaptive threshold method (SATM), in which only the inter-scan variability was corrected, with the reference standard measurement by intravascular ultrasonography (IVUS).Materials and MethodsThe Hounsfield unit (HU) values of whole voxels and the centerline in each of the cross-sections of the 22 target coronary artery segments were obtained from 15 patients between March 2009 and June 2010, in addition to the corresponding voxel size. Lumen volume was calculated mathematically as the voxel volume multiplied by the number of voxels with HU within a given range, defined as the lumen for each method, and compared with the IVUS-derived reference standard. Subgroup analysis of the lumen area was performed to investigate the effect of lumen size on the studied methods. Bland-Altman plots were used to evaluate the agreement between the measurements.ResultsLumen volumes measured by SATM was significantly smaller than that measured by IVUS (mean difference, 14.6 mm3; 95% confidence interval [CI], 4.9–24.3 mm3); the lumen volumes measured by LATM and IVUS were not significantly different (mean difference, −0.7 mm3; 95% CI, −9.1–7.7 mm3). The lumen area measured by SATM was significantly smaller than that measured by LATM in the smaller lumen area group (mean of difference, 1.07 mm2; 95% CI, 0.89–1.25 mm2) but not in the larger lumen area group (mean of difference, −0.07 mm2; 95% CI, −0.22–0.08 mm2). In the smaller lumen group, the mean difference was lower in the Bland-Altman plot of IVUS and LATM (0.46 mm2; 95% CI, 0.27–0.65 mm2) than in that of IVUS and SATM (1.53 mm2; 95% CI, 1.27–1.79 mm2).ConclusionSATM underestimated the lumen parameters for computed lumen segmentation in CCTA, and this may be overcome by using LATM.

High-definition ultrasound characterization of acute cyclophosphamide-induced cystitis in the mouse.

PurposeTo examine associations if any between changes in voiding function, hematuria, and bladder ultrasonography metrics in murine cyclophosphamide-induced chemical cystitis.Materials and MethodsCystitis was induced in 6 female mice by an intraperitoneal injection of cyclophosphamide (300 mg/kg). Voiding frequency, void volume, hematuria assessment, and ultrasonographic measurements of the bladder were obtained at baseline, days 1 to 5, and days 9, 11, and 13. Voiding was induced with preferred sweet drinking solution and voiding data collected using an automated data collection system in 135 minute sessions. Bladder wall thickness, lumen volume, and vascular Doppler were acquired using a high definition ultrasound system. Spearman's correlation was used to analyze the association between the voiding changes, hematuria, and ultrasound findings.ResultsHematuria was present 24 hours after cyclophosphamide injection. All animals displayed increased bladder vascularity, bladder wall thickness, and void frequency that was associated with concurrent decreased total and average void volumes. Increased bladder wall vascularity was correlated with the presence of hematuria (r=0.59, p<0.01) and bladder wall thickness (r=0.79, p<0.01). Hematuria correlated with increased void frequency (r=0.34, p<0.01). Average void volume was negatively correlated with hematuria (r=−0.50, p<0.01) and frequency (r=−0.38, p<0.01).ConclusionsHigh-definition ultrasound imaging permits in vivo monitoring of changes in bladder morphology associated with voiding function in relation to cyclophosphamide-induced cystitis. Ultrasound imaging of the bladder may assist in differential diagnosis of bladder dysfunction.

Factors Associated With Lower Incidence of Rupture in Abdominal Aortic Aneurysms

Introduction: The only current standard in international guidelines for estimating rupture risk of an abdominal aortic aneurysm (AAA) is the maximum diameter. The aim of this study was to evaluate anatomical factors in large (>80mm) AAA, in which the impact of diameter on rupture incidence is similar and profound, that may be associated with lower incidence of rupture. Methods: This was a retrospective study including patients with large (>80mm) aneurysms. Total of 62 patients were included in the study; matched 1:1 for age, and smoking (31 elective; 92±9.7mm vs. 31 ruptures; 95.7±12mm; p=0.5). Pre-operative computed tomography angiography was analyzed with a dedicated workstation and AAA anatomical characteristics were compared. The prognostic utility of several factors on rupture occurrence was also examined with receiver operating characteristic (ROC) curves. Results: Significantly different anatomical characteristics between elective vs ruptures were infra-renal aortic neck diameter at 5mm, 10mm and 15mm, neck length and calcification, common iliac length (CIA), pelvic artery index, left CIA and external iliac artery, total and true lumen volume. Intraluminal thrombus (ILT) volume did not differ (elective vs. ruptures; 233cc vs 245cc, p=0.76), although its form did (elective vs. ruptures; no thrombus 0% vs 20%, p=0.025; circular thrombus 63.3% vs 44%, p=0.03, respectively). After multivariate analysis, shorter left CIA (OR 1.07, CI. 1.01- 1.1, p=0.016) and smaller total aneurysm volume (OR 1.007, CI. 1.001-1.014, p=0.016) were associated with intact AAA. After a ROC curve analysis, left CIA < 50mm demonstrated lower incidence of rupture with sensitivity 60% and specificity 78%, while for total aneurysm volume of < 380cc the sensitivity and the specificity was 60% and 60%, retrospectively. Conclusion: Anatomical characteristics other than maximum diameter AAAs seem to be associated with incidence of rupture. Lower total aneurysm volume, but not ILT volume, and shorter left CIA may be associated with lower incidence of AAA rupture, even in large diameter AAA. Disclosure: Nothing to disclose

Revealing the respiratory system of the coffee berry borer (Hypothenemus hampei; Coleoptera: Curculionidae: Scolytinae) using micro-computed tomography

The coffee berry borer (Hypothenemus hampei) is the most economically important insect pest of coffee globally. Micro-computed tomography (micro-CT) was used to reconstruct the respiratory system of this species for the first time; this is the smallest insect (ca. 2 mm long) for which this has been done to date. Anatomical details of the spiracles and tracheal tubes are described, images presented, and new terms introduced. The total volume and the relationship between tracheal lumen diameter, length and volume are also presented. The total length of the tracheal tubes are seventy times the length of the entire animal. Videos and a 3D model for use with mobile devices are included as supplementary information; these could be useful for future research and for teaching insect anatomy to students and the public in general.

Fully automatic segmentation of type B aortic dissection from CTA images enabled by deep learning

PurposeThis study sought to establish a robust and fully automated Type B aortic dissection (TBAD) segmentation method by leveraging the emerging deep learning techniques. MethodsPreoperative CTA images of 276 patients with TBAD were retrospectively collected from January 2011 to December 2018. Using a reproducible manual segmentation protocol of three labels (whole aorta, true lumen (TL), and false lumen (FL)), a ground truth database (n = 276) was established and randomly divided into training and testing sets in a rough 8:1 ratio. Three convolutional neural network (CNN) models were developed on the training set (n = 246): single one-task (CNN1), single multi-task (CNN2), and serial multi-task (CNN3) models. Performance was evaluated using the Dice coefficient score (DCS) and lumen volume accuracy on the testing set (n = 30). Pearson correlation, Intra-class correlation coefficients and Bland–Altman plots were used to evaluate the inter-observer measurement agreement. ResultsCNN3 performed the best, with mean DCSs of 0.93 ± 0.01, 0.93 ± 0.01 and 0.91 ± 0.02 for the whole aorta, TL, and FL, respectively (p < 0.05). Each label volume from CNN3 showed excellent agreement with the ground truth, with mean volume differences of −31.05 (−82.76 to 20.65) ml, 4.79 (−11.04 to 20.63) ml, and 8.67(−11.40 to 28.74) ml for the whole aorta, TL, and FL, respectively. The segmentation speed of CNN3 was 0.038 ± 0.006 s/image. ConclusionDeep learning-based model provides a promising approach for accurate and efficient segmentation of TBAD and makes it possible for automated measurements of TBAD anatomical features.

P868Temporal remodeling of coronary arteries during progression of atherosclerosis with serial coronary CT angiography using 3D metrics: results from the PARADIGM study

Abstract Aim To determine compensatory enlargement and luminal reduction of coronary arteries during the progression of atherosclerosis with serial coronary computed tomography angiography (CCTA) by using volumetric measurements. To date, the impact of coronary plaque progression on temporal remodeling, as opposed to the static remodeling, has only been studied with invasive imaging modalities and primarily two-dimensional areas rather than three-dimensional volumes. Methods In total, 1,245 patients with suspected coronary artery disease (CAD) at 13 sites (61±9 years, 39% women) underwent serial CCTA with interscan interval of ≥2 years. The primary objective was to assess volumetric temporal remodeling, defined as the linear association between the change in coronary plaque, lumen and vessel volume at follow-up CCTA on a per-segment level. Temporal remodeling was determined in strata of low and high baseline plaque burden as well as different coronary segments at baseline. Linear regression analysis and Pearson's correlation coefficients were calculated to assess associations. Results Amongst 1,245 patients with 19,920 segments, the median interscan interval was 3.3 (IQR 2.6–4.8) years. For each 1 mm3 increase in plaque volume, the increase in vessel volume was 0.72 mm3 and the decrease in lumen volume was 0.28 mm3 (Figure 1, both p&lt;0.001). Volumetric temporal remodeling was similar in low versus high PAV [0.70 mm3 vs 0.73 mm3 (p for interaction=0.491)] and left-main arteries versus all other segments [0.78 mm3 vs. 0.72 mm3 (p for interaction=0.336)], but not in proximal versus distal segments at baseline [0.75 mm3 vs. 0.61 mm3 (p for interaction=0.020)]. Figure 1. Volumetric temporal remodeling Conclusion In general, coronary plaque grows approximately 70% outward and 30% into the coronary lumen during the progression of atherosclerosis. Volumetric temporal remodeling is not limited by baseline plaque burden, but is potentially dependent on its location within the coronary artery tree. Acknowledgement/Funding NRF of Korea (Grant No. 2012027176); Dalio Institute of Cardiovascular Imaging and Michael J. Wolk Foundation

P6173Plaque characteristics on coronary CT angiography in case of discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR)

Abstract Background The usefulness of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) evaluation has been confirmed in the determination of revascularization of coronary artery disease. When FFR≤0.8 and iFR≤0.89 were regarded as the criteria for positivity, the discordance was noted in approximately 20%, but this cause has not been well established. Purpose The purpose of this study was to investigate the patient background and features on coronary CT angiography (CCTA) showing the discordance between FFR≤0.8 and iFR≤0.89. Methods The subjects were consecutive 85 cases with 108 vessels in which stenosis of 30–90% was detected at one vessel of at least 2mm or more in the major epicardial vessels and FFR and iFR was performed within subsequent 90 days, among suspected cases of coronary arterial diseases which underwent CCTA. The factors showing the discordance between FFR and iFR (patient background, coronary artery calcification score, high risk plaque features on CCTA (positive remodeling, low attenuation plaque), plaque characteristics by a plaque analysis software using a new algorithm called labeling method (vessel volume, plaque volume, lumen volume, plaque length, maximum plaque burden, necrotic core area, fibrous area and calcium area) were evaluated using logistic regression analysis on per-patient and per-vessel basis. Results There were no significant both FFR and iFR positive definite factors on per-patient basis. The lumen volume/vessel volume (OR: 0.93, 95% CI: 0.88–0.98, P=0.0032) (OR: 0.90, 95% CI: 0.85–0.95, P&lt;0.0001),minimum lumen area (MLA) (OR: 0.59, 95% CI: 0.41–0.85, P=0.0006) (OR: 0.64, 95% CI: 0.44–0.92, P=0.0047), the plaque volume/vessel volume (OR: 1.05, 95% CI: 1.01–1.10, P=0.0114) (OR: 1.09, 95% CI: 1.04–1.15, P=0.0002) and maximum plaque burden (OR: 1.08, 95% CI: 1.01–1.15, P=0.0095) (OR: 1.06, 95% CI: 1.00–1.13, P=0.0406) were significant both FFR and iFR positive definite factors on per-vessels basis. Discordance between FFR≤0.8 and iFR≤0.89 was observed in 23 vessels (21.3%) of 19 patients. In FFR positive and iFR negative group (15 vessels, 13.9%), positive remodeling (PR) (OR: 4.38, 95% CI: 1.13–17.00, P=0.0294) was only significant predictor. In FFR negative and iFR positive group, there was no significant predictors. Conclusions In both FFR and iFR, only lumen volume /vessel volume, MLA, plaque volume/vessel volume and plaque burden were significant positive definite factors. As for the discordance between FFR and iFR, PR is significant predictor in FFR positive and iFR negative group.

P861A quantitative CCTA evaluation in non-obstructive coronary artery disease for the diagnosis of vessel-specific ischemia: results from the prospective, multicenter, international CREDENCE trial

Abstract Aim To improve the diagnosis of coronary vessel-specific ischemia in non-obstructive coronary artery disease (CAD) using a quantitative whole-heart coronary computed tomography angiography (CCTA) evaluation. To date, predictors of ischemia in non-obstructive CAD remain underexplored. Methods Within the CREDENCE trial, 612 patients with suspected CAD at 13 sites (64±10 years, 70% men) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography with 3-vessel fractional flow reserve (FFR) measurements. For this specific analysis, only vessels with non-obstructive plaque (1–49% maximal diameter stenosis) by CCTA were included. The primary endpoint was coronary vessel-specific ischemia which was defined as FFR ≤0.80 (or ≥90% stenosis). Multivariable logistic regression modeling was performed to evaluate the effect of quantitative CCTA features beyond coronary stenosis on the prevalence of vessel-specific ischemia. Results FFR ≤0.80 (or ≥90% stenosis) was prevalent in 22.8% of 1,102 vessels with non-obstructive plaque. Using a step-wise approach, in addition to diameter stenosis (χ2=72), non-calcified PAV (χ2=126, P&lt;0.001), lumen volume (χ2=175, P&lt;0.001) and number of lesions with &gt;30% stenosis (χ2=187, P=0.001) were independent CCTA-predictors of coronary vessel-specific ischemia (Figure 1). In the final model, diameter stenosis was no longer significantly associated with ischemia (P=0.236). Figure 1 Conclusion In vessels with non-obstructive plaque on CCTA, ischemia was present in approximately 20%. Measures of overall non-calcified plaque burden and smaller lumen volume were more important determinants of vessel-specific ischemia than maximal diameter stenosis. Acknowledgement/Funding NIH R01-HLL118019; Dalio Foundation and Michael J. Wolk Foundation

P6181The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve

Abstract Background A low coronary lumen volume to left ventricle mass ratio (V/M) derived from coronary computed tomography angiography (CCTA) has been proposed as a factor contributing to impaired myocardial blood flow (MBF) even in the absence of obstructive coronary artery disease (CAD). Objective To elucidate the association of V/M with non-invasively obtained MBF parameters by means of [15O]H2O positron emission tomography (PET), as well as its correlations with invasively measured fractional flow reserve (FFR), overall and specifically in vessel with non-obstructive CAD. Methods This is a substudy of the PACIFIC trial, in which 208 patients underwent CCTA, and [15O]H2O PET prior to invasive coronary angiography (ICA) in conjunction with 3 vessel FFR measurements. Patient specific V/M was calculated for 152 patients. Matched vessel specific hyperemic MBF (hMBF), coronary flow reserve (CFR), FFR, and patient specific V/M were available for 431 vessels. The median V/M (20.71 mm3/g) was used to divide the study population into a group with a low V/M (&lt;20.71 mm3/g) and a high V/M (≥20.71 mm3/g). Non-obstructive CAD was defined as a ≤50% stenosis grade on ICA. Results Overall, a higher percentage of vessels with an abnormal hMBF (34% vs. 19%, p=0.009), lower FFR values (0.93 [interquartile range: 0.85–0.97] vs. 0.95 [0.89–0.98], p=0.016), and a higher number of positive FFR values (20% vs. 9%, p=0.004) were observed among vessels in the low V/M group. Furthermore, a weak correlation between V/M, global hMBF (R=0.179, p=0.027), and global CFR (R=0.163, p=0.045) as well as a weak significant association with vessel specific hMBF (p=0.027), and FFR (p&lt;0.001) was observed (figure 1). V/M was not independently predictive of vessels specific MBF parameters or FFR. Among vessels with non-obstructive CAD (361 vessels), an abnormal hMBF tended to be more frequently observed in vessels with a low patient specific V/M (21% vs. 13%, p=0.056). Globally, there was no correlation between V/M and hMBF nor CFR. Patient specific V/M tended to be weakly associated with vessel specific hMBF (p=0.083) and was associated with FFR (p=0.027) (figure 1). Lastly, patient specific V/M tended to be independently predictive of FFR in this specific group. Conclusion Overall, vessels with an abnormal hMBF, and positive FFR measurements were more frequently observed in patients with a low V/M compared to those with a high V/M. Furthermore, V/M weakly correlated with global hMBF as well as with CFR and was associated with vessel specific hMBF and FFR. However, there was no correlation between V/M and global nor vessel specific blood flow parameters in the absence of obstructive CAD, notwithstanding a weak association of V/M with FFR within this group was noted.

Expanded Petticoat technique to promote the reduction of contrasted false lumen volume in patients with chronic type B aortic dissection

ObjectiveThis study examined the outcomes of our novel concept of expanded provisional extension to induce complete attachment strategy (Petticoat) for safety, durability, and remodeling of chronic type B dissections. MethodsTwenty patients with chronic type B aortic dissection with aneurysmal degeneration qualified for an expanded Petticoat strategy (stent graft in the thoracic, plus additional distal bare stent into the abdominal and infrarenal aorta, followed by parallel stent grafts into common iliac arteries). Computed tomography was performed preoperatively and at 1, 6, and 12 months after surgery. ResultsThe primary technical success was 100%. The 30-day mortality rate was 0%. At 12 months, favorable aortic remodeling and complete false lumen (FL) thrombosis were noted as 100% in the thoracic and infrarenal aorta. The volume of contrast-enhanced FL decreased from 186 ± 75.4 mL all along the dissection preoperatively (range, 70-360 mL), to 6.32 ± 5.4 mL postoperatively (range, 0.0-19.6 mL) and was only observed in the visceral aorta (P = .000089). Despite persistent flow in a small area of the FL, the maximal aortic size was stable in follow-up. Neither paraplegia nor visceral branch occlusion were noted in the follow-up. ConclusionsThe treatment of aortic dissections with an expanded Petticoat strategy seems to be safe and offers good early results. It significantly reduced the volume of contrast enhanced FL. Further investigation of any subsequent results will be necessary.

Type 2 diabetes mellitus is associated with increased left ventricular mass independent of coronary artery volume

To determine the relationship of left ventricular mass (LVM) and coronary artery volume in diabetic patients and the controls. This work included 448 consecutive patients (206 patients with diabetes and 242 non-diabetic participants) who underwent coronary computed tomography angiography (CTA) for evaluation of coronary artery disease (CAD). The whole coronary artery tree and the LVM were analysed using a cardiac imaging workstation. Multivariable logistic regression analysis was used to determine the independent association with coronary artery lumen volume to LVM ratio (V/M). The total coronary artery cumulative volume and the coronary cumulative length showed no differences between groups (p>0.05); however, the LVM in patients with diabetes was significantly greater than that in controls (132.46±45.04 versus 115.82±29.13, p=0.006), and the total epicardial coronary arterial lumen volume to LVM ratio (V/M) was significantly lower in the diabetic group than in the non-diabetic group (2.02 cm3/100±0.73 g versus 2.31 cm3/100±0.82 g, p=0.024). In multivariate logistic regression analysis, diabetes was associated with V/M (odds ratio [OR] 2.027, 95% confidence interval [CI]: 1.462-2.728, p=0.001), and hypertension was not associated with V/M (OR 1.191, 95% CI: 0.978-1.451, p=0.081). Patients with diabetes demonstrated a significantly lower coronary CTA-derived coronary V/M than controls. V/M may have an important role as a global measure of coronary vasculature in diabetic patients.

The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve

BackgroundA diminished coronary lumen volume to left ventricle mass ratio (V/M) derived from coronary computed tomography angiography (CCTA) has been proposed as factor contributing to impaired myocardial blood flow (MBF) even in the absence of obstructive disease on invasive coronary angiography (ICA). MethodsPatients underwent CCTA, and positron emission tomography (PET) prior to ICA. Matched global V/M, global, and vessel specific hyperaemic MBF (hMBF), coronary flow reserve (CFR), and, FFR were available for 431 vessels in 152 patients. The median V/M (20.71 mm3/g) was used to divide the population into patients with either a low V/M or a high V/M. ResultsOverall, a higher percentage of vessels with an abnormal hMBF and FFR (34% vs. 19%, p = 0.009 and 20% vs. 9%, p = 0.004), as well as a lower FFR (0.93 [interquartile range: 0.85–0.97] vs. 0.95 [0.89–0.98], p = 0.016) values were observed in the low V/M group. V/M was weakly associated with vessel specific hMBF (R = 0.148, p = 0.027), and FFR (R = 0.156, p < 0.001). Among vessels with non-obstructive CAD on ICA (361 vessels), no association between V/M and vessel specific hMBF nor CFR was noted. However, in the absence of obstructive CAD, V/M was associated with (R = 0.081, p = 0.027), and independently predictive for FFR (p = 0.047). ConclusionOverall, an abnormal vessel specific hMBF and FFR were more prevalent in patients with a low V/M compared to those with a high V/M. Furthermore, V/M was weakly associated with vessel specific hMBF and FFR. In the absence of obstructive CAD on ICA, V/M was weakly associated with notwithstanding independently predictive for FFR.

Inhibition of miR-17-5p promotes mesenchymal stem cells to repair spinal cord injury.

The aim of this study was to explore the role of microRNA-17-5p (miR-17-5p) in the pathogenesis of spinal cord injury repair by mesenchymal stem cells (MSCs), and to investigate the possible underlying mechanism. MiR-17-5p mimics and negative controls were transfected into MSCs. Dual-luciferase reporter gene assay was used to verify the functional binding between miR-17-5p and its target mRNA. After overexpression or knockdown of miR-17-5p, the expression level of target genes in MSC cells was analyzed by Real-time quantitative polymerase chain reaction (qRT-PCR) and Western blot. The proliferation ability of cells was detected by cell counting kit-8 (CCK-8) assay. The effect of miR-17-5p and VEGF-A on angiogenesis was assessed by HUVEC assay. T8 spinal cord injury model was constructed in nude mice. All mice were divided into the negative control group, the SCI group, the miR-17-5p-NC group, the miR-17-5p-inhibitor group, and the miR-17-5p-inhibitor + sh-VEGF-A group. After injection of different treated MSCs at the lesion site, the proportion of intact tissue as well as reduced lumen volume was measured at 28 d. Meanwhile, the motor function of hind limbs was scored based on the Basso Beattie Bresnahan (BBB) standard scale at 7 d, 14 d, 21 d, and 28 d after transplantation, respectively. A binding site of miR-17-5p was found on the mRNA of VEGF-A. The protein expression of VEGF-A was strikingly altered after overexpression or knockdown of miR-17-5p. Knocking down miR-17-5p expression significantly increased the protein level of VEGF-A and GDNF. Meanwhile, miR-17-5p down-regulation significantly enhanced the viability and the angiogenic ability of MSCs. However, simultaneous knockdown of miR-17-5p and VEGF-A showed the opposite results. After spinal cord injury, the proportion of intact spinal cord tissues in mice was significantly reduced, whereas reduced lumen volume was remarkably increased. After injection of MSCs alone, the proportion of intact tissues was significantly increased. After knocking down miR-17-5p, the proportion was further increased. However, no significant effect was found on the amount of intact tissues after knocking out VEGF-A. Moreover, the reduction in cavity volume appeared to present an opposite trend comparable to the proportion of intact tissues. The BBB scores were significantly decreased in the mice model, while remarkably increased after MSC transplantation. Furthermore, the BBB score was the highest in the miR-17-5p knockout group, while VEGF-A knockout had little effect on it. In addition, no significant difference was found in the mRNA expression GFP in the spinal cord of mice in different groups after MSCs treatment. Inhibition of miR-17-5p up-regulates the expression of VEGF-A and GDNF in MSCs, and promotes the repair of spinal cord injury by MSCs.

Reproducibility of simultaneous imaging of intracranial and extracranial arterial vessel walls using an improved T1-weighted DANTE-SPACE sequence on a 3 T MR system

PurposeTo systematically investigate the scan-rescan, intra-observer, and inter-observer reproducibility of an improved DANTE-SPACE sequence for the simultaneous assessment of intra- and extracranial arterial vessel wall morphology. Materials and methodsThirty-five healthy volunteers and 10 patients with atherosclerotic plaque formation were each scanned twice using a T1-weighted DANTE-SPACE sequence on a 3 T MR system equipped with a 32-channel combined head and neck coil. Reproducibility analyses were performed for measurements of lumen and vessel wall volume, mean and maximum wall thickness, as well as for the normalized wall index. Intracranial and extracranial arterial segments were compared. ResultsIntra-class correlation coefficients (ICC) and Bland-Altman plots indicated good to excellent reproducibility for all morphologic measurements (all ICCs >0.77). In addition, the range of ICCs of extracranial arteries (0.80–0.99) was significant higher than that of intracranial arteries (0.77–0.98, P = 0.003). The range of ICCs of patients (0.79–0.99) was generally higher than that of volunteers (0.77–0.99, P = 0.47), especially for extracranial arteries. ConclusionsThe improved T1-weighted DANTE-SPACE sequence is a reproducible method for the simultaneous assessment of intra- and extracranial vessel wall using a single MR scan. This method could potentially be used for assessing responses to therapy and for monitoring disease progression.

Endurance exercise training does not limit coronary atherosclerosis in familial hypercholesterolemic swine

Prospective, cohort studies in humans demonstrate that moderate to high levels of physical activity reduce both morbidity and mortality of coronary heart disease (CHD) including a decreased progression and/or regression of CHD with life‐style modification which includes exercise. However, a thorough review of both human and animal literature reveals equivocal evidence to support an intrinsic, direct exercise effect in attenuating the development of CHD. Exercise reduces development and/or causes regression of atherosclerotic lesions in mice and rabbits, however in larger mammals including primates, the evidence is more equivocal. A major limitation has been the lack of large animal models with clinically evident CHD disease. Thus, we sought to determine the effect of endurance exercise in CHD development and compensatory remodeling in a swine model of familial hypercholesterolemia (FH) that exhibits robust, complex atherosclerosis. Castrated male Rapacz familial hypercholesterolemic (FH) swine were obtained from the University of Wisconsin Swine Research and Teaching Center. Pigs were randomly assigned to either sedentary (Sed; n=9) or exercise trained (Ex; n=8) groups. At 10 months of age, Ex pigs began a 10 month treadmill‐training intervention consisting of moderate‐intensity (70% of maximal heart rate) once per day, for 5 days each week. At 14 months, all pigs were switched to a high‐fat, high‐cholesterol diet (HF; by weight 13% protein, 21.3% fat, 41.4% carbohydrate, 2% cholesterol and 1% sodium cholate). CHD was assessed by intravascular ultrasound (IVUS) both prior to (14 months of age) and after completion of 6 months on the HF diet (20 months of age). Angiograms and IVUS were obtained using standard coronary catheterization techniques. IVUS pullbacks (0.5 mm/sec; Galaxy II, Boston Scientific, 40MHz) were obtained for the proximal anterior descending (LAD) and left circumflex (LCX) arteries. For analysis, the total segment was subdivided into 3 sections and total vessel volume, lumen volume, total plaque burden volume and percent plaque burden were determined in the proximal, mid, and distal segments from 3D reconstruction (QIVUS software; Medis). Prior to HF diet, Ex resulted in a greater coronary artery size (vessel and lumen volume) in the proximal and mid sections of the LCX compared to SED, with no effect in the LAD. Relative plaque volume was minimal (~15–20% vessel area) in both Sed and Ex groups. After 6 months on HF diet, there was a 5–6 fold increase in absolute plaque volume in all segments of the LCX and LAD in both groups. Ex had no effect on absolute plaque volume at 20 months in any segment of either LCX or LAD. In both Sed and Ex groups, vessel volume was greater at 20 months compared to 14 months such that lumen volume was maintained despite the increase in plaque volume, i.e. compensatory outward remodeling was similar in both groups. Overall at 20 months, there was no significant difference in vessel volume, lumen volume, absolute or relative plaque volume in either the LCX or LAD between Sed and Ex animals. These findings fail to support an independent, direct effect of exercise in limiting CHD progression in familial hypercholesterolemia.Support or Funding InformationNIH HL52490This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

RELATIONSHIP OF CORONARY ATHEROSCLEROSIS, CORONARY LUMEN, AND CORONARY ISCHEMIA: RESULTS FROM THE PROSPECTIVE, MULTICENTER, INTERNATIONAL CREDENCE TRIAL

To explore the relationship between coronary atherosclerotic plaque volume, coronary lumen volume and coronary ischemia by coronary CT angiography (CCTA). 612 patients with suspected coronary artery disease at 17 sites (64 ± 10 years, 30% women) underwent CCTA, invasive coronary angiography and 3-

IMPROVED DIAGNOSIS OF VESSEL-SPECIFIC ISCHEMIA BY STEPWISE CONSIDERATION OF STENOSIS SEVERITY, NON-CALCIFIED PLAQUE VOLUME, AND CORONARY LUMEN VOLUME: RESULTS FROM THE PROSPECTIVE, MULTICENTER, INTERNATIONAL CREDENCE TRIAL

Stenosis severity alone is unreliable to identify ischemia, but atherosclerotic plaque characteristics can improve accuracy. We thus evaluated a stepwise approach of coronary stenosis severity, non-calcified atheroma volume (NCAV) and coronary lumen volume (CLV) for diagnosis of vessel-specific

An implicit discontinuous Galerkin method for modeling acute edema and resuscitation in the small intestine.

Edema, also termed oedema, is a generalized medical condition associated with an abnormal aggregation of fluid in a tissue matrix. In the intestine, excessive edema can lead to serious health complications associated with reduced motility. A $7.5\%$ solution of hypertonic saline (HS) has been hypothesized as an effective means to reduce the effects of edema following surgery or injury. However, detailed clinical edema experiments can be difficult to implement, or costly, in practice. In this manuscript we introduce an implicit in time discontinuous Galerkin method with novel adaptations for modeling edema in the 3D layered physiology of the intestine. The model improves over early work via inclusion of the tissue intrinsic storage coefficient, and the effects of Starling overestimation for high venous pressures. Validation against a recent clinical experiment in HS resuscitation of acute edema is presented; the results support the clinical hypothesis that 7.5% HS solution may be effective in the resuscitation of acute edema formation. New results include an improved view into the effects of resuscitation on the hydrostatic pressure profile of edematous rats, effects on lumenal volume attenuation, relative fluid gain and an estimation of the impacts of both acute edema and resuscitation on intestinal motility.