Plaque Characteristics Research Articles

The relationship between atherogenic index of plasma and plaque vulnerabilities: an optical coherence tomography study

BackgroundAtherogenic index of plasma (AIP) has been recommended as a marker of plasma atherogenicity. The impact of AIP on plaque characteristics is not fully understood.PurposeThe study investigates the relationship between AIP and coronary plaque features in patients with acute coronary syndrome (ACS).MethodsFrom January 2016 to June 2017 pre-intervention optical coherence tomography (OCT) was performed in 522 ACS patients. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Patients were divided into four groups according to AIP quartiles.ResultsA total of 332 patients were included for the analysis. The prevalence of thin-cap fibroatheroma (TCFA) (group I [lowest] 9.09% vs group II 16.5% vs group III 44.7% vs group IV [highest] 52.9%), macrophage accumulation (group I 18.2% vs group II 22.4% vs group III 31.8% vs group IV 47.1%), plaque rupture (group I 10.4% vs group II 14.1% vs group III 17.6% vs group IV 34.1%) and plaque erosion (group I 2.6% vs group II 2.4% vs group III 14.1% vs group IV 12.9%) were significantly different among AIP quartiles. Multivariate logistic regression revealed the risk of TCFA (odds ratio 11.130, 95% confidence interval 4.186–29.593, p < 0.001) and plaque rupture (OR 5.332, 95% CI 2.040–13.937, p < 0.001) increased in group IV compared to group I. Receiver operating characteristics curve showed the predictive value of AIP for TCFA and plaque rupture were 0.720 and 0.669 respectively.Conclusion(s)AIP is an independent predictor for vulnerable plaques beyond traditional factors. It can be integrated in clinical practice for risk stratification of ACS patients.Trial registrationAll patients gave their consent to participate in the study and the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University approved it (2020047X).

Evaluating the influence of morphological features on the vulnerability of lipid-Rich plaques during stenting.

Lipid-rich atheromas are linked to plaque rupture in stented atherosclerotic arteries. While fibrous cap thickness is acknowledged as a critical indicator of vulnerability, it is likely that other morphological features also exert influence. However, detailed quantifications of their contributions and intertwined effects in stenting are lacking. Therefore, our goal is to assess the impact of plaque characteristics on the fibrous cap stress and elucidate their underlying mechanisms. We analyzed the stent deployment over a 3D patient-specific coronary artery reconstructed from intravascular optical coherence tomography (IVOCT) through finite element methods. Additionally, we performed sensitivity analysis on 78,000 distinct plaque geometries of two-dimensional arteries for verification. Results from the 3D patient-specific model indicate strong correlations between maximum fibrous cap stress and lipid arc (r=0.769), area stenosis (r=0.550), and lumen curvature (r=0.642). Plaques with lipid arcs > 60°, area stenosis > 75%, and lumen curvatures > 5 mm-1 are at increased rupture risk. While we observed a rise in stress with lipid core thickness, it was less representative than other features. Fibrous cap thickness showed a poor correlation, with the sensitivity analysis revealing its significance only when high stretches are induced by other features, likely due to its J-shaped stress-stretch response. Contrary to physiological pressure, the stent expansion generates unique vulnerable features as the stent load-transferring characteristics modify the plaque?s response. This study is expected to prompt further clinical investigations of other morphological features for predicting plaque rupture in stenting.

Simulating atherosclerotic plaque mechanics using polyvinyl alcohol (PVA) cryogel artery phantoms, ultrasound imaging and inverse finite element analysis.

The aim of this study is to demonstrate the potential of polyvinyl alcohol phantoms to simulate atherosclerotic features. In addition, a testing and simulation framework is developed for full PVA vessel material characterization using ring tensile testing and inflation testing combined with non-invasive ultrasound imaging and computational modelling. Strain stiffening behavior was observed in PVA through ring tensile tests, particularly at high (n=6) freeze-thaw cycles. Inflation testing of bi-layered phantoms featuring lipid pool inclusions demonstrated high strains at shoulder regions. The application of an inverse finite element framework successfully recovered boundaries and determined the shear moduli for the PVA wall to lie within the range 27 kPa to 53 kPa. The imaging-modelling framework presented facilitates the use and characterization of arterial mimicking phantoms to further explore plaque rupture. It also shows translational potential for non-invasive mechanical characterization of atherosclerotic plaques to improve the identification of clinically relevant metrics of plaque vulnerability.

Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial

BACKGROUND: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography. METHODS: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test. Among those with preserved renal function who underwent coronary computed tomography angiography, we examined relationships between ischemia and CAD by coronary computed tomography angiography, overall, and by stress test modality, regardless of subsequent randomization. Core laboratories categorized ischemia as severe, moderate, mild, or none, while the extent and severity of anatomic CAD were categorized based on the modified Duke prognostic index. RESULTS: Among 3601 participants with interpretable stress tests and coronary computed tomography angiography, ischemia severity was weakly associated with CAD extent/severity (r=0.27), with modest variability in strength of association by modality: nuclear (n=1532; r=0.40), echocardiography (n=827; r=0.15), cardiac magnetic resonance imaging (n=108; r=0.31), and exercise tolerance test (n=1134; r=0.18). The extent of infarction on nuclear imaging and echocardiography was weakly associated with CAD extent/severity. CONCLUSIONS: Overall, ischemia severity on stress testing showed weak to moderate associations with the anatomic extent of CAD in this cohort with moderate or severe ischemia on local interpretation and controlled symptoms. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01471522.

Association between perforator stroke after middle cerebral artery elective stenting and arterial remodeling patterns: a high-resolution MRI-based retrospective cohort study.

Patterns of arterial remodeling may be associated with outcomes in patients with severe middle cerebral artery (MCA) stenosis after endovascular treatment (EVT). This study aims to investigate the potential correlation between arterial remodeling patterns in patients with severe MCA stenosis, and plaque characteristics and procedure-related perforator stroke (PS). Consecutive patients with MCA atherosclerotic disease who underwent EVT at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2023 were retrospectively enrolled in this study. The clinical and surgical data of the patients were evaluated. Remodeling index values >1.05, 0.95-1.05, and <0.95 indicated positive remodeling (PR), intermediate remodeling (IR), and negative remodeling (NR), respectively. Based on the remodeling index values calculated by high-resolution magnetic resonance imaging (HR-MRI), the arterial remodeling patterns were classified as NR or non-NR; non-NR was defined as both PR and IR. The primary endpoint was procedure-related PS. Plaque characteristics included the plaque area, plaque burden, contrast-enhancement ratio, and plaque distribution. Plaque features and the incidence of procedure-related PS were compared between the NR and non-NR groups. Differences in the categorical variables between the patients with NR and non-NR were assessed using the Chi-square test (χ2) or Fisher's exact test. Differences in the continuous variables between the two groups were assessed using the Student t-test or Mann-Whitney U-test. A total of 65 patients (mean age: 57.6 years) were enrolled in the study. Of the patients, 45 (69.2%) showed NR and 20 (30.8%) showed non-NR. The primary endpoint of procedure-related PS occurred in 3 patients (3/65, 4.6%). On HR-MRI, the entire cohort had a mean plaque area of 10.0 mm2, a mean plaque burden of 92.0 %, and a mean enhancement ratio of 1.3. Compared to the non-NR group, the NR group had a smaller plaque area (9.2 vs. 11.6 mm2, P=0.001). The probability of the primary end point was 15.0% in the non-NR group and 0.0% in the NR group (P=0.026). PS after MCA elective stenting may be related to non-NR based on HR-MRI. Further prospective and multicenter studies need to be conducted to confirm these findings.

Application of computed tomography angiography imaging in coronary heart disease screening and analysis of associated risk factors.

Coronary heart disease (CHD) remains a leading cause of morbidity and mortality worldwide. Early detection and risk stratification are crucial for effective management. This study evaluates the efficacy of coronary computed tomography angiography (CTA) in CHD screening and analyses its correlation with traditional risk factors in an asymptomatic population. This study focused on 1,000 patients aged 40-80 years who visited two comprehensive tertiary hospitals in the region between January 2020 and December 2022. Patients with a history of coronary revascularisation, arrhythmia or poor image quality were excluded. CTA was used to assess the coronary artery calcium score (CACS), stenosis severity, plaque characteristics and myocardial perfusion and function. These parameters were analysed alongside traditional risk factors (e.g., age, sex, body mass index, blood pressure, glucose and lipid levels, smoking status and family history) using logistic regression to determine their correlation with CHD. This study found a significant correlation between the CACS and CHD severity. CTA results showed that 41.2% of patients had normal results, 28.8% had mild CHD, 20.0% had moderate CHD and 10.0% had severe CHD. Traditional risk factors were independently associated with CHD. Myocardial perfusion and function parameters also correlated significantly with CTA findings, declining progressively with increasing CHD severity. CTA provides a comprehensive assessment of CHD, correlating significantly with traditional risk factors and myocardial functional parameters. Its use in screening could facilitate the early detection and tailored management of CHD in asymptomatic individuals. Further research is warranted to establish its predictive value for long-term cardiovascular outcomes.

Comparison of stable carotid plaques in patients with mild-to-moderate carotid stenosis with vulnerable plaques in patients with significant carotid stenosis.

To compare the characteristics of stable and vulnerable carotid plaques, and investigate the diagnostic performance of wall shear stress (WSS) based on magnetic resonance plaque imaging in carotid plaques. Retrospectively analyzed and divided 64 atherosclerotic plaques into stable carotid plaque groups with mild-to-moderate stenosis and vulnerable carotid plaque groups with significant stenosis. Computational fluid dynamics simulations were performed to calculate WSS parameters by using three-dimensional wall geometry based on high-resolution magnetic resonance plaque imaging of carotid bifurcation and patient specific boundary conditions obtained through color Doppler ultrasound. WSS parameters including upstream (WSSup), downstream (WSSdown), and core (WSScore) of plaque. The WSS parameters values were compared between the stable and vulnerable carotid plaque groups. Receiver operating characteristic curves and area under the curve (ROC-AUC) and Python were used to evaluate discriminative efficacy of WSS. WSSdown exhibited significant decrease in the vulnerable carotid plaque group (2.88 ± 0.41 Pa) compared to the stable carotid plaque group (4.47 ± 0.84 Pa) (P = .003). The difference of WSSup (3.28 ± 0.85 Pa vs 4.02 ± 0.74 Pa) and WSScore (1.12 ± 0.18 Pa vs 1.38 ± 0.38 Pa) between the two groups were also pronounced (P = .02, 0.01, respectively). The ROC-AUC values for WSSup, WSSdown, WSScore were 0.75 (95% CI, 0.58-0.93), 0.96 (95% CI, 0.79-1.14), 0.69 (95% CI, 0.56-0.83) respectively. When the value of WSSdown was 3.5 Pa, the sensitivity was 93.7% (95% CI, 76.1-111), specificity and accuracy was 87.5% (95% CI, 70.0-105), 88.4% (95% CI, 70.6-105) respectively. Notably, among these parameters, WSSdown demonstrated the highest discriminative efficiency with a F1 Score of 0.90, Diagnostic Odds Ratio of 105.0 and Matthews Correlation Coefficient of 0.81. Vulnerable carotid plaques with significant stenosis have lower WSS compared to stable plaques with mild-to-moderate stenosis, and downstream WSS showing the highest diagnostic efficacy.

Prevalence of ipsilateral “vulnerable carotid plaques with

BackgroundCarotid plaques may be an important etiology in ischemic stroke. We aimed to assess carotid plaque characteristics ipsilateral and contralateral to the ischemic stroke and assessed the prevalence of “vulnerable carotid plaques with <50% stenosis” based on different imaging-based definitions in patients with large vessel occlusion and source of embolic stroke of undetermined source (ESUS) on CT Angiography (CTA). MethodsData are from the ESCAPE-NA1 trial (Efficacy and safety of nerinetide for the treatment of acute ischemic stroke), a multicenter, randomized study that included anterior circulation large vessel occlusion patients undergoing thrombectomy. Various CTA features of plaque vulnerability were combined to define “vulnerable carotid plaques” in different ways. Within ESUS patients, prevalence of vulnerable plaques ipsilateral vs. contralateral to the intracranial occlusion was compared. ResultsWe analyzed 132 patients whose ischemic stroke mechanism was determined to be ESUS. Plaques causing 30–50 % stenosis (as compared to no stenosis) and plaque surface irregularity were significantly more common in ipsilateral carotid arteries (37[28.0 %] vs. 18[13.6 %]; p < 0.001 and 102[77.3 %] vs. 78[59.1 %]; p = 0.002). The prevalence of ipsilateral “vulnerable carotid plaques” varied depending on imaging definition used for such plaques between 55 and 74 %, but irrespective of the definition used, the prevalence of “vulnerable carotid plaques” was consistently higher in ipsilateral carotid arteries compared to contralateral carotid arteries. ConclusionsIn ESUS patients undergoing thrombectomy for anterior circulation large vessel occlusion, vulnerable carotid plaques are more prevalent ipsilateral to the intracranial occlusion. Irregular plaque surface, and a higher degree of stenosis were the most common vulnerable plaque features.

Plaque characterization and individualized risk assessment

Risk assessment and accurate plaque characterization are key to individual prognosis in coronary artery disease (CAD). The standard of care is cardiac computed tomography (CT), including calcium scoring and coronary CT angiography (CCTA). Diagnosis is based on the CAD-RADS (Coronary Artery Disease-Reporting and Data System) classification. New developments include CT-based fractional flow reserve (CT-FFR) and plaque quantification ("virtual histology"). Acalcium score of0 indicates an event risk of less than 1% over 10years [7, 17]. CAD-RADS classes1 to5 allow risk assessment compared to patients without coronary plaques [2]. CT-FFR has high accuracy (area under the curve [AUC] 0.90; 95% confidence interval 0.87-0.94) in assessing the hemodynamic significance of stenoses compared with invasive coronary angiography [25]. Plaque quantification has shown that anecrotic core greater than 4% is associated with an almost fivefold increase in 5‑year event risk [29]. The presence of obstructive CAD (stenosis > 50%) is astrong prognostic factor. The evaluation of the hemodynamic relevance of 40-90% stenoses by CT-FFR or other functional tests is already guideline-compliant in the USA, but not yet in Germany. Quantitative approaches to measure plaque volume and composition are gaining importance in research and are expected to become relevant in clinical practice. The CAD-RADS 2.0 classification, which also provides therapy recommendations, should be used to assess the extent of CAD.

Abstract 4137243: Dynamic changes of pericoronary fat attenuation index predicting changes of coronary plaque burden

Background: Percent atheroma volume (PAV) is a validated index of coronary plaque burden, linking to adverse cardiac events. Meanwhile, pericoronary fat attenuation index (FAI) on coronary computed tomography angiography (CCTA) image is a novel prognostic marker of coronary inflammation. Research Questions: It is unknown the impact of coronary inflammation (i.e., FAI) on the progression of coronary PAV in patients at an increased risk of adverse cardiac events. Methods: Patients with type 2 diabetes mellitus (T2DM) who underwent at least two clinically indicated CCTA examinations (time interval &gt; 1 year) at our center were potentially eligible for enrollment. Eligible patients presented with more than one study plaque, defined as non-obstructive stenosis at baseline and not being intervened during serial CCTA. Longitudinal CCTA images were assessed for FAI and compositional plaque characteristics (e.g., PAV) using dedicated post-processing softwares. The relationships between changes in FAI and progression of compositional PAV were examined using the logistic and linear regression analysis. Results: A total of 204 T2DM patients (mean age, 61.2 ± 9.3 years; male, 68.1%) with 366 study plaques were enrolled. All patients were treated with statins, and their time interval between longitudinal CCTAs was 14.1 (12.9, 17.6) months. Compared with patients with improved coronary inflammation (ΔFAI ≤ 0), those with deteriorated coronary inflammation (ΔFAI &gt; 0) had lower high density lipoprotein cholesterol and baseline FAI, whereas higher blood pressure (all p &lt; 0.05). Meanwhile, compared to patients with ΔFAI ≤ 0, those with ΔFAI &gt; 0 had more Δoverall and Δnon-calcified PAV (all p &lt; 0.05). Importantly, these findings were consistent in a dedicated propensity score matching analysis. In logistic regression analysis, ΔFAI &gt; 0 was associated with annual progression of overall PAV and non-calcified PAV, whereas ΔFAI ≤ 0 associated with annual regression of overall PAV and non-calcified PAV after adjusting for cardiac risk factors, baseline PAV and medications (all p &lt; 0.05). Similarly, in linear regression analysis, changes of FAI were independently positively associated with annual changes of overall PAV (β=0.545, p&lt; 0.001) and non-calcified PAV (β=0.461, p&lt; 0.001) (Figure 1). Conclusion: In this longitudinal CCTA study, changes of coronary inflammation are closely correlated with changes of overall and non-calcified PAV among T2DM patients treated with statins.

Abstract 4137782: Fibrinogen-to-Albumin Ratio Does Not Correlate with Comprehensively Assessed Coronary Artery Disease Severity or High-Risk Plaque Features on Coronary Computed Tomographic Angiography

Background: Fibrinogen-to-albumin ratio (FAR) has been proposed as a readily available inflammatory biomarker associated with coronary artery disease (CAD). However, its association with CAD severity and prognosis has predominantly been assessed in patients with acute coronary syndromes (ACS). The Leiden score is a validated comprehensive measure of CAD incorporating stenosis proximity, severity, and plaque type that independently predicts cardiovascular events. Whether FAR is associated with Leiden score or high-risk plaque features on coronary computed tomographic angiography (CCTA) in stable outpatients is unknown. Methods: Adult outpatients undergoing clinically indicated CCTA were enrolled (5/2021-9/2023) in a prospective study assessing the relationship of plaque to immune markers and provided same-day pre-scan peripheral venous blood samples. CCTAs were post-processed and analyzed by the consensus of two expert readers blinded to clinical data using a 17-segment model to determine coronary artery calcium (CAC), Leiden score, and high-risk plaque features. Patients were grouped by FAR (quartiles), Leiden score (&lt;5, 5-20, &gt;20), and CAC score (0, &gt;0-100, &gt;100-300, &gt;300-1000, &gt;1000). Numerical variables were compared via Wilcoxon and Kruskal-Willis tests. Spearman correlation was calculated between FAR and Leiden score. Results: Of 284 patients, 53.8% were male, 86.7% were white, and 58.8% were on a statin (Table 1). Median FAR was 70.3 mg/g, 64.0% had a non-zero CAC score, and 25.0% had at least one segment with one high-risk plaque feature. Across quartiles of FAR, there was no difference in Leiden score (5.8 (IQR: 0.0-18.5), 12.4 (3.1-20.7), 8.0 (0.0-19.9), 6.8 (0.0-21.1), p=0.50) or probability of having at least one segment with at least one (29.6%, 23.9%, 23.9%, 22.5%, p=0.69) or two (18.3%, 14.1%, 12.7%, 15.5%, p=0.66) high-risk plaque features. There was no correlation between FAR and Leiden score (R=0.03, p=0.66). There was no difference in FAR when stratified by Leiden score (Table 1, p=0.53), CAC score (Table 2, p=0.50), or number of segments with at least one high-risk plaque feature (Table 3, p=0.18). Conclusion: In a prospective cohort of adult outpatients across a wide spectrum of CAD burden with high rates of baseline statin use, FAR was not associated with CAD or presence of high-risk plaque features on CCTA. Further evaluation of its role as an inflammatory biomarker in larger populations, particularly patients without ACS, is required.

High-risk features in non-culprit lesions and clinical outcome after NSTEMI versus STEMI.

Complete non-culprit (NC) revascularization may help reduce recurrent events after NSTEMI, especially if NC lesions would harbor high-risk plaque features similar to STEMI. The study aimed to assess differences in fractional flow reserve (FFR)-negative NC plaque morphology in patients presenting with NSTEMI versus STEMI and assess the association of high-risk plaque morphology and clinical outcome. In the prospective PECTUS-obs study, 438 patients presenting with myocardial infarction (MI) underwent optical coherence tomography (OCT) of all FFR-negative intermediate NC lesions. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE, all-cause mortality, non-fatal MI or unplanned revascularization) at two-year follow-up. Four hundred and twenty patients had at least one analyzable OCT, including 203 (48.3%) with NSTEMI and 217 (51.7%) with STEMI. The prevalence of high-risk plaques (HRP), including thin-cap fibroatheromas (TCFA), plaque rupture and thrombus, was comparable between groups. MACE occurred in 29 (14.3%) NSTEMI patients and 16 (7.4%) STEMI patients (Punivariable=0.025 and Pmultivariable=0.270). Incidence of MACE was numerically higher among patients with HRP, irrespective of the clinical presentation at index (Pinteraction=0.684). Among high-risk plaque criteria, plaque rupture was associated with MACE in both NSTEMI (p<0.001) and STEMI (p=0.020). Presence of NC HRP is comparable between NSTEMI and STEMI and leads to numerically higher event rates in both. These results call for additional research on complete revascularization in NSTEMI and treatment of HRP.

Patient-Level Pericoronary Adipose Tissue Mean Attenuation: Associations with Plaque Characteristics.

Pericoronary adipose tissue attenuation (PCATa), observed from coronary computed tomography angiography (CCTA), is emerging as an inflammation marker. This study evaluated the relationship between PCATa and plaque characteristics, including plaque type, burden, and coronary calcification. An observational study was conducted on 466 patients with suspected chronic coronary syndrome who underwent clinically indicated CCTA. PCATa was measured along the proximal 40 mm of the coronary arteries and averaged to represent the patient's level. Plaque type was assessed, compositional plaque volumes were measured, and plaque burdens were quantified. The coronary calcification scores (CCSs) were categorized into groups. Statistical methods included t-tests, ANOVA, and multivariate regression analysis. PCATa differed significantly between calcified (-81.7 Hounsfield units (HU)) and soft (-77.5 HU) plaques. PCATa was positively associated with total plaque burden (β = 3.6) and non-calcified plaque burden (β = 7.0), but negatively correlated with calcified plaque burden (β = -3.5), independent of clinical factors and tube voltage (p < 0.05). The effect of PCATa was stronger when plaques of a different composition were absent. No significant differences in PCATa were found among different CCS groups. PCATa increased for calcified compared to soft plaques. The non-calcified plaque burden was associated with a higher PCATa, while the calcified plaque burden was associated with a lower PCATa.

&lt;i&gt;Kalayanaka Ghrita&lt;/i&gt; Ameliorates Okadaic Acid Induced Memory Deficits in Wistar Rats

Background: Alzheimer’s disease depicts the characteristic features of intracellular neurofibrillary tangles and extracellular amyloid plaques. Kalyanaka ghrita (KG) is an Ayurvedic formulation used to treat impaired learning and memory such as Manasmandata or Buddhimandyata. KG is traditionally used to enhance memory. The constituents present in KG are also reported to be memory-enhancing, anti-inflammatory, and antioxidant and KG is reported to be effective in neurodegeneration in rats induced by β-amyloid. Aim: This study is aimed to validate the effect of KG on memory deficit, tauopathy and neurodegeneration induced by intracerebroventricular administration of okadaic acid. Methods: Okadaic acid was administered intracerebroventricularly on day 7 to the Wistar rats. KG was administered orally or intranasal from day 14 to 35 to the respective groups. The behavioural parameters on spatial memory, social recognition, and novel object recognition tests were determined. The molecular parameters such as brain acetylcholinesterase activity, protein phosphatase 2A, antioxidant parameters, monoamine levels and the brain histopathology were studied. Results: KG treatment significantly improved cognition, as evidenced by a decrease in escape latency, path length, and social and novel object recognition tests. KG treatment also increased the brain Protein phosphatase 2A, reversed the oxidative stress, and decreased brain acetylcholinesterase. The brain monoamines were reversed upon treatment with KG. Further, the molecular and histological studies confirmed the prevention of neuronal damage. Conclusion: These findings imply the traditional nootropic property of KG. The neuroprotective properties and decreased neurofibrillary tangles upon treatment with KG suggest KG to be a potential therapy for AD-like neurodegeneration.

Artificial intelligence applied to coronary artery calcium scans (AI-CAC) significantly improves cardiovascular events prediction

Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) applied to CAC scans can predict non-CHD events, including heart failure, atrial fibrillation, and stroke. We applied AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) of 5830 asymptomatic individuals (52.2% women, age 61.7 ± 10.2 years) in the multi-ethnic study of atherosclerosis during 15 years of follow-up, 1773 CVD events accrued. The AUC at 1-, 5-, 10-, and 15-year follow-up for AI-CAC vs. Agatston score was (0.784 vs. 0.701), (0.771 vs. 0.709), (0.789 vs. 0.712) and (0.816 vs. 0.729) (p < 0.0001 for all), respectively. AI-CAC plaque characteristics, including number, location, density, plus number of vessels, significantly improved CHD prediction in the CAC 1–100 cohort vs. Agatston Score. AI-CAC significantly improved the Agatston score for predicting all CVD events.

Natural history of a newly developed calcified nodule: incidence, predictors, and clinical outcomes.

Calcified nodules (CNs) are an increasingly important, high-risk lesion subset. We sought to identify the emergence of new CNs and the relation between underlying plaque characteristics and new CN development. Patients who had undergone two optical coherence tomography (OCT) studies that imaged the same untreated calcified lesion at baseline and follow-up were included. New CNs were an accumulation of small calcium fragments at follow-up that were not present at baseline. Cardiac death, myocardial infarction (MI), or clinically driven revascularisation related to OCT-imaged, but untreated, calcified lesions were then evaluated. Among 372 untreated calcified lesions, with a median of 1.5 (first and third quartiles: 0.7-2.9) years between baseline and follow-up OCTs, new CNs were observed in 7.0% (26/372) of lesions at follow-up. Attenuated calcium representing residual lipid (odds ratio [OR] 3.38, 95% confidence interval [CI]: 1.15-9.98; p=0.03); log10 calcium volume index (length×maximum arc×maximum thickness; OR 2.76, 95% CI: 1.10-6.95; p=0.03); angiographic Δangle between systole and diastole, per 10° (OR 2.30, 95% CI: 1.25-4.22; p=0.01); and time since baseline OCT, per year (OR 1.36, 95% CI: 1.05-1.75; p=0.02) were all associated with new CN development. Clinical events were revascularisation and/or MI and were more frequent in lesions with versus without a new CN (29.3% vs 15.3%; p=0.04). New CNs developed in untreated, lipid-containing, severely calcified lesions with a larger angiographic hinge motion (between systole and diastole), compared with lesions without CNs, and were associated with worse clinical outcomes.

Association of coronary inflammation with plaque vulnerability and fractional flow reserve in coronary artery disease

BackgroundThe fat attenuation index (FAI) measured using coronary computed tomography angiography (CCTA) enables the direct evaluation of pericoronary adipose tissue composition and vascular inflammation. We aimed to investigate the association of fractional flow reserve (FFR) and plaque vulnerability with coronary inflammation. MethodsPatients with suspected coronary artery disease (CAD) who underwent CCTA and invasive FFR measurements within 90-day were included. A cloud-based medical device, CaRi-Heart, serves as a surrogate tool for evaluating coronary inflammation based on FAI by analyzing CCTA images. The correlations between CCTA-defined plaque characteristics, invasive coronary angiographic and physiologic assessments, and CaRi-Heart risk were analyzed. The primary endpoint was the patient-oriented composite outcome (POCO) consisting of all-cause death, any myocardial infarction, and any revascularization. ResultsA total of 564 patients (median age 67.0 years; 75.4 ​% men) were included. There were no significant differences in quantitative and qualitative plaque characteristics or FFR between the high- and low-CaRi-Heart risk groups (i.e., ≥5 ​% and <5 ​%). During the median follow-up of 3.2 years [1.13–4.73 years], CaRi-Heart risk ≥5 ​% was associated with a significantly higher rate of POCO compared to CaRi-Heart risk <5 ​% (0.9 ​% vs. 10.1 ​%, P ​= ​0.037). The CaRi-Heart risk was an independent predictor of POCO as a continuous (adjusted HR 1.016, 95 ​% CI 1.005–0.027, P ​= ​0.004) and categorical variable (CaRi-Heart risk ≥5 ​%, adjusted HR 2.949, 95 ​% CI 1.182–7.360, P ​= ​0.021), regardless of high-risk plaque characteristics and FFR. ConclusionCoronary inflammation risk assessed using CaRi-Heart risk provides independent prognostic information regardless of plaque vulnerability and physiologic stenosis in patients with CAD.

Multimodal Intravascular Imaging of the Vulnerable Coronary Plaque.

Vulnerable coronary plaques are atherosclerotic lesions which, due to their specific phenotype, are prone to plaque rupture and to cause acute coronary syndromes, with subsequent relevant morbidity and mortality. Strategies to break the chain link between plaque vulnerability and adverse clinical events include optimized pharmacologic prevention and potentially also preemptive percutaneous coronary interventions (previously defined as "plaque sealing" or "plaque passivation"). Various morphologic features of the vulnerable plaques have been described, including aspects regarding the large necrotic lipid content, the thin fibrous cap, the presence and extent of the presence of calcifications with small size and calcification angle, and as well as the large macrophage infiltration within the plaque. The detection of these features of plaque vulnerability is possible with intravascular imaging modalities such as intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT). This review explores the peculiarities of these three imaging modalities for the detection of vulnerable coronary plaque features.

Morphological characterization of coronary plaques in young indian patients with acute coronary syndrome: A multicentric study

ObjectivesThe prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18–50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging. MethodsThis was a prospective, multicentric, non-interventional study on patients aged 18–50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups. ResultsThe study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%. ConclusionsYoung Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.

New progress in screening and treatment of carotid atherosclerotic stenosis

Carotid atherosclerotic plaque is the main cause of ischemic stroke. In recent years, with the continuous innovation of novel imaging technologies, numerous classification standards for carotid plaques provide more powerful evidence for the features of carotid plaques and perioperative vascular assessment, as well as the reference for surgeons in choosing therapeutic decisions. Ultrasound is the preferred non-invasive and convenient screening tool for carotid stenosis. Invasive examinations such as CT angiography and magnetic resonance angiography are suitable for carotid stenosis patients to determine the plaque composition and stability, which can guide surgical decision-making and help to prevent serious cardiovascular and cerebrovascular adverse events. Advances in the treatment of carotid artery stenosis have focused on the improvement and innovation of vascular interventional devices and surgical procedures, including double-layer stents, coated stents and transcarotid artery revascularization. As technology continues to evolve, molecular imaging and more minimally invasive screening as well as therapies will be the way forward.