Rapid Progression Of Coronary Atherosclerosis Research Articles

The impact of baseline calcified plaque volume on coronary rapid plaque progression by serial coronary computed tomography angiography in patients with type 2 diabetes

Objectives Patients with type 2 diabetes mellitus (T2DM) are susceptible to coronary artery disease (CAD), and coronary outcomes in these patients are heterogeneous. However, the impact of coronary plaque compositions on rapid plaque progression (RPP) in patients with T2DM has rarely been reported. This study aimed to investigate the association of coronary plaque compositions with rapid lesion volume progression in patients with T2DM. Materials and Methods A total of 159 subjects (aged 62.51 ± 10.3 years, 68.6% were male) who underwent serial coronary computed tomography angiography (CCTA) with type 2 diabetic status were enrolled. Annual change of plaque volume (PV) (mm3/year) was defined as PV change divided by inter-scan period. RPP was defined as the progression of plaque burden (PV divided by vessel volume multiplied by 100) ≥0.59%/year. Plaque components were compared between RPP and no RPP groups. Then all patients were divided into 3 groups according to the baseline calcified plaque volume tertiles. The outcome was whether RPP occurred. Results The median inter-scan period was 2.09 (range 1.41–3.33) years. The overall incidence of RPP was 61.0%. The calcified plaque volume decreased significantly in the RPP group as compared to the no RPP group. The risk of RPP (odds ratio [OR] 0.39; 95% confidence interval [CI]: 0.17-0.88; p = 0.024) was reduced in tertiles III as compared to that in tertiles I even after adjustment for baseline variables (OR 0.21; 95% CI: 0.07–0.63; p = 0.005). Moreover, adding the calcified plaque volume significantly raised the predictive value for the RPP (0.370, p = 0.030, and 0.059, p = 0.025, NRI, and IDI respectively) as compared to traditional factors. Conclusion The baseline calcified plaque volume is an independent protective factor for the rapid progression of coronary atherosclerosis in patients with T2DM.

Glycemic control is independently associated with rapid progression of coronary atherosclerosis in the absence of a baseline coronary plaque burden: a retrospective case–control study from the PARADIGM registry

BackgroundThe baseline coronary plaque burden is the most important factor for rapid plaque progression (RPP) in the coronary artery. However, data on the independent predictors of RPP in the absence of a baseline coronary plaque burden are limited. Thus, this study aimed to investigate the predictors for RPP in patients without coronary plaques on baseline coronary computed tomography angiography (CCTA) images.MethodsA total of 402 patients (mean age: 57.6 ± 10.0 years, 49.3% men) without coronary plaques at baseline who underwent serial coronary CCTA were identified from the Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry and included in this retrospective study. RPP was defined as an annual change of ≥ 1.0%/year in the percentage atheroma volume (PAV).ResultsDuring a median inter-scan period of 3.6 years (interquartile range: 2.7–5.0 years), newly developed coronary plaques and RPP were observed in 35.6% and 4.2% of the patients, respectively. The baseline traditional risk factors, i.e., advanced age (≥ 60 years), male sex, hypertension, diabetes mellitus, hyperlipidemia, obesity, and current smoking status, were not significantly associated with the risk of RPP. Multivariate linear regression analysis showed that the serum hemoglobin A1c level (per 1% increase) measured at follow-up CCTA was independently associated with the annual change in the PAV (β: 0.098, 95% confidence interval [CI]: 0.048–0.149; P < 0.001). The multiple logistic regression models showed that the serum hemoglobin A1c level had an independent and positive association with the risk of RPP. The optimal predictive cut-off value of the hemoglobin A1c level for RPP was 7.05% (sensitivity: 80.0%, specificity: 86.7%; area under curve: 0.816 [95% CI: 0.574–0.999]; P = 0.017).ConclusionIn this retrospective case–control study, the glycemic control status was strongly associated with the risk of RPP in patients without a baseline coronary plaque burden. This suggests that regular monitoring of the glycemic control status might be helpful for preventing the rapid progression of coronary atherosclerosis irrespective of the baseline risk factors. Further randomized investigations are necessary to confirm the results of our study.Trial registrationClinicalTrials.gov NCT02803411.

Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors

Background and aimsThe atherogenic index of plasma (AIP) has been suggested as a marker of plasma atherogenicity. This study aimed to assess the association between AIP and the rapid progression of coronary atherosclerosis using serial coronary computed tomography angiography (CCTA). MethodsA total of 1488 adults (60.9 ± 9.2 years, 58.9% male) who underwent serial CCTA with a median inter-scan period of 3.4 years were included. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Rapid plaque progression (RPP) was defined as the change of percentage atheroma volume (PAV) ≥1.0%/year. All participants were divided into three groups based on AIP tertiles. ResultsBaseline total PAV (median [interquartile range (IQR)]) (%) (group I [lowest]: 1.91 [0.00, 6.21] vs. group II: 2.82 [0.27, 8.83] vs. group III [highest]: 2.70 [0.41, 7.50]), the annual change of total PAV (median [IQR]) (%/year) (group I: 0.27 [0.00, 0.81] vs. group II: 0.37 [0.04, 1.11] vs. group III: 0.45 [0.06, 1.25]), and the incidence of RPP (group I: 19.7% vs. group II: 27.3% vs. group III: 31.4%) were significantly different among AIP tertiles (all p < 0.05). In multiple logistic regression analysis, the risk of RPP was increased in group III (odds ratio: 1.52, 95% confidence interval: 1.02–2.26; p = 0.042) compared to group I after adjusting for clinical factors and baseline total PAV. ConclusionsBased on serial CCTA findings, AIP is an independent predictive marker for RPP beyond traditional risk factors.

Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry.

BackgroundRapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography–determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP.Methods and ResultsQualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher‐ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78–0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52–0.67]; Duke coronary artery disease score, 0.74 [0.68–0.79]; ML model 1, 0.62 [0.55–0.69]; ML model 2, 0.73 [0.67–0.80]; all P<0.001; statistical model, 0.81 [0.75–0.87], P=0.128).ConclusionsBased on a ML framework, quantitative atherosclerosis characterization has been shown to be the most important feature when compared with clinical, laboratory, and qualitative measures in identifying patients at risk of RPP.

Coronary Plaque Progression and Regression in Asymptomatic African American Chronic Cocaine Users With Obstructive Coronary Stenoses: A Preliminary Study.

Although rapid progression of coronary atherosclerosis was observed in chronic cocaine users, it is unknown whether reduced cocaine use retards the progression of atherosclerosis. We investigated whether reduced cocaine use over a 12-month period was associated with coronary plaque regression in cocaine users. Fifteen African American chronic cocaine users with previously coronary computed tomography angiography (CCTA)-confirmed >50% coronary stenosis in Baltimore, Maryland, were enrolled in a study to investigate whether reduced cocaine use is associated with changes in coronary plaque burden over a 12-month period of cash-based incentive intervention, which was implemented to systematically reinforce cocaine abstinence. In addition to previous CCTA (preintervention), CCTA was performed at the intervention baseline and at postintervention. Plaque analyses were performed to determine the trajectory of plaque changes in the absence of intervention by comparing the preintervention with the intervention baseline studies; the trajectory of plaque changes associated with the intervention by comparing the intervention baseline with the postintervention studies; and (3) whether reduced cocaine use was independently associated with changes in coronary plaque burden. During the 12-month cash-based incentive intervention period, cocaine use in participants was lower. The medians of noncalcified plaque indices were 37.8 (interquartile range [IQR] 29.3-44.0), 43.1 (IQR 38.3-49.0), and 38.7 (IQR 31.2-46.8) mm at preintervention, intervention baseline, and postintervention, respectively. Multivariable generalized estimating equation analysis showed that both total plaque and noncalcified plaque indices at preintervention were significantly lowered as compared with intervention baseline levels; both total plaque and noncalcified plaque indices after intervention were significantly lowered as compared with intervention baseline levels; and reduced cocaine use was independently associated with lower total plaque volume index (P < 0.0001) and noncalcified plaque volume index (P = 0.010). Our findings suggest that continued cocaine use may be associated with noncalcified plaque progression, whereas reduced cocaine use may be associated with noncalcified plaque regression. Larger studies are needed to confirm these findings.

Abstract P078: Accelerated Coronary Atherosclerosis in Postmenopausal Women with Claudication - Data from Women’s Angiographic Vitamin and Estrogen (WAVE) Trial

Introduction: Claudication, a manifestation of peripheral artery disease (PAD), and coronary artery disease (CAD) often coexist. Both are thought to be due to atherosclerosis. The presence of PVD in patients with CAD is associated with an increased incidence of adverse cardiac events. It is not clear, however, if this increased risk is associated with a more rapid progression of coronary atherosclerosis in patients with CAD. Hypothesis: We assessed the hypothesis that the increased cardiovascular risk associated with PAD in patients with CAD is due to an increased progression of atherosclerosis. Methods: The Women’s Angiographic Vitamin and Estrogen (WAVE) trial evaluated the effects of hormone replacement therapy and antioxidant vitamins in postmenopausal women with known CAD. In WAVE, 320 women underwent careful clinical follow-up for 2.8 years and had entry and exit quantitative coronary angiograms. The degree of coronary narrowing was blindly assessed. We looked at the incidence of clinical events and changes in angiographic coronary luminal diameter between women who had claudication and those who did not. Results and Conclusion: Women with claudication were more likely to be current smokers and hypertensive. Prior to WAVE, they had had more cerebrovascular accidents. Those with claudication had more rapid progression of coronary narrowing (Table). The difference in previously diseased segments remained significant after multivariate adjustment for baseline differences and traditional cardiovascular risk factors. The presence of claudication was not associated with a risk-adjusted increase in all-cause mortality and myocardial infarction, which may be a reflection of the low power of the cohort. In conclusion, after 2.8 years of follow-up, a history of claudication was associated with a more rapid progression of coronary narrowing.

Enfermedad renal: implicaciones terapéuticas en insuficiencia cardíaca y cardiopatía isquémica

Heart failure (HF) is more prevalent and evolves more rapidly in patients with renal failure (RF). Renal failure not only produces myocardial damage, but also induces the development of clinical heart failure thus making the treatment of these patients more difficult. The incidence of HF in patients with RF is around 15%. Renal function in patients with RF is lower than in the general population. This is true for patients with preserved and depressed left ventricular ejection fraction (LVEF). HF mortality increases 30% for every 1-mg/dL increase in creatinine and renal function should always be considered when assessing the cardiovascular risk and therapeutic alternatives of cardiovascular patients. Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers and aldosterone blockers may cause acute renal failure and serum creatinine and potassium should be closely monitored. Chronic RF is a human model of accelerated atherosclerosis. It induces a rapid progression of coronary atherosclerosis and make atherosclerotic plaques more vulnerable to acute coronary syndromes (ACS) because of coagulation changes inherent to RF. Ischemia is also more frequent due to the imbalance between oxygen requirements and supplies. Chronic RF is associated with a worse outcome in patients with ACS and increases the risk of bleeding, and is associated with a higher mortality in patients under surgical or percutaneous coronary revascularization. Of the patients treated with an interventional coronary procedure (ICP), 3,3% suffer acute RF. Saline administration at a dose of 1 ml/kg/h for 12 hours before and 12 hours after ICP prevents the development of acute RF. Although the role of N-acetylcysteine is under discussion, taking into account the favourable risk profile of this drug, it seems reasonable to administer N-acetylcysteine in addition to saline administration. In ACS patients with severe RF, the risk of severe bleeding depends upon the anticoagulation regimen, increasing particularly when unfractionated heparin is used in combination with GP IIb/IIIa inhibitors.

Rapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome

HomeCirculationVol. 119, No. 16Rapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBRapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome Ichiro Sakamoto, Masahiro Mohri and Hideo Yamamoto Ichiro SakamotoIchiro Sakamoto From the Department of Cardiology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan. Search for more papers by this author , Masahiro MohriMasahiro Mohri From the Department of Cardiology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan. Search for more papers by this author and Hideo YamamotoHideo Yamamoto From the Department of Cardiology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan. Search for more papers by this author Originally published28 Apr 2009https://doi.org/10.1161/CIRCULATIONAHA.108.839522Circulation. 2009;119:2233–2234A 67-year-old normotensive, normolipidemic man presented with short-lasting chest pain followed by syncope. Intracoronary ergonovine maleate (40 μg) provoked a severe spasm in the middle portion of right coronary artery (Figure 1A and 1B, arrow), but there was no significant (>50%) right or left coronary artery disease after intracoronary nitrates (Figure 1C). The patient was diagnosed as having vasospastic angina. Download figureDownload PowerPointFigure 1. Right coronary arteriograms before (A) and after intracoronary ergonovine (B) and isosorbide dinitrate (ISDN; C).Three years later, he presented with sustained, nitroglycerin-resistant chest pain at our emergency room. Emergent coronary arteriography revealed a high-grade stenosis where coronary spasm had been documented earlier (Figure 2A, arrow). Intracoronary administration of isosorbide dinitrate improved distal filling but failed to dilate the stenosed segment (Figure 2B). Intravascular ultrasound confirmed coronary plaque at that segment (Figure 2B, inset), and a bare metal stent was successfully implanted (Figure 2C). Serial changes in serum enzymes confirmed the diagnosis of acute non–ST-elevation myocardial infarction. Download figureDownload PowerPointFigure 2. Right coronary arteriograms before (A) and after intracoronary isosorbide dinitrate (ISDN; B) and percutaneous coronary intervention (PCI; C).Although coronary spasm has been implicated to cause atherosclerosis progression over years,1 there are few reports demonstrating a critical role of coronary artery spasm in rapid plaque progression and the development of acute coronary syndrome. Because there was no disease progression in left coronary artery segments, it was assumed that focal spasm might have contributed to a ruptured atheromatous plaque in our patient, leading eventually to myocardial infarction. Previous experimental studies have shown that coronary artery spasm could cause intraplaque hemorrhage and acute myocardial infarction in the swine model.2 Thus, coronary vasospasm may play an important role in the pathogenesis of not only variant angina but also acute coronary syndrome, as seen in this patient.DisclosuresNone.FootnotesCorrespondence to Masahiro Mohri, MD, PhD, Department of Cardiology, Kyushu Kosei-Nenkin Hospital, 1-8-1 Kishinoura, Kitakyushu 806-8501, Japan. E-mail [email protected]References1 Nobuyoshi M, Tanaka M, Nosaka H, Kimura T, Yokoi H, Hamasaki N, Kim K, Shindo T, Kimura K. Progression of coronary atherosclerosis: is coronary spasm related to progression? J Am Coll Cardiol. 1991; 18: 904–910.CrossrefMedlineGoogle Scholar2 Kuga T, Tagawa H, Tomoike H, Mitsuoka W, Egashira S, Ohara Y, Takeshita A, Nakamura M. Role of coronary artery spasm in progression of organic coronary stenosis and acute myocardial infarction in a swine model: importance of mode of onset and duration of coronary artery spasm. Circulation. 1993; 87: 573–582.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kim J, Park J, Yang Y, Lee S, Kim D, Song J, Kang D, Park S, Park S and Song J (2022) Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up, Heart, 10.1136/heartjnl-2021-320645, 108:16, (1303-1309), Online publication date: 1-Aug-2022. Mori H, Takahashi J, Sato K, Miyata S, Takagi Y, Tsunoda R, Sumiyoshi T, Matsui M, Tanabe Y, Sueda S, Momomura S, Kaikita K, Yasuda S, Ogawa H, Shimokawa H and Suzuki H (2020) The impact of antiplatelet therapy on patients with vasospastic angina: A multicenter registry study of the Japanese Coronary Spasm Association, IJC Heart & Vasculature, 10.1016/j.ijcha.2020.100561, 29, (100561), Online publication date: 1-Aug-2020. Montenegro Sá F, Ruivo C, Graça Santos L, Antunes A, Soares F, Baptista J and Morais J (2018) Ultra-rapid progression of coronary artery disease or undiagnosed unstable plaque? A brief review from a case report, Revista Portuguesa de Cardiologia (English Edition), 10.1016/j.repce.2018.02.016, 37:3, (259-264), Online publication date: 1-Mar-2018. Montenegro Sá F, Ruivo C, Graça Santos L, Antunes A, Campos Soares F, Baptista J and Morais J (2018) Progressão ultrarrápida de doença coronária ou placa instável não detetada?, Revista Portuguesa de Cardiologia, 10.1016/j.repc.2017.04.005, 37:3, (259-264), Online publication date: 1-Mar-2018. Shah P, Bajaj S, Virk H, Bikkina M and Shamoon F (2015) Rapid Progression of Coronary Atherosclerosis: A Review, Thrombosis, 10.1155/2015/634983, 2015, (1-6), Online publication date: 28-Dec-2016. April 28, 2009Vol 119, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.839522PMID: 19398679 Originally publishedApril 28, 2009 PDF download Advertisement SubjectsAcute Coronary Syndromes

Therapeutic options for premature coronary artery disease

Although cardiovascular disease is commonly recognized as a disease of the elderly, young patients are also at risk for coronary atherosclerosis, which has a devastating impact on their more active lifestyle. In identifying patients at risk for a cardiovascular event, global risk models often fail to assess family history, an important risk factor in patients with premature coronary artery disease (P-CAD). P-CAD refers to the accelerated development of coronary atherosclerosis before age 55 in men and 65 in women, which may be the result of acquired or primary causes. Acquired P-CAD is associated with an underlying medical condition or influencing factor, such as systemic lupus erythematosus or cocaine use, that directly contributes to the rapid progression of coronary atherosclerosis. It is important to evaluate young patients for acquired P-CAD because in many instances treatment may be tailored to the underlying medical condition. Most cases of P-CAD, however, are the result of primary causes involving more complex interactions among genetic, metabolic, and environmental risk factors. Patients with primary P-CAD usually have a family history of coronary disease, suggesting a strong genetic component. With the use of genome-wide association analysis, several chromosome loci have been identified as being linked to the development of coronary atherosclerosis and risk factors. The chromosome 9p21.3 locus, which is the most replicated to date, has provided some insight into the pathologic mechanism of coronary disease. The confirmation and replication of these associations through further study will lead to earlier detection of P-CAD in at-risk patients and a better understanding of the underlying pathologic mechanisms, thereby influencing the development of preventive therapies.

C-reactive protein and rapidly progressive coronary artery disease--is there any relation?

High plasma C-reactive protein (CRP) levels have been associated with an unfavorable outcome in patients with coronary artery disease (CAD), and a direct participation of CRP in the atherosclerotic process has been postulated. The aim of this study was to evaluate the possible relationship of high plasma CRP levels with the rapid progression of coronary atherosclerosis (RPCAD). In all, 194 patients who were readmitted and underwent repeat coronary angiography because of recurrence of symptoms following successful percutaneous coronary intervention were studied. Median angiographic follow-up time was 6 months. Rapid progression CAD was defined as the presence of a new lesion, > 25% in luminal diameter stenosis, in a previously nondiseased vessel, or deterioration of a known, nontreated lesion by at least 25%. By multivariate analysis, patients with high plasma CRP levels upon first admission were at higher risk of RPCAD. In particular, odds ration (OR) = 1.8; 95% confidence interval (CI) = 1.3-3.6; p value = 0.02 in patients with CRP = 0.5-2 mg/dl versus patients with CRP < 0.5 mg/dl, and OR = 7.1; 95% CI = 3.8-9.5; p value < 0.001 in patients with CRP > 2 mg/dl versus patients with CRP < 0.5 mg/dl. Increased plasma CRP levels could possibly identify patients at high risk for the development of RPCAD.

Frequent angina attacks lead to rapid progression of coronary atherosclerosis in a patient with vasospastic angina pectoris -a case report-

Frequent angina attacks lead to rapid progression of coronary atherosclerosis in a patient with vasospastic angina pectoris -a case report-