Smaller Lumen Area Research Articles

A systematic study of Pseudobulbus Cremastrae seu Pleiones: Characteristics, Origin, chemical composition and toxicology

Ethnopharmacological relevancePseudobulbus Cremastrae seu Pleiones (PCSP) is a multi-source traditional Chinese medicine (TCM) with diverse chemical compositions and toxicity levels. The authenticity identification and safety evaluation of PCSP have attracted widespread attention in clinical applications. Aim of this studyThe objective of this study was to evaluate the authenticity and safety of commercially available PCSP. Materials and methodsMorphological and microscopic identification, HPLC chromatogram, UPLC-Q-TOF-MS/MS with molecular networking were applied to the authenticity identification of PCSP. The safety of different PCSPs was evaluated by acute toxicity in zebrafish at maximum non-lethal concentration (MNLC) and 10% lethal concentration (LC10). Intestinal toxicity of PCSP was assessed through histological staining, intestinal goblet cells, neutrophils, and intestinal opacity. ResultsFour sources of PCSP varied in size, epidermal longitudinal grooves, and microscopic features. GNPS analysis identified 61, 47, 44, and 56 chemical compounds in Cremastra appendiculate (CA), Oreorchis patens (Lindl.) Lindl. (OPL), Iphigenia indica A. Gray (IIG), and Tulipa edulis (Miq.) Baker (TEB). Colchicine and militarine, were discovered as distinguishing markers. Acute toxicity in zebrafish ranked as follows: IIG > OPL > CA > TEB. Further studies on the intestinal toxicity of the authentic PCSP (CA, OPL) showed that CA induced less damage with a smaller lumen area, fewer neutrophils and goblet cells, and reduced peristalsis inhibition compared to OPL, indicating greater safety. ConclusionFour different sources of PCSP were accurately distinguished based on three dimensions: character, components, and toxicity. OPL and CA were considered as genuine products, while CA with lower toxicity was more suitable for clinical applications.

Short-term glycemic variability and intracranial atherosclerotic plaque stability assessed by high-resolution MR vessel wall imaging in type 2 diabetes mellitus

ObjectiveTo investigate the relationship between short-term glycemic variability in patients with T2DM and the vulnerability of intracranial atherosclerotic plaques using HR-MR-VWI. Materials and methodsIn total, 203 patients with acute ischemic stroke (AIS)/transient ischemia (TIA) combined with T2DM were enrolled. All of them underwent HR-MR-VWI during the period between July 2020 and July 2023. 203 patients were divided into groups with higher (1,5-AG≤ 30.7 μmol/L) and lower (1,5-AG> 30.7 μmol/L) short-term glycemic variability. Patients were also divided into the T1WI and non-T1WI hyperintensity groups. Associated factors(FBG, HbA1c, and 1,5-AG)for the T1WI hyperintensity were analyzed by binary logistic regression. We used the area under the curve (AUC), while the sensitivity and specificity were calculated at the optimal threshold. The Delong test was employed to compare the quality of the AUC of the predictors. ResultsThe group with higher short-term glycemic variability had a higher incidence of the hyperintensity on T1WI, higher degree of enhancement, higher degree of stenosis and smaller lumen area (P < 0.05). The T1WI hyperintensity group had higher HbA1c levels, higher hemoglobin levels and lower 1,5-AG levels(P < 0.05). 1,5-AG (OR = 0.971, 95 % CI: 0.954∼0.988, P = 0.001), HbA1c (OR=1.305, 95 % CI: 1.065∼1.598, P = 0.01) and male sex (OR = 2.048, 95 % CI: 1.016∼4.128, P = 0.045)/(OR=2.102, 95 % CI: 1.058∼4.177, P = 0.034) were independent risk factors for the hyperintensity on T1WI. 1,5-AG demonstrated enhanced performance and yielded the highest AUC of the receiver operator characteristic curve (AUC = 0.726), with sensitivity and specificity values of 0.727 and 0.635 respectively. Conclusion1,5-AG, HbA1c and male sex are independent predictors of intracranial plaques with T1WI hyperintensity, the greater short-term glycemic variability, the higher incidence of vulnerable plaques.

Linking anatomical and histological traits of the digestive tract to resource consumption and assimilation of omnivorous tetra fishes.

This study explores the interplay between digestive tract traits, food intake, and assimilation in omnivorous tetra fishes (Psalidodon bifasciatus, P. aff. gymnodontus, and Bryconamericus ikaa) from the Iguaçu River basin, an ecologically significant region known for high endemism. We hypothesize that variations in digestive tracts across species would be associated with differences in diet, isotopic composition in fish tissues, and overall diet assimilation. To test this, we employed stereoscopic and light microscopy to characterize the gross anatomy, histomorphology, and histochemistry of fish digestive tracts. Additionally, we used stomach content and stable isotope analyses to trace fish diets. While these tetra fishes shared histological structures, disparities were noted in anatomical digestive traits and diet preferences. The smallest species, B. ikaa, with a shorter intestine, had fewer pyloric caeca and primarily consumed animal-based diets. Conversely, P. bifasciatus and P. aff. gymnodontus, with longer intestines, displayed numerous pyloric caeca and consumed a balanced mix of animal and plant items. Despite anatomical and dietary differences, all three species predominantly assimilated animal-origin food. The tetra fishes had histological variations among digestive tract segments, with the esophagus having the thickest muscular layer, gradually thinning towards the posterior intestine. The final portion of the intestine exhibited a significant expansion in the lumen perimeter, while the esophagus had the smallest lumen area. Goblet cells were most concentrated in the posterior intestine for all species. The gross anatomy of these tetra fishes aligns with their omnivorous habit, while diet assimilation was dominated by animal-origin food. These findings provide crucial insights into the structural and tissue characteristics of their digestive systems, laying the groundwork for deeper exploration into the physiological aspects of their digestive tracts and enhancing our understanding of their feeding strategies.

Abstract WP116: Plaque Features and Infarct Pattern in Ischemic Stroke With Bilateral Carotid Artery Atherosclerosis

Objective: to compare the carotid artery plaque characteristics between ipsilateral and contralateral infarct in ischemic stroke with bilateral carotid artery atherosclerosis, and explore the association between plaque characteristics and infarct pattern. Methods: a total of 186 ischemic stroke patients with bilateral carotid artery atherosclerosis were included, carotid artery plaque burden (the degree of stenosis, maximum wall thickness, lumen area, wall area, normalized wall index (NWI=wall area/[lumen area+ wall area]), and eccentricity index), and vulnerability (intraplaque hemorrhage [IPH], calcification, irregular surface, thin or ruptured fibrous cap[TRFC], and lipid-rich necrotic core[LRNC]) were obtained by MR vessel wall imaging, infarct pattern was divided as single and multiple/recurrent infarcts in infarct ipsilateral carotid artery. Ipsilateral and contralateral carotid artery plaque features were compared, then the carotid artery plaque characteristics on the infarct side were correlated with the infarct pattern. Results: the mean age of subjects included was 68 years old, 79.6% of them were male. Compared with contralateral carotid artery plaque, plaque burden at the ipsilateral carotid artery was much heavy, presented with a higher degree of stenosis, smaller lumen area (0.22±0.15 vs. 0.28±0.15), larger wall area (0.50±0.19 vs.0.42±0.17), and higher eccentricity index (0.67±0.13 vs. 0.58±0.23), all p values&lt;0.05. The vulnerable plaques were also more prevalent at ipsilateral infarct, with a high percentage of IPH (47.8% vs. 19.8%), irregular surface (36.3% vs. 17.5%), TRFC (38.5% vs.12.3%), and LRNC (38.1% vs. 15.9%), all p values were &lt;0.05. After adjusting for covariates, the degree of stenosis (OR=1.590, 95% CI 1.048-2.410) and LRNC (OR=0.259, 95% CI 0.087-0.769) were associated with multiple or recurrent infarcts independently. Conclusion: in ischemic stroke with bilateral carotid atherosclerosis, the atherosclerotic plaque burden at ipsilateral infarct was much heavier and more vulnerable. Both lumen stenosis and plaque components were correlated with multiple or recurrent infarcts in this population.

Impact of plaque characteristics on percutaneous coronary intervention-related microvascular dysfunction: insights from angiographic microvascular resistance and intravascular ultrasound.

The correlation between percutaneous coronary intervention (PCI)-related microvascular dysfunction (MVD) and plaque characteristics remains unclear. To investigate this correlation and its prognosis, we assessed changes in MVD by angiographic microvascular resistance (AMR) and intracoronary ultrasound scans after PCI. We conducted a retrospective study that enrolled 250 patients with coronary artery disease between July 2016 and December 2018. We collected demographic characteristics, laboratory tests, coronary angiography (CAG) and intracoronary ultrasound findings. We calculated quantitative flow ratio (QFR) and AMR by CAG. The endpoint was vessel-oriented composite outcomes (VOCOs). After 47 exclusions, we divided 203 cases into a deteriorated group (n=139) and an improved group (n=64) based on AMR change after PCI. Compared with the improved group, the deteriorated group had smaller lumen area [3.03 (interquartile range, 2.20-3.91) vs. 3.55 mm2 (interquartile range, 2.45-4.57), P=0.033], higher plaque burden [78.92% (interquartile range, 73.95-82.61%) vs. 71.93% (interquartile range, 62.70-77.51%), P<0.001], and higher proportion of lipidic components (13.86%±4.67% vs. 11.78%±4.41%, P=0.024). Of 186 patients who completed 4.81±1.55 years follow-up, 56 developed VOCOs. Receiver-operating characteristic (ROC) curve analysis showed post-PCI AMR and VOCOs correlation (area under the curve: 0.729, P<0.001). Multivariate regression analysis showed post-PCI AMR >285 mmHg·s/m correlated with adverse outcome (hazard ratio =4.350; 95% confidence interval: 1.95-9.703; P<0.001). Intravascular ultrasound (IVUS) imaging and AMR revealed an association of post-PCI MVD with a smaller lumen area, more severe plaque burden, and a higher percentage of lipidic components. Post-PCI MVD was an independent risk factor for poor prognosis.

Molecular mechanisms involved in pre-eclampsia through expressional regulation of endothelin-1

IntroductionPreeclampsia (PE) is a condition affecting 2–8% of all pregnancies and is a leading cause of perinatal morbidity and mortality. In our study; we aim to investigate the differences in endothelin-1 (ET-1) at both tissue and blood level in the placenta, umbilical cord, and maternal blood obtained from different experimental groups and the changes in the contraction response of umbilical arteries in order to explain how PE affects mother and fetus. MethodsUmbilical cord and placenta samples were obtained from normotensive controls (n = 10) and patients with preeclampsia (n = 10), aged 20–39 years, who delivered by cesarean section at term (between 37 and 39 weeks). All samples were investigated with isolated tissue bath, histopathological, immunohistochemical and real-time PCR methods. ResultsET-1 messenger RNA expression levels and immunoreactivity were found significantly higher in the PE group while microRNA-1 and microRNA-125b (miR-125b) levels were significantly decreased in placenta compared to control. miR-125b levels were found significantly higher in maternal and umbilical cord blood samples of the PE group. The enlargement in intervillous space, decrease in villous branching, increase in syncytial knots and smaller lumen areas in umblicard cord vessels were also observed. In tissue bath experiments, there were no significant differences in ET-1 responses between groups. DiscussionWe tried to evaluate molecular mechanisms of PE pathogenesis through expressional regulation and contraction response of ET-1. Although quite abundant work in this field has previously highlighted the importance of ET-1 system, further work is needed to determine the molecular mechanisms underlying expressional regulation of ET-1 in PE.

Coronary risk factors and plaque morphology; semi-automated quantative coronary CTA analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction With advances in coronary computed tomography angiography (CTA) technology dedicated semi-automated coronary plaque analysis software become researches field of interest. With detailed plaque analysis we can improve CTA diagnostic accuracy and prognostic value, this way improving chronic coronary syndrome (CCS) outcomes. Purpose The aim of this study was to evaluate well known modifiable coronary risk factors (arterial hypertension (AH), smoking, diabetes mellitus (DM), hypercholesterolemia, physical inactivity, obesity) and statin use in relation to more detailed plaque features. Methods 100 patients with stable angina and no previous history of CCS underwent CTA and were diagnosed with one or more intermediate stenosis (correspond to 50-69% stenosis). A total of 112 stenosis were analysed with post-processing semi-automated CTA dedicated software. This is a sub-study from a bigger trial, where intermediate lesions were analysed. Results Overall all lesions were analyzed as whole and at the vessel cross-section of maximum obstruction site. 45 different parameters were obtained. Analysis made at the level of whole lesion showed that smokers had lower plaque and dense calcium volumes (Table 1), statin users lower fibrous fatty and necrotic core volumes (Table 2). Obstruction area analysis showed significant larger vessel wall area and diameter in non-smokers group (Table 1), whereas statin users had smaller lumen area and diameter stenosis (Table 2). Patients with DM had bigger necrotic core volume with significant bigger fibrous fatty and necrotic core percentages (Table 3). AH, hypercholesterolemia, physical inactivity or obesity did not show any significant relation with plaque features (p≥0.05). Renal insufficiency was excluded as a risk factor as all patients referred to CTA had normal or slightly decreased renal function (GFR &amp;gt;60 ml/min.). Conclusion Our study shows that modifiable risk factors (smoking and DM) alongside with statin use are related to quantitative atherosclerotic plaque parameters. For risk factors modification impact on plaque characteristics studies should be done. Abstract Table 1; 2; 3.

Assessing the characteristics and diagnostic value of plaques for patients with acute stroke using high-resolution magnetic resonance imaging.

A comprehensive understanding of atherosclerotic plaques aids physicians in evaluation and treatment of stroke. This study set out to evaluate the characteristics and diagnostic value of atherosclerotic plaques in patients with acute stroke and stenotic middle cerebral artery (MCA) using high-resolution magnetic resonance imaging. Sixty-five consecutive patients with transient ischemic attack or recent ischemic stroke were prospectively recruited. All enrolled patients underwent routine magnetic resonance scans and cross-sectional scans of the stenotic MCA vascular wall. Differences in vascular wall parameters and location, the enhancement degree, and remodelling patterns of plaques in the stenotic MCA were compared between symptomatic (n=30) and asymptomatic (n=35) groups of patients. The statistically significant indicators were then subjected to logistic regression analysis to identify which factors could better predict acute stroke. Compared with the asymptomatic group, the symptomatic group had a smaller lumen area (LA) (P=0.027), larger plaque area (P<0.001), larger remodelling index (P<0.001), more superior/posterior plaques (P=0.001), more obviously enhanced plaques (P<0.001), and a greater number of PR patterns (P<0.001) in the stenotic MCA. Logistic regression analysis showed that the plaque area, remodelling patterns, LA in the stenotic MCA, enhancement degree, and plaque location were predictors of acute stroke. The combination of the plaque area and LA in the stenotic MCA, and the plaque enhancement degree had optimal predictive value (area under the curve =0.927). A larger plaque area and smaller LA in the stenotic MCA, and obvious plaque enhancement might indicate that a patient is prone to acute stroke.

Hemodynamics is associated with vessel wall remodeling in patients with middle cerebral artery stenosis.

To evaluate the relationship between hemodynamics and vessel wall remodeling patterns in middle cerebral artery (MCA) stenosis based on high-resolution magnetic resonance imaging and computational fluid dynamics (CFD). Forty consecutive patients with recent ischemic stroke or transient ischemic attack attributed to unilateral atherosclerotic MCA stenosis (50-99%) were prospectively recruited. All patients underwent a cross-sectional scan of the stenotic MCA vessel wall. The parameters of the vessel wall, the number of patients with acute infarction, translesional wall shear stress ratio (WSSR), wall shear stress in stenosis (WSSs), and translesional pressure ratio were obtained. The patients were divided into positive remodeling (PR) and negative remodeling (NR) groups. The differences in vessel wall parameters and hemodynamics were compared. Correlations between the parameters of the vessel wall and hemodynamics were calculated. Of the 40 patients, 16 had PR, 19 had NR, and the other 5 displayed non-remodeling. The PR group had a smaller lumen area (p = 0.004), larger plaque area (p < 0.001), normal wall index (p = 0.004), and higher WSSR (p = 0.004) and WSSs (p = 0.023) at the most narrowed site. The PR group had more enhanced plaques (12 vs 6, p = 0.03). The number of patients with acute stroke in the PR group was more than that in the NR group (11 vs 4, p = 0.01). The remodeling index (r = 0.376, p = 0.026) and plaque area (r = 0.407, p = 0.015) showed a positive correlation with WSSR, respectively. Hemodynamics plays a role in atherosclerotic plaques and vessel wall remodeling. Individuals with greater hemodynamic values might be more prone to stroke. • Stenotic plaques in middle cerebral artery with positive remodeling have smaller lumen area and larger resp. higher plaque area, normal wall index, translesional wall shear stress ratio, and wall shear stress than negative remodeling. • The remodeling index and plaque area are positively correlated with translesional wall shear stress ratio. • Hemodynamic may help to understand the role of positive remodeling in the development of acute stroke.

Association between Intraplaque Hemorrhage and Vascular Remodeling in Carotid Arteries: The Plaque at RISK (PARISK) Study

Introduction: Vascular remodeling is a compensatory enlargement of the vessel wall in response to atherosclerotic plaque growth. We aimed to investigate the association between intraplaque hemorrhage (IPH), vascular remodeling, and luminal dimensions in recently symptomatic patients with mild to moderate carotid artery stenosis in which the differences in plaque size were taken into account. Materials and Methods: We assessed vessel dimensions on MRI of the symptomatic carotid artery in 164 patients from the Plaque At RISK study. This study included patients with recent ischemic neurological event and ipsilateral carotid artery stenosis <70%. The cross section with the largest wall area (WA) in the internal carotid artery (ICA) was selected for analysis. On this cross section, the following parameters were determined: WA, total vessel area (TVA), and lumen area (LA). Vascular remodeling was quantified as the remodeling ratio (RR) and was calculated as TVA at this position divided by the TVA in an unaffected distal portion of the ipsilateral ICA. Adjustment for WA was performed to correct for plaque size. Results: Plaques with IPH had a larger WA (0.56 vs. 0.46 cm²; p < 0.001), a smaller LA (0.17 vs. 0.22 cm²; p = 0.03), and a higher RR (2.0 vs. 1.9; p = 0.03) than plaques without IPH. After adjustment for WA, plaques containing IPH had a smaller LA (B = −0.052, p = 0.01) than plaques without IPH, but the RR was not different. Conclusion: After correcting for plaque size, plaques containing IPH had a smaller LA than plaques without IPH. However, RR was not different.

Prevalence, Features, and Prognosis of Artery-to-Artery Embolic ST-Segment-Elevation Myocardial Infarction: An Optical Coherence Tomography Study.

BackgroundThe major underlying mechanisms contributing to acute coronary syndrome are plaque rupture, plaque erosion, and calcified nodule. Artery‐to‐artery embolic myocardial infarction (AAEMI) was defined as ST‐segment–elevation myocardial infarction caused by migrating thrombus formed at the proximal ruptured plaque. The aim of this study was to investigate the prevalence and clinical features of AAEMI by using optical coherence tomography.Methods and ResultsThis study retrospectively enrolled 297 patients with ST‐segment–elevation myocardial infarction who underwent optical coherence tomography before percutaneous coronary intervention. Patients were divided into 4 groups consisting of plaque rupture, plaque erosion, calcified nodule, and AAEMI according to optical coherence tomography findings. The prevalence of AAEMI was 3.4%. The culprit vessel in 60% of patients with AAEMI was right coronary artery. Minimum lumen area at the culprit site was larger in AAEMI compared with plaque rupture, plaque erosion, and calcified nodule (4.0 mm2 [interquartile range (IQR), 2.2–4.9] versus 1.0 mm2 [IQR, 0.8–1.3] versus 1.0 mm2 [IQR, 0.8–1.2] versus 1.1 mm2 [IQR, 0.7–1.6], P<0.001). Lumen area at the rupture site was larger in patients with AAEMI compared with patients with plaque rupture (4.4 mm2 [IQR, 2.5–6.7] versus 1.5 mm2 [IQR, 1.0–2.4], P<0.001). In patients with AAEMI, the median minimum lumen area at the occlusion site was 1.2 mm2 (IQR, 1.0–2.1), 40% of them had nonstent strategy, and the 3‐year major adverse cardiac event rate was 0%.ConclusionsAAEMI is a rare cause for ST‐segment–elevation myocardial infarction and has unique morphological features of plaque including larger lumen area at rupture site and smaller lumen area at the occlusion site.

Abstract 13025: Methotrexate Carried in Lipid Core Nanoparticles Prevented the Dilation and Dissection of the Aortic Arch in Mice With Marfan Syndrome by Increasing the Bioavailability of Intracellular Adenosine

Introduction: Mutations in the fibrillin-1 gene result in aneurysms and rupture of the aorta, the main cause of mortality in patients with Marfan syndrome (MFS). Inflammation is associated with dissection and rupture of the aorta. We showed that methotrexate (MTX) carried in lipid core nanoparticles (LDE) had powerful anti-inflammatory effects on atherosclerotic lesions and myocardial infarction. Hypothesis: To investigate whether treatment with LDE-MTX can prevent the development of aortic arch lesions in MFS. Methods: mgΔloxPneo MFS murine model and wild-type mice were allocated in 3 groups of treatment: LDE only; MTX in commercial formulation; LDE-MTX. The treatment occurred weekly at a dose of 1mg/kg ip, between the 3rd and 6th month of life, period in which both dilation and dissection of the aortic arch are observed. After 12 weeks, animals were submitted to analysis of the aortic arch. Results: Compared to LDE and MTX groups, LDE-MTX treatment showed smaller lumen area of ascending and descending aorta and aortic arch segments in MFS mice. LDE-MTX also decreased collagen volume fraction and the amount of aortic dissections, but did not affect the thickness of the vessel wall and the number of elastic fiber ruptures. Protein expression of the inflammatory markers CD68 (macrophages), CD3 (lymphocytes) and tumor necrosis factor alpha, of the apoptotic marker caspase 3 and of type 1 collagen were lower in LDE-MTX group when compared to LDE and MTX. Moreover, treatment with LDE-MTX reduced TGF-β, ERK and SMAD3 protein expression. Of note, CD68 and CD3 protein expression were positively correlated with the lumen area of the aortic arch (r2=0.36; p&lt;0.001), indicating the importance of inflammation for the aortic dilation. The increase in bioavailability of intracellular adenosine was suggested by higher expression of A2a adenosine receptor and lower levels of adenosine deaminase in the aortic arch. Conclusions: Possibly by increasing the bioavailability of intracellular adenosine, LDE-MTX treatment had the ability to reduce the processes of inflammation, apoptosis and fibrosis that are consequent to fibrillin-1 mutation. By these means, LDE-MTX may conceivably prevent the development of the dilation and dissection in the aortic arch, the hallmarks of MFS.

Influence of Asthma Onset on Airway Dimensions on Ultra-high-resolution Computed Tomography in Chronic Obstructive Pulmonary Disease.

Asthma onset before the age of 40 years is associated with distinct clinical manifestations in chronic obstructive pulmonary disease (COPD) patients, but its morphologic features remain unestablished. This study aimed to explore airway morphology in COPD patients with asthma onset before 40 years of age using ultra-high-resolution computed tomography (U-HRCT), which allows a more accurate quantitation of the lumen and the wall in smaller airways than using conventional CT. Clinical data of 500 consecutive patients undergoing full inspiratory U-HRCT (1024×1024 matrix and 0.25 mm slice thickness) were retrospectively analyzed. COPD patients without asthma, COPD patients with asthma onset at age below or 40 years and above, and non-COPD smoker controls (N=137, 29, 34, and 22, respectively) were enrolled. The length, lumen area (LA), wall thickness and area (WA), and wall area percent (WA%) of the segmental (third-generation) to sub-subsegmental (fifth-generation) bronchus and the low attenuation volume percent (LAV%) were measured. LA and WA were smaller in the fourth and fifth generation in COPD patients than in non-COPD controls, regardless of the age of asthma onset. LA was smaller and WA% was larger in the fourth-generation and fifth-generation airways in COPD with asthma onset before 40 years than COPD without asthma, whereas WA did not differ between them. In multivariate analyses, asthma onset before 40 years was associated with smaller LA in COPD patients independent of demographics, use of inhaled corticosteroids and long-acting bronchodilators, airflow limitation, and LAV%. Asthma onset before 40 years of age could be associated with greater lumen narrowing of the airways in COPD.

Prognostic value of intracoronary imaging-derived measures for non-infarct related vessel revascularization throughout 7 years among patients with ST-elevation myocardial infarction

Abstract Background Underlying plaque characteristics that lead to future revascularization during long-term follow-up remain poorly understood. Purpose We aimed to explore intracoronary imaging-derived measures as assessed by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) associated with non-infarct related vessel revascularization (non-TVR) arising from imaged segments during long-term (up to 7 years) follow-up among patients with ST-elevated myocardial infarction (STEMI). Methods A total of 94 STEMI patients enrolled into the IBIS-4 (Integrated Biomarker Imaging Study-4) study undergoing serial (baseline and 13 months) IVUS and OCT in 2 non-infarct-related coronary arteries under high-intensity statin therapy were analyzed in the present study. Patients were divided into 2 groups according to the occurrence of non-TVR within previously imaged vessel segments (non-TVR: n=14, no non-TVR: n=80). Results Baseline characteristics including LDL level were comparable between groups. At baseline, lesions with future non-TVR were associated with greater percent atheroma volume by IVUS (55.6±5.4% vs. 49.6±6.1%, P&amp;lt;0.001), minimum lumen area by OCT (3.4±1.7 mm2 vs. 6.0±3.3 mm2, P=0.004), and a higher prevalence of fibroatheroma (60.0% vs. 20.1%, P=0.007) by OCT compared with those without. Among patients with serial imaging, lesions with non-TVR had a trend towards a less reduction of percent atheroma volume (−0.2±3.8% vs. −2.4±4.2%, P=0.083). Conclusion Greater plaque burden, smaller lumen area, and higher prevalence of OCT-detected fibroatheroma at baseline were associated with non-infarct related vessel revascularization. Lesions with non-TVR tend to have less-pronounced regression of coronary atheroma despite intensive statin therapy and achieved LDL levels. Non-TVR 7 years after index PCI Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Clinical outcomes of calcified nodules detected by optical coherence tomography: a sub-analysis of the CLIMA study.

The goal of the present post hoc analysis of the CLIMA registry was to establish the relationship between calcified nodules (CNs) with (CND) or without (CNWD) disruption of the superficial intimal fibrous layer and one-year occurrence of target lesion myocardial infarction (MI) and/or cardiac death. CND and CNWD were identified based on the presence or absence of superficial irregularities indicative of disruption of the intimal fibrous layer, with possible overlying local thrombus. In total, 222 CNs were found in the 1,776 non-culprit LAD plaques. CND had larger maximum calcific arc and smaller lumen area. Cardiac death and MI occurred in 20% of patients in the CND group versus 2.7% in the CNWD group and 3.3% in the group without CN (p<0.001). This figure was mainly due to the 13.3% incidence of cardiac death in the CND group versus 2.0% in the CNWD group and versus 2.2% in the group without CN (p<0.001). The presence of CND was confirmed as an independent predictor of events (HR 6.58, 95% CI: 2.7-15.8, p<0.001). The presence of CND was associated with a high one-year incidence of cardiac death and/or target lesion MI.

Optical Coherence Tomography-Based Modeling of Stent Deployment in Heavily Calcified Coronary Lesion.

In this work, a heavily calcified coronary artery model was reconstructed from optical coherence tomography (OCT) images to investigate the impact of calcification characteristics on stenting outcomes. The calcification was quantified at various cross sections in terms of angle, maximum thickness, and area. The stent deployment procedure, including the crimping, expansion, and recoil, was implemented. The influence of calcification characteristics on stent expansion, malapposition, and lesion mechanics was characterized. Results have shown that the minimal lumen area following stenting occurred at the cross section with the greatest calcification angle. The calcification angle constricted the stretchability of the lesion and thus resulted in a small lumen area. The maximum principal strain and von Mises stress distribution patterns in both the fibrotic tissue and artery were consistent with the calcification profiles. The radially projected region of the calcification tends to have less strain and stress. The peak strain and stress of the fibrotic tissue occurred near the interface with the calcification. It is also the region with a high risk of tissue dissection and strut malapposition. In addition, the superficial calcification with a large angle aggregated the malapposition at the middle of the calcification arc. These detailed mechanistic quantifications could be used to provide a fundamental understanding of the role of calcification in stent expansions, as well as to exploit their potential for enhanced pre- and post-stenting strategies.

Intravascular ultrasound radiofrequency signal analysis of blood speckles: Physiological assessment of intermediate coronary artery stenosis.

This study aimed to systematically investigate feasibility of radiofrequency intravascular ultrasound (RF-IVUS) analysis of blood signals for assessing functionally significant coronary stenosis. First, in-vivo human study was performed to evaluate 83 intermediate coronary lesions from 75 patients, using 40-MHz RF-IVUS, fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). Average blood integrated-backscatter (IB) values within lumen were measured at proximal and distal segments to the stenosis; ΔIB values between the two sites were calculated. Second, bench-test was performed to assess relationships of blood IB values to blood flow velocity and hematocrit using 40 and 60-MHz RF-IVUS. In in-vivo study, ΔIB values across the stenosis significantly correlated with both FFR (r = -.85, p < .0001) and iFR (r = -.65, p < .0001), which was confirmed in small minimum lumen area (MLA) lesions (MLA <2.0 mm2 ). Receiver operating characteristic curve analyses identified the best cut-off value as 10.06 of ΔIB values for predicting FFR ≤0.8 and iFR ≤0.89 (sensitivity 76.2 and 95.5%, specificity 100 and 82.0%, positive predictive value 100 and 65.6%, negative predictive value 80.4 and 98.0%, accuracy 92.9 and 92.8% for FFR and iFR). Bench-test study also identified that blood IB values exponentially changed as a function of blood flow velocity at any given hematocrit in both 40 and 60-MHz RF-IVUS. This study supports the potential utility of RF-IVUS analysis of blood signals to estimate functional ischemia, demonstrating relationships of blood ΔIB values to FFR and iFR, as well as relationships between blood IB values and flow velocity.

Imaging Characteristics of Mismatch Lesions: An Angiographic and Intravascular Ultrasound Analysis of 1369 Coronary Lesions.

To evaluate the angiographic and intravascular ultrasound (IVUS) characteristics of coronary mismatch lesions. Better understanding about the characteristics of mismatch lesions may help to achieve more accurate lesion assessment and, thereby, to improve the outcomes of percutaneous coronary intervention (PCI). Angiographic and IVUS data from 1369 lesions were analyzed. Mismatch lesion was defined as the difference between proximal and distal reference lumen diameters of ≥1.0 mm or ≥30% of the distal reference lumen diameter. The incidence of mismatch lesions was 20.1% (275/1369). Compared to nonmismatch group, mismatch group had longer lesions (21.3 [6.4] mm vs 18.4 [6.4] mm, P < .001) with smaller minimum lumen diameter (0.87 [0.29] mm vs 1.10 [0.31] mm, P < .001) and more severe diameter stenosis (78.8% [9.2%] vs 66.3% [10.3%], P < .001). On IVUS, mismatch group had larger lumen area (18.7 [5.0] vs 15.8 [5.1] mm2, P < .001) but lower plaque burden at the proximal reference segment (41.0% [9.2%] vs 45.7% [9.9%], P < .001) and smaller lumen area (4.83 [1.89] vs 7.36 [2.89] mm, P < .001) but higher plaque burden at the distal reference segment (42.9% [10.4%] vs 41.4% [10.1%], P = .023). Multivariable logistic regression analysis showed that mismatch lesions were frequently accompanied by diffuse lesions (odds ratio [OR] = 2.50; 95% confidence interval [CI]: 1.83-3.40; P < .001), bifurcation lesions (OR = 5.83; 95% CI: 4.40-7.74; P < .001), and lesions with a low TIMI flow grade (OR = 1.70; 95% CI: 1.08-2.67; P = .022) or severe diameter stenosis (OR = 3.05; 95% CI: 2.10-4.43; P < .001). Mismatch lesions are quite common and characterized by greater lesion complexity compared with nonmismatch lesions. Further studies may be necessary to address the impact of this lesion type on the outcome of PCI.

Correlation between adiponectin polymorphism and atherosclerotic plaque compositions under intravascular ultrasound (IVUS).

To discuss the correlation between polymorphism of rs266729 (-11377C/G, Cytosine/Guanine) (adiponectin promoter) site and atherosclerotic plaque compositions as well as related indicators under intravascular ultrasound (IVUS). 76 patients with coronary heart disease from December 2014 to December 2016 were enrolled. The PCR-RFLP method was used to analyze the adiponectin gene polymorphism in rs266729 site. All the objects were divided into CC type group (n=26), CG type group (n=23), and GG type group (n=27) according to the results of polymorphism. The amount of lesions and length of lesion in the vessel were determined according to the images of coronary angiography. The indicators from each group, including minimum external elastic membrane area, the smallest lumen area, the patch area, the patch load, the lipid pool area, the lipid pool/plaque area, the fiber cap thickness, the reconstruction index, the positive reconstruction, the negative reconstruction and the patch character were measured according to the IVUS results. The baseline data from distinct the gene types showed no significant difference. The results of quantitative IVUS plaque analysis indicated a statistical difference of factors such as plaque area, plaque burden, lipid pool area, lipid pool/plaque area, and remodeling index between the CC and GG types (p<0.05). The levels of aminopeptidase N (APN), tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), fasting serum insulin (FIN), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) among diverse groups presented statistical difference (p<0.05). Of note, the analysis results of IVUS qualitative components of plaque showed that soft plaque in CC group was 42.3% (11/26), which was significantly lower than GG group 11.1% (3/27) (p<0.05). The vascular remodeling ratio in CC group 26.9% (7/26) was also significantly decreased compared to that in GG group 66.7% (18/27) (p<0.05). The tubular and diffuse ratio in CC groups according to the comparison of diseased vessel, count, length of the lesion were 34.6% (9/26) and 42.3% (11/26), respectively. Our data on biochemical indicators demonstrates CC type gives rise to poor prognosis compared to GG type does, which suggests that close attention should be paid in the impact of adiponectin polymorphism on atherosclerotic plaque compositions.

Xylogenesis in the early life stages of maritime pine

Trees change throughout their life stages, and although age-dependent changes are reported in the literature, the early life stages of trees are often excluded from these studies. The sapling/pole life stage corresponds to the establishment phase of a tree in the forest. To understand how wood formation changes in the early growing stages we compared xylogenesis in saplings/pole (10–15 years old) and young trees (50–55 years old). Trees were selected from two adjacent areas in different regeneration phases from a maritime pine (Pinus pinaster Aiton) plantation located on the west coast of Portugal. The cambial and differentiating xylem cells were monitored from March 2015 to March 2017. The climatic conditions in these years were contrasting: 2015 was hot and dry and 2016 wet. Xylogenesis started around the same time in both age-classes but ended later in young trees in both years. Despite the shorter duration, sapling/pole trees formed more tracheids than young trees in both years, presenting an intensive growth strategy. Tracheids in young trees did not present differences between years, but sapling/pole trees presented fewer tracheids with a higher latewood proportion and smaller lumen area in the driest year (2015). Our results show that sapling/pole trees have an intensive growth strategy, whereas older trees (50–55 years) present a conservative growth strategy with a longer growing season. If the frequency and intensity of droughts increases, sapling/pole trees will reduce growth immediately, whereas older trees will reduce productivity in the following years. Thus, it is expected that forest productivity will decrease under a scenario of increasing drought.