Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Slides 1 20 -vulnerable patient with movies

57 views

Published on

SHAPE Society

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Slides 1 20 -vulnerable patient with movies

  1. 1. Dear Member of AEHA Thank you for participating in the First Vulnerable Patient Symposium. This educational CD contains multiple PowerPoint slide presentations along with animated movies. Also included the Part I and II of the Vulnerable Patient Manuscript. AEHA would like to thank the generous support of : Amersham Health, CV Therapeutics, diaDexus, and American Heart Technologies.
  2. 2. Introducing The Vulnerable Patient Consensus Statement Published in
  3. 3. Circulation Journal Vol108, No14; October 7, 2003
  4. 4. Abstract Circulation Journal Vol108, No14; October 7, 2003
  5. 5. Naghavi et al. Circulation. 2003;108:1664
  6. 6. Naghavi et al. Circulation. 2003;108:1664
  7. 7. Underlying Pathologies of "Culprit" Coronary Lesions Naghavi et al. Circulation. 2003;108:1664 Ruptured plaques ( ~ 70%) • Stenotic ( 20%) • Nonstenotic ( 50%) Nonruptured plaques ( ~ 30%) • Erosion • Calcified nodule • Others/Unknown *Adapted from Falk and associates,6 Davies,7 and Virmani and colleagues.7
  8. 8. Plaque rupture1966Constantinides Plaque rupture1966Chapman Thrombogenic gruel1964Byers Plaque ulceration1963Gore Plaque thrombosis1961Crawford Plaque erosion1957Helpern Plaque fissure1940Horn Rupture-induced occlusion1938Wartman Rupture of atheromatous abscess1934Leary Plaque rupture1931Olcott Description UsedYearAuthor Descriptions Used by Pioneers for Culprit Plaques Naghavi et al. Circulation. 2003;108:1664 Plaque ruptureFriedman 1966
  9. 9. Plaque rupture illustrated in 1966
  10. 10. The Challenge of Terminology • Culprit Plaque; A Retrospective Term Naghavi et al. Circulation. 2003;108:1664 Vulnerable Plaque = Future Culprit Plaque • Vulnerable Plaque; A Prospective Term
  11. 11. • Outward (positive) remodeling • Endothelial dysfunction • Intraplaque hemorrhage • Glistening yellow • Superficial calcified nodule Minor criteria • Critical Stenosis • Fissured plaque • Endothelial denudation with superficial platelet aggregation • Thin cap with large lipid core • Active inflammation (monocyte/macrophage and sometimes T-cell infiltration) Major criteria Criteria for Defining Vulnerable Plaque Based on the Study of Culprit Plaques Naghavi et al. Circulation. 2003;108:1664
  12. 12. • Shear stress (flow pattern throughout the coronary artery) • Calcification burden and pattern (nodule vs scattered, superficial vs deep, etc) • Collagen content versus lipid content, mechanical stability (stiffness and elasticity) • Color (yellow, glistening yellow, red, etc) • Remodeling (expansive vs constrictive remodeling) • Plaque stenosis (luminal narrowing) • Plaque lipid core size • Plaque cap thickness Plaque Morphology / Structure Markers of Vulnerability at the Plaque/Artery Level Naghavi et al. Circulation. 2003;108:1664
  13. 13. • Certain microbial antigens (eg, HSP60, C. pneumoniae) • Matrix-digesting enzyme activity in the cap (MMPs 2, 3, 9, etc) • Angiogenesis, leaking vasa vasorum, and intraplaque hemorrhage • Rate of apoptosis (apoptosis protein markers, coronary microsatellite, etc) Superficial platelet aggregation and fibrin deposition (residual mural • thrombus) • Plaque oxidative stress • Endothelial denudation or dysfunction (local NO production, anti- /procoagulation properties of the endothelium) • Plaque inflammation (macrophage density, rate of monocyte infiltration and density of activated T cell) Plaque Activity / Function Markers of Vulnerability at the Plaque/Artery Level Naghavi et al. Circulation. 2003;108:1664
  14. 14. • Total arterial burden of plaque including peripheral (eg, carotid IMT) • Total coronary vasoreactivity (endothelial function) • Total coronary calcium burden • Transcoronary gradient of serum markers of vulnerability Pan-Arterial Markers of Vulnerability at the Plaque/Artery Level Naghavi et al. Circulation. 2003;108:1664
  15. 15. Naghavi et al. Circulation. 2003;108:1664 The most common type
  16. 16. Naghavi et al. Circulation. 2003;108:1664 The Most Common Type of Vulnerable Plaque
  17. 17. Naghavi et al. Circulation. 2003;108:1664 Non-Stenotic Vulnerable Plaques overall are More Dangerous Since they are far More Frequent than Stenotic Ones
  18. 18. Writer and Director: Morteza Naghavi, MD Design and Animation: Mark Johnson Music: Eric Jarvis Click here to escape the movie Click to view the Natural History of Atherosclerosis and Vulnerable Plaques

×