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1) Clinical data confirms that coronary calcium detected by electron beam computed tomography (EBT) is found in 96% of patients presenting with or developing acute coronary syndromes, and that these patients have significantly greater coronary artery calcium scores at baseline compared to asymptomatic matched individuals. 2) Histologic studies show that coronary artery calcium occurs in all types of plaques, including stable (43%), rupture-prone (54%), and erosion-prone (77%) plaques. 3) Therefore, coronary artery calcium detected by imaging is a marker of atherosclerotic plaque burden but not necessarily a marker of stable or unstable plaque, as there is considerable overlap in calcium presence between different plaque types.
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162 calcium imaging
Scores >400 are associated with a 10-fold increased risk of future events. Calcium imaging should be used routinely to identify patients at high risk. Matthew Budoff is an assistant professor who presents on this topic and discloses a relationship with Imatron, Inc. relating to speaking engagements.
International Journal of Cardiovascular Diseases & Diagnosis
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Papillary fibroelastoma, a primary cardiac tumour commonly found on the cardiac valves is less frequently found on the non-valvular myocardium. Most non-valvular papillary fibroelastomas are confined to the left ventricle and the atrial origin of this tumour is rare. We present a case of papillary fibroelastoma originating from the left atrial ridge or the Coumadin ridge (the confluence of the long axis of the left upper pulmonary vein with the roof of the left atrial appendage). There are a few sporadic reports of the origin of papillary fibroelastomas from the left atrial ridge and the majority of these have presented with cerebral embolism. These uncommon tumours have a predilection to cause embolic phenomenon, especially those arising from the left atrial ridge. Hematuria post transplant
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162 calcium imaging
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International Journal of Cardiovascular Diseases & Diagnosis
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199 plaque severity and coronary occlusion
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2) Medical treatments like ACE inhibitors, beta-blockers, and aldosterone antagonists can reduce mortality in heart failure patients, but their effect on sudden cardiac death is limited.
3) Guidelines do not make strict recommendations for CRT-D vs CRT-P, preferring to offer guidance based on clinical condition, device complications, and cost. The document discusses factors to consider for individual patients.
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- Active immunization of mice with specific apo B-100 peptide sequences reduced atherosclerosis by up to 70% and shifted plaque composition.
- Passive immunization of mice with human antibodies against two peptides also reduced atherosclerosis and macrophage content in plaques.
- Some human IgM levels against oxidized LDL peptides correlate with severity of atherosclerosis and plaque composition.
- The research suggests certain oxidized LDL peptides could be targets for vaccines or passive immunotherapy to treat atherosclerosis
3 mouse
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213 oral apo ai mimetic peptide for reduction of atherosclerosis
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II. The peptides are thought to protect against atherosclerosis through reverse cholesterol transport and removing oxidized lipids. Orally administered D-amino acid peptides were shown to be stable in circulation and enhance HDL's ability to prevent LDL oxidation.
III. The research suggests D-amino acid apo A-I mimetic peptides could provide a potential oral treatment for atherosclerosis and other diseases caused by oxidized lipids.Arterial remodeling paul sch
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in patients with stable angina versus unstable coronary syndromes. It found that lesions in unstable patients had greater plaque burden despite similar lumen narrowing, and a greater extent of positive arterial remodeling compared to stable patients. Lesions in unstable patients also tended to have more echolucent plaque morphology. The results suggest that bulky, remodeled plaques may be more prone to rupture and cause acute coronary syndromes.
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The document discusses that less obstructive plaques pose a greater risk of coronary occlusion than severely obstructed plaques due to their greater numbers. It also states that the aggregate risk of rupture from many non-significant lesions exceeds that of fewer significant lesions, so a myocardial infarction is more likely to originate from a non-significant lesion. Additionally, it explains that while electron beam tomography (EBT) cannot identify vulnerable plaques directly, it can identify vulnerable patients based on their coronary artery calcium (CAC) scores and percentile ranks, as risk increases with higher scores. EBT is also useful for estimating prognosis and tracking changes in plaque in response to treatment over time.
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255 in vivo coronary sinus thermography
This document discusses in vivo coronary sinus thermography. It shows graphs of temperature differences over time between the coronary sinus and right atrium in controls and CAD patients, finding a significant difference. It lists ongoing research using thermography to study tachycardia, arrhythmias, medication effects, heart failure, and organ function. It concludes that new catheters are being developed to increase thermography sensitivity, it is being used in other parts of the cardiovascular system, and coronary sinus temperature may provide future information about patients, not just plaque.
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035 respiratory infection of apo e ko mice
1) Acute respiratory infection caused by influenza virus led to excessive plaque inflammation in the aortas of ApoE knockout mice.
2) One third of infected mice showed inflammatory infiltrates associated with platelet clusters and fibrin near the plaques.
3) The study aimed to investigate if acute respiratory infection can increase plaque inflammation and macrophage infiltration, and to examine related cytokine and receptor expression over the longer term.
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1. The study found that periadventitial fat tissue in atherosclerotic mouse models takes up more SPIO nanoparticles, a MRI contrast agent, than normal mice, and contains more macrophage-like cells.
2. Preliminary studies in rabbits and humans also showed greater SPIO uptake and more CD68+ cells in periadventitial fat of diseased vessels compared to healthy vessels.
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037 association for eradication of heart attack
This document discusses vulnerable plaque and the history of research on plaque vulnerability. It provides definitions of vulnerable plaque and different types of vulnerable plaque such as rupture-prone plaques. The document outlines pioneers in plaque research and emerging techniques for detecting vulnerable plaque both invasively, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and non-invasively using magnetic resonance imaging (MRI). It summarizes the natural history of vulnerable plaques and their role in acute coronary events.
3rd vulnerable plaque rumberger 3 16-02 1
Electron beam tomography (EBT) is a scanning method introduced in 1984 that can rapidly image the heart using a scanning electron beam. EBT has been used in over 600 scientific papers to study cardiac imaging and determine coronary artery calcium. Coronary artery calcification is the hardening of the coronary arteries that has been known for 300 years but is now understood to be an active process that can occur early in atherosclerotic plaque development and is intimately involved in the pathophysiology of coronary artery disease, regulated similarly to bone mineralization and repair. EBT images show calcification appears centrally within atherosclerotic plaques.
218 pharmacologic stabilization of vulnerable plaque
218 pharmacologic stabilization of vulnerable plaqueSociety for Heart Attack Prevention and Eradication
This document discusses potential pharmacologic approaches to stabilizing vulnerable plaque. It lists various categories of drugs that may help stabilize plaque, including anti-inflammatory agents, antioxidants, lipid-lowering agents, antiplatelets, anticoagulants, anti-microbials, and drugs that target specific inflammatory pathways and cytokines. Within each category, it provides examples of individual drugs that have been or could be investigated for plaque stabilization. The goal is to reduce inflammation and oxidation within plaque to make it less likely to rupture and cause heart attack or stroke. However, the concept of pharmacologically stabilizing vulnerable plaque is still preliminary and requires further research.208 peter libby
Dr. Peter Libby earned his medical degree from the University of California, San Diego and completed his training in internal medicine and cardiology at Brigham and Women's Hospital. He is currently the Mallinckrodt Professor of Medicine at Harvard Medical School and Chief of the Cardiovascular Division at Brigham and Women's Hospital. Dr. Libby's research focuses on the role of inflammation in vascular diseases like atherosclerosis. He has published extensively on cardiovascular medicine and atherosclerosis in journals like Circulation and The New England Journal of Medicine.
044 mice mri
This study aimed to image atherosclerotic plaques in the aortas of Apo E deficient mice using MRI. To visualize the aorta, contrast agent was injected into mice both while inside and outside of the MRI scanner. Respiratory gating was used to reduce motion artifacts from breathing by intubating mice and providing ventilation. Initial scans showed the aorta but more optimization is needed, such as decreasing the dose of iron contrast agent used and adding ECG gating to address motion from the heart. Future plans include further refining the MRI protocol and beginning a similar study in rabbits.
Vulnerable plaque overview
Vulnerable plaque refers to dangerous forms of atherosclerotic plaques that can rupture or induce thrombosis, disrupting blood flow. The document discusses the history and research around vulnerable plaque, including pioneers in the field and emerging techniques to detect vulnerable plaque such as intravascular ultrasound, optical coherence tomography, and magnetic resonance imaging. It summarizes that vulnerable plaques are typically characterized by a thin fibrous cap, large lipid core, and presence of macrophages.
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213 oral apo ai mimetic peptide for reduction of atherosclerosis
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218 pharmacologic stabilization of vulnerable plaque
218 pharmacologic stabilization of vulnerable plaque
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Harvey hecht md aeha sat
The document discusses the role of imaging coronary calcium using electron beam tomography (EBT) scans. It provides evidence that EBT calcium scores are strongly correlated with the amount of atherosclerotic plaque buildup. It also shows that higher EBT calcium scores are associated with significantly higher risks of future cardiovascular events, with risk increasing progressively as calcium scores rise. EBT calcium scoring more accurately predicts cardiovascular risk than traditional risk models like Framingham and can reclassify a person's risk level in about half of intermediate-risk individuals.
Rumberger
This document discusses using coronary artery calcium scoring via CT scan and high-sensitivity C-reactive protein (hs-CRP) testing to predict risk of myocardial infarction and sudden cardiac death in asymptomatic patients. It finds that higher calcium scores and hs-CRP levels are associated with greater risk. It recommends using a patient's calcium score, hs-CRP level, and their combination to stratify patients into low, intermediate, and high risk groups to guide clinical follow-up and aggressiveness of prevention efforts.
Budoff
Scores >400 are associated with a 10-fold increased risk of future events. Calcium imaging should be used routinely to identify patients at high risk. Matthew Budoff is an assistant professor who presents on this topic and discloses a relationship with Imatron, Inc. relating to speaking engagements.
162 calcium imaging
Scores >400 are associated with a 10-fold increased risk of future events. Calcium imaging should be used routinely to assess risk. Matthew Budoff is an assistant professor of cardiology who discloses a relationship with Imatron, Inc as a speaker.
ARVD (Arrythmogenic right ventricular cardiomyopathy) - updated task force cr...
This document discusses arrythmogenic right ventricular cardiomyopathy (ARVC). It begins by explaining the genetics of ARVC, noting that mutations can be either dominant or recessive. It then describes the natural history, clinical presentation, diagnosis, and criteria used to diagnose ARVC based on the revised Task Force Criteria. This includes major and minor criteria in categories such as imaging, electrocardiography findings, biopsy results, and family history. The document concludes by discussing management strategies for ARVC including ICD therapy, antiarrhythmic drugs, ablation, heart failure treatment, and transplantation.
Vp presentation jar 3 29 03
This document discusses how coronary artery calcium scoring using computed tomography (CT) and levels of the inflammatory marker C-reactive protein (CRP) can be used together to predict cardiovascular risk. It finds that higher calcium scores and CRP levels each indicate greater risk of future heart attacks and cardiac deaths. The combination of an intermediate calcium score and elevated CRP may identify patients who would benefit from more aggressive prevention treatment and closer follow-up. The document recommends using calcium scoring and CRP testing together in asymptomatic individuals to help refine clinical decision making and prevention strategies.
214 how can calcium score improve your practice
This document discusses how coronary artery calcium scoring using computed tomography (CT) and levels of the inflammatory marker C-reactive protein (CRP) can be used together to predict cardiovascular risk. It finds that higher calcium scores and CRP levels each indicate greater risk of future heart attacks and cardiac deaths. The combination of an intermediate calcium score and elevated CRP may identify those at intermediate risk who could benefit from more aggressive prevention efforts like closer follow-up or treatment targeting both inflammation and plaques. Together, calcium scoring and CRP testing provide complementary information that can refine clinical decision making for asymptomatic individuals.
214 how can calcium score improve your practice
This document discusses how coronary artery calcium scoring using computed tomography (CT) and levels of the inflammatory marker C-reactive protein (CRP) can be used together to predict cardiovascular risk. It finds that higher calcium scores and CRP levels each indicate greater risk of future heart attacks and cardiac deaths. The combination of an intermediate calcium score and elevated CRP may identify patients who would benefit from more aggressive prevention treatment and closer follow-up. The document recommends using calcium scoring and CRP testing together in asymptomatic individuals to help refine clinical decision making and prevention strategies.
Bicuspid Aortic Valve and Aortopathy
2015 review of BAV and associated aortopathy, including morphology, natural history and brief overview of management.
ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA/CARDIOMYOPATHY
ARVD is one of important coardiomyopathy in our clinical practice,early diagnosis, risk stratification and early diagnosis of CHF, management of VT will make big difference in patient life
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad ateroscleróticaSociedad Española de Cardiología
Focus en el diagnóstico y tratamiento de las enfermedades coronarias. Evolución no invasiva de la enfermedad ateroscleróticaarrhythmogenic right ventricular dysplasia/Cardiomyopathy
This case discusses arrhythmogenic right ventricular cardiomyopathy (ARVC) in a 19-year-old female whose sister recently passed away from the condition. ARVC is characterized by replacement of the RV myocardium with fibrofatty tissue and electrical instability. The patient's sister's autopsy confirmed ARVC. The doctor discusses the pathology, diagnosis, treatment including ICDs and screening of relatives of ARVC to help inform the patient of her risk.
Aeha muller 2
This document discusses various methods for identifying vulnerable plaques, including non-invasive imaging techniques like CT and MRI, as well as invasive techniques like intravascular ultrasound (IVUS) and optical coherence tomography (OCT). It summarizes several studies that examined autopsy specimens to determine the prevalence of thin-capped fibroatheromas and disrupted plaques. The document also describes the goals of using advanced IVUS spectral analysis to characterize plaque composition in vivo and a potential natural history study to determine if detecting vulnerable plaque can predict future cardiovascular events.
093 multi slice fast ct
This document discusses the use of electron beam tomography (EBT) and multi-slice computed tomography (MSCT) to detect and quantify coronary artery calcification as a means to identify asymptomatic individuals at increased risk of coronary events. Several clinical studies have demonstrated the prognostic value of coronary calcium detected by EBT. EBT and MSCT have sufficient resolution to visualize coronary arteries non-invasively. While calcium does not indicate vulnerable plaque, the amount of calcium correlates with overall plaque burden. Future studies will help define the role of calcium detection in clinical risk stratification, though MSCT has not yet been used in outcome studies. The meaning of non-calcified plaque detected by EBT and MSCT also requires further clarification.
093 multi slice fast ct
1) EBT and MSCT can visualize coronary arteries with sufficient resolution due to their temporal and spatial capabilities.
2) Clinical studies have shown coronary calcium detection via EBT can successfully identify asymptomatic individuals at increased risk of coronary events.
3) The prognostic value of non-calcified plaques detected by EBT and MSCT after contrast injection is still unclear. Future studies will help define the role of coronary calcium detection in risk stratification.
Ct calcium scoring 1
CT calcium scoring can detect asymptomatic coronary artery disease by identifying coronary artery calcification. Calcium starts accumulating early in atherosclerosis and increases as the disease progresses. While a calcium score of zero does not rule out disease, it is associated with a very low risk of cardiac events. Higher calcium scores correlate with increased risk. CT calcium scoring provides individualized risk assessment and can guide aggressive risk factor modification in high-risk patients.
Out flow tract ventricular tachycardia
A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the
emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with
gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular
function without delayed enhancement. The presenting electrocardiogram (ECG)
is shown in Figure 1.
Best strategy to improve patients quality of life
Best strategy to improve patients quality of life
dr. Patrianef, SpB(K)BV
PIT VII IDI Kota Bogor, 1-2 November 2014
Chris ellis calcium scoring cta
Coronary calcium scoring may be a more logical way to assess cardiovascular risk than established epidemiological models. The document discusses how atherosclerosis is complex and poorly understood, making risk assessment difficult. Studies show calcium scoring independently predicts risk and enhances risk stratification beyond traditional risk factors. Large trials found higher calcium scores strongly associated with future coronary events and mortality. The document argues looking for disease through calcium scoring is more intuitive than using charts or equations without an imaging biomarker of disease. It concludes calcium scoring individualizes risk assessment better than population-based guidelines.
Fuster aha-2005-dallas-biomarkers,
This document summarizes research on biochemical and imaging markers for cardiovascular disease. It includes 3 sections:
1. It discusses several major risk factors for cardiovascular events and how biomarkers like CRP, fibrinogen, and homocysteine can provide additional predictive value beyond traditional risk factors.
2. It reviews studies on emerging biomarkers for inflammation, thrombosis, and oxidative stress, and their association with future cardiovascular outcomes in prospective studies.
3. It presents data on imaging markers like carotid intimal thickness, echocardiography, and electron beam computed tomography and their ability to track disease severity and response to treatment.
The document concludes by discussing features of an ideal cardiovascular biomarker and potential surrogate markers of endothelial function
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More from Society for Heart Attack Prevention and Eradication
AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
AHA SHAPE Symposium 2017 Dr. Naghavi PresentationSociety for Heart Attack Prevention and Eradication
This document discusses developing an artificial intelligence system to predict short-term cardiovascular disease (CVD) events. The goal is to eradicate unexpected heart attacks by predicting risk similar to hurricane forecasts. Existing studies are cited that show over 50% of heart attacks are first symptoms of underlying disease. The document outlines previous work by SHAPE to define vulnerable patients and release guidelines. It proposes using machine learning on existing cohort data to develop algorithms predicting heart attacks within 12 months, and validate the system. The hope is this can trigger preventative actions and add over 10 years to life expectancy. Funding is needed to implement the proposed "Machine Learning Vulnerable Patient Project".AHA SHAPE Symposium 2017 Dr. Kloner Presentation
Triggers of cardiovascular events can include physical and emotional stress. Stress from events like earthquakes, blizzards, intense sporting games, and overexertion from activities like snow shoveling have been shown to increase the risk of acute cardiovascular outcomes like myocardial infarction. While modern therapies have improved cardiovascular health, research continues to show temporary increases in cardiovascular mortality associated with highly emotional sporting events even in recent years. Managing risk factors, reducing stress, and utilizing preventative therapies may help reduce the impact of triggers on cardiovascular health.
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland PresentationSociety for Heart Attack Prevention and Eradication
The document introduces the All of Us Research Program, which aims to collect health data from one million Americans to advance precision medicine research. It was announced by President Obama in 2015. The program receives funding from the federal government and private partners. It collects various types of health data from participants through surveys, health records, samples, and devices. The data is stored and shared securely while protecting privacy. The goal is to generate new medical discoveries and more personalized healthcare through collaboration between researchers and participants.AHA SHAPE Symposium 2017 Dr. Yen Presentation
A machine learning model outperformed the ACC/AHA Pooled Cohort Equations Risk Calculator in detecting high-risk asymptomatic individuals and recommending statin treatment for cardiovascular disease prevention in the Multi-Ethnic Study of Atherosclerosis. The machine learning model used support vector machines and data augmentation to derive a CVD risk predictor from nine variables in the MESA study population. It demonstrated higher sensitivity, specificity, and AUC compared to the ACC/AHA risk calculator, recommending statin treatment for fewer individuals while missing fewer cardiovascular events.
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
This document discusses machine learning applications in cardiac imaging presented by Piotr Slomka. It describes how machine learning can improve image analysis, diagnosis, and risk prediction. Machine learning combines multiple data points like imaging and clinical data to predict outcomes. Deep learning can perform tasks like image segmentation. Machine learning provides quantitative scores that predict disease, need for intervention, or patient outcomes to help clinicians. The goal is to integrate machine learning into clinical decision making.
Vu lplaque1 pasterkamp
This document summarizes a post-mortem study examining the prevalence of inflammatory cells in non-ruptured atherosclerotic plaques. The study found that moderate or heavy staining for macrophages was present in 45% of femoral artery cross-sections and 84% of femoral arteries had at least one cross-section with moderate/heavy inflammation. There was no observed relationship between the degree of inflammation in the left and right coronary arteries within individuals, indicating the level of local inflammation is locally determined with little predictive value for other arteries.
Vulnerable plaque vulnerable patient
The document provides guidelines for defining vulnerable plaque and vulnerable patients from the Association for Eradication of Heart Attack. It outlines major and minor histopathological and clinical criteria for vulnerable plaque including active inflammation, thin fibrous cap with large lipid core, endothelial denudation, and stenosis. Potential screening and diagnostic methods are discussed at the plaque, systemic, and blood levels ranging from non-invasive imaging to intravascular techniques. Different types of vulnerable plaque that can cause acute coronary events are also categorized.
Vulnerable patient talk in poland
The document summarizes research on vulnerable plaques and markers of vulnerability. It finds that ruptured plaques are the most common type of culprit lesion, accounting for around 70% of cases. Major criteria for defining vulnerable plaque include outward remodeling, endothelial dysfunction, and a thin fibrous cap with a large lipid core. Both plaque morphology and activity need to be assessed to identify vulnerability.
Vulnerable patient slides without movies
This document contains a summary of a presentation on vulnerable patient syndrome. It includes PowerPoint slides and videos on defining and identifying vulnerable plaques and patients. It thanks sponsors for their support of the educational event. The slides define vulnerable plaques as those likely to rupture in the future, causing heart attacks, and provide criteria for identifying them based on morphology and activity. Biomarkers and conditions that increase plaque and myocardial vulnerability are also summarized. The presentation outlines a pyramid approach for screening, diagnosing, and treating vulnerable patients annually to help reduce heart attacks and their high costs.
Vulnerable (thrombogenic blood
This document summarizes presentations from symposia on vulnerable plaque and discusses the relationship between plaque, blood, and patients in atherothrombosis. It notes that multiple factors like diabetes, smoking, and hyperlipidemia can make blood more thrombogenic and moderate the severity of acute events after plaque rupture. Statins, aspirin, and other drugs that target tissue factor or thrombin pathways may be promising antithrombotic agents by inhibiting thrombosis initiation and propagation.
Vuln shape aha 2005
The document discusses vulnerable plaque and challenges in detecting and treating it. It describes various imaging techniques for detecting vulnerable plaque such as thermography, MRI, CT angiography, and optical coherence tomography. However, it notes that while these can identify high-risk features, it remains unclear what exactly defines vulnerable plaque and whether imaging findings truly correlate with risk. The document also notes that while statins reduce events, the relationship between plaque burden and events is unclear, and better defining and detecting the disease is still needed before new therapies can be developed.
Vuln plaque poster burke
1) The study examined 92 hearts from patients with severe coronary artery disease who died suddenly. The hearts were sectioned and plaque types were classified.
2) The number of "vulnerable" plaques, particularly thin cap atheromas, was highest in hearts of patients who died from acute plaque rupture and lowest in those with incidental disease.
3) Thin cap atheromas and other unstable plaque types were concentrated in the proximal coronary segments, similar to the distribution of plaque ruptures. The study suggests vulnerable plaques contribute to acute coronary syndromes and are non-uniformly distributed within the coronary arteries.
Vp watch editorial_slide 25short-
1) Drug-coated stents, particularly those coated with sirolimus, have shown promise in reducing restenosis compared to bare metal stents. Sirolimus inhibits cell proliferation and has been shown in studies to reduce intimal hyperplasia and restenosis in animal models by 50% or more.
2) A study by Suzuki et al. found that a sirolimus-coated stent reduced restenosis by 50% through inhibiting cellular proliferation in a dose-dependent manner compared to a bare metal stent. Adding dexamethasone to the coating did not provide additional benefit.
3) If results of the RAVEL clinical trial showing "zero" restenosis out to 5 years
Vp watch editorial_slide25
This document discusses drug-coated stents for preventing restenosis. It summarizes a study showing that stents coated with sirolimus via a polymer matrix reduced restenosis by 50% by inhibiting cell proliferation. Adding dexamethasone provided no additional benefit. Other studies also showed sirolimus inhibits smooth muscle cell proliferation. If results of the RAVEL trial showing "zero" restenosis at 210 days hold true long-term, sirolimus-coated stents may become the standard therapy for coronary revascularization. Questions are raised about whether coating vulnerable plaques could be a primary treatment and if multiple vulnerable plaques would all be stented.
Vp watch editorial_slide25short-
1) Drug-coated stents, particularly those coated with sirolimus, have shown promise in reducing restenosis compared to bare metal stents. Sirolimus inhibits cell proliferation and has been shown in studies to reduce intimal hyperplasia and restenosis in animal models by 50% or more.
2) A study by Suzuki et al. found that a sirolimus-coated stent reduced restenosis by 50% through inhibiting cellular proliferation in a dose-dependent manner compared to a bare metal stent. Adding dexamethasone to the coating did not provide additional benefit.
3) If results of the RAVEL clinical trial showing "zero" restenosis out to 5 years
Vp watch2002
I. This document discusses various animal models that have been used to study atherosclerosis and plaque rupture, including quail, pigeons, chickens, dogs, monkeys, pigs, rats, rabbits, and mice. It provides details on the types of lesions developed and similarities to human disease for each model.
II. The double knockout LDL/apoE mice are highlighted as offering improvements in studying clinical complications of atherosclerosis like human heart disease. However, it is unclear how closely they model vulnerable plaques.
III. Questions are raised about how closely the coagulation systems of these animal models resemble humans and whether any model fully captures repeated plaque ruptures and the role of aging in natural history as seen in humans.
Vp symposium31602
Trans-Blood Vision is a patented infrared technique that uses short-wave infrared wavelengths to see directly through blood. It has the potential to find vulnerable plaque lesions without first entering them, determine their size and surface characteristics in high resolution, and look at their material constituents both on and below the surface. While it cannot provide direct visual guidance for therapy or penetrate as deeply as ultrasound, combining it with augmentative technologies could allow for real-time multi-mode detection, analysis, and therapy guidance of vulnerable plaque lesions. The document concludes that Trans-Blood Vision warrants significant investigation, possibly in combination with other emerging technologies.
Vpschoenhagen
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
Vp meeting orlando2003_new template
The document discusses ways to improve prediction of coronary events beyond the traditional Framingham Risk Score (FRS). It finds that adding C-reactive protein (CRP) measurement to the FRS results in a better model that significantly improves risk prediction, especially for those at intermediate risk. Measuring coronary artery calcium via scanning also seems to enhance prediction over the FRS alone. However, these findings require replication in other patient populations before firmly concluding CRP and calcium scoring can modify physician interpretation of patient risk based on the FRS.
Vpiii lobby-02
The document discusses magnetic resonance imaging (MRI) studies of atherosclerosis in human carotid arteries. It summarizes several studies examining features of carotid plaques such as calcified regions, neovasculature and necrotic cores, reproducibility of measurements, appearance of intraplaque hemorrhage, and MRI appearance of thick fibrous caps. The document includes MRI images and photomicrographs comparing MRI findings to histology.
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3rd vulnerable plaque rumberger 3 16-02 3
- 1. MI or SCD in Patients with VeryMI or SCD in Patients with Very Abnormal Cardiac Test ResultsAbnormal Cardiac Test Results 25% 12.3% Circ 1998;97:535-43 7.1% JACC 2001;37:1551-7 17% Cancer Database 0 5 10 15 20 25 30 EBT Score >1,000 Severe SPECT Abn. MWMA Stress Echo Lung Cancer Mortality AnnualEventRate(%) * Asymptomatic Subjects, No Intervention, 36 m. f/u, n=104 * Wayhs JACC 2002;39:225-30 ** ** Known Lung Cancer
- 2. 25 % 50 % 75 % 90 % Patient's Score Coronary Calcium Scores in Asymptomatic Women 1 10 100 1000 10000 35 40 45 50 55 60 65 70 75 80 Age CoronaryCalciumScore Coronary Calcium Scores in Asymptomatic Men 1 10 100 1000 10000 35 40 45 50 55 60 65 70 75 80 Age Electron Beam CT – Patient Database Hoff et al, Am J Cardiol 2001;87:1335-1339 EBT Database n=32,246
- 3. Prediction of MI/SCD in Asymptomatic Patients:Prediction of MI/SCD in Asymptomatic Patients: EBTEBT Raggi et al AHJ 2001;141:193-199Raggi et al AHJ 2001;141:193-199 0.36 0.51 0.71 0.99 1.38 1.92 2.64 3.62 4.9 6.54 0 1 2 3 4 5 6 7 0 10 20 30 40 50 60 70 80 90 Percentile Rank for Baseline EBCT Calcium Score 676 initially asymptomatic patients676 initially asymptomatic patients 3232++7 months f/u7 months f/u AnnualAnnual AbsoluteAbsolute RiskRisk
- 4. 15 1.25 1.6 1.6 1.8 2.15 2.35 2.5 5 Lp(a) Homocysteine TC Fibrinogen t-PA Ag TC/HDL hs-CRP hs-CRP + TC/HDL EBT Score > 75th RR in men from the Physicians Health Study - values in the upper quartile Meta-analysis of 6 EBT Studies Risk of MI in Apparently Healthy PeopleRisk of MI in Apparently Healthy People
- 5. 96% 16% 25% 8% 29% 8% 39% 0% 0 20 40 60 80 100 Obst. Disease 1-Vessel 2-Vessel 3-Vessel SCD (n=28) Control (n=18) Schmermund et alSchmermund et al AtherosclerosisAtherosclerosis 2001 Apr;155(2):499-5082001 Apr;155(2):499-508 %ofIncidence Obst. Disease: >75% area stenosis SCD in Patients Under the Age of 50 MOST acute coronary syndromes occur in patients with extensive pre-existing CAD
- 6. EBT and Vulnerable Plaque:EBT and Vulnerable Plaque: Stary ClassificationStary Classification I Isolated macrophage foam cells II Mainly intracellular lipid accumulation, “Fatty Streak” III Extra-cellular lipid pools, intra- and extra-cellular calcium IV Core of extra-cellular lipids, “Atheroma” V Lipid core covered by fibrous cap Fibroatheroma (Va)/Mainly calcific (Vb)/Mainly fibrotic (Vc) VI Surface defect (VIa)/Hematoma-hemorrhage (VIb)/Thrombus (VIc) “regression” possible potentially “vulnerable”
- 7. Clinical data confirm that coronary calcium by EBT is found in 96% of those patients either presenting or, in future, developing acute coronary syndromes - AND that the amount of CAC was significantly greater at baseline in such individuals compared with asymptomatic age and gender matched persons Histologic Plaque CharacteristicsHistologic Plaque Characteristics and Coronary Artery Calciumand Coronary Artery Calcium
- 8. Histologic Plaque CharacteristicsHistologic Plaque Characteristics and Coronary Artery Calciumand Coronary Artery Calcium 77 43 54 0 10 20 30 40 50 60 70 80 Acute Rupture Erosion Stable Frequency(%)Frequency(%) Histologic plaque characterizationHistologic plaque characterization Stary, Circ 1995;92:1355-1374Stary, Circ 1995;92:1355-1374 Davies, NEJM 1984;310:1137-1140Davies, NEJM 1984;310:1137-1140 Corrado, Circ 1994;90:2315-2323Corrado, Circ 1994;90:2315-2323 after Schmermund et alafter Schmermund et al Circulation [10/01]Circulation [10/01] 0 % 20 % Extent (relativetototalplaquearea)
- 9. Histologic Plaque CharacteristicsHistologic Plaque Characteristics and Coronary Artery Calciumand Coronary Artery Calcium Thus, because there exists considerable overlap between all types of plaques, calcium is a marker for neither stable nor unstable plaque
- 10. Histologic Plaque CharacteristicsHistologic Plaque Characteristics and Coronary Artery Calciumand Coronary Artery Calcium Thus, because there exists considerable overlap between all types of plaques, calcium is a marker for neither stable nor unstable plaque