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Intravascular ultrasound (IVUS) can be used to characterize plaque and select populations for interventional diagnosis and treatment. IVUS has the potential to identify vulnerable plaque by measuring plaque volume and distinguishing tissue types, with a sensitivity of 90% and specificity of 95%. While current IVUS systems provide high resolution imaging, research aims to improve tissue contrast and resolution through techniques analyzing the radiofrequency signal and comparing IVUS to other imaging modalities. IVUS is widely used today for intravascular imaging but continued advances may help identify individuals at high risk of heart events.
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Detection of vulnerable atherosclerotic plaques by nis
Detection of vulnerable atherosclerotic plaques by nisSociety for Heart Attack Prevention and Eradication
Near-infrared spectroscopy can identify features of vulnerable atherosclerotic plaques by analyzing biological tissue absorbance in the near-infrared wavelength range. Studies from 1998-2001 showed this technique could detect lipid pools, thin caps, and macrophages in human aortic plaques with high sensitivity and specificity. It also identified lipid-rich plaques in human coronary sections and living rabbit models. A percutaneous coronary near-infrared spectroscopy catheter was tested safely in pigs and humans. Additional clinical studies are needed but this technique may help identify vulnerable plaques in the catheterization laboratory.104 new advances in thermography
Thermography is a new technique for detecting atherosclerotic plaque vulnerability. A new catheter-based system called the Epiphany Thermography System can precisely measure plaque temperature and has shown higher temperatures in proximal versus distal plaque segments. Studies have found that greater temperature differences between segments predicts future cardiovascular events, with 86% sensitivity and 79% specificity. Preliminary research also indicates thermography may help identify vulnerable patients by measuring inflammation levels in coronary sinus blood draining the heart.
Introducing a novel model
1) Researchers studied a novel method for quantifying and tracking macrophage homing into atherosclerotic plaques using superparamagnetic iron oxide nanoparticles (SPIO).
2) They injected SPIO into ApoE-deficient mice with and without proinflammatory cytokines and found higher iron content and more macrophages in plaques of cytokine-treated mice using histology and mass spectrometry.
3) This demonstrates that SPIO allows both quantitative and qualitative assessment of macrophage infiltration and shows infiltration is enhanced by cytokines, suggesting SPIO-enhanced MRI could noninvasively monitor monocyte recruitment dynamics into plaques over time.
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This document discusses inflammation in coronary arteries and culprit lesions. It finds that:
1. Inflammation is present in many non-culprit lesions, not just culprit lesions, based on a study of 74 coronary arteries.
2. Inflammation therefore has a very low positive predictive value (<3%) for identifying the actual culprit lesion responsible for a clinical event like a heart attack.
3. Inflammation appears to be a local arterial phenomenon, as cross-sectional sampling of inflammation in one part of an artery did not strongly correlate with levels in other parts or in paired left/right arteries.
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This document provides an overview of the new VP.org website and its goals of promoting research on vulnerable plaque (VP). Key points:
1) The website will include an online library called "Atheroline" with medical literature and multimedia about atherosclerosis and VP.
2) A toolbar will provide one-click access to VP-related information resources.
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4) An upcoming VP symposium is announced to bring together researchers and the VP community. The overall aim is to accelerate research with the goal of someday eradicating heart attacks.
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This document summarizes research on intravascular ultrasound elastography, a technique to identify vulnerable plaques. It discusses how elastography works by measuring the strain (deformation) of tissues under pressure changes. Studies found elastography could detect plaque composition like lipid pools and distinguish vulnerable plaques with thin fibrous caps and large lipid cores. In vivo studies in humans and animals demonstrated elastography identifies regions with high strain that correspond to vulnerable plaque characteristics. Elastography provides a potential new method to detect vulnerable plaques at high risk of rupture.
134 mr contrast agents for vulnerable plaque imaging
134 mr contrast agents for vulnerable plaque imagingSociety for Heart Attack Prevention and Eradication
1. MS-325 is an albumin-targeted gadolinium contrast agent that highlights inflamed vessel walls and facilitates plaque imaging. It provides prolonged vessel wall enhancement on MRI, allowing for detection of plaque burden and characterization.
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Histopathological results of spio distribution in mice (after 24hs)
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The document describes histopathology results showing fluorescent microspheres adhering to atherosclerotic plaques in an Apo E mouse model after 24 hours. One macrophage was seen containing 10 fluorescent microspheres adhering to a fibrous plaque. An aggregation of 4 labeled macrophages was attached to an advanced plaque. Numerous macrophages were adhering to an isolated fatty streak comprised mainly of foam cells.111 human carotid mri spio
This document discusses using superparamagnetic iron oxide (SPIO) enhanced MRI to non-invasively detect vulnerable plaque. Vulnerable plaque can cause heart attacks and strokes by rupturing or eroding and suddenly blocking arteries. Different types of vulnerable plaque are described. SPIO particles are colloidal iron oxide that can enhance MRI detection of plaque activity beyond just morphology. Studies in animals and initial human clinical trials using SPIO MRI to identify vulnerable carotid plaque before endarterectomy are mentioned as promising for non-invasive detection.
Detection of vp by mri after spio maziar
1) This study investigated the use of super paramagnetic iron oxide (SPIO) nanoparticles and MRI to detect active inflammation in atherosclerotic plaques.
2) In mouse and rabbit models of atherosclerosis, SPIO accumulated in atherosclerotic lesions and correlated with histological markers of inflammation.
3) MRI of plaques in these animals showed changes after SPIO injection, indicating SPIO can help identify actively inflamed plaques.
4) A current human clinical trial is evaluating if SPIO-enhanced MRI can detect vulnerable carotid plaques by comparing MRI to histology of plaques removed in surgery.
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This document describes an experiment examining the uptake of Feridex, an iron oxide nanoparticle, by macrophages over time and at different concentrations of Feridex. Macrophages were exposed to four concentrations of Feridex mimicking the in vivo ratio and incubated for 20 minutes, 1 hour, 6 hours, and 24 hours. The percentage of macrophages that took up Feridex increased with both higher Feridex concentrations and longer incubation times.
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SPECT/CT shows promise for atherosclerosis imaging by combining anatomical CT imaging of plaque volume with molecular SPECT imaging of plaque activity. SPECT could potentially image multiple molecular processes simultaneously, such as apoptosis, oxidized LDL, or inflammation. Recent advances in SPECT technology include improved resolution, sensitivity, and the ability to perform dynamic cardiac SPECT to quantify blood flow and endothelial function. Combined structural and molecular imaging may allow more accurate risk assessment and monitoring of treatment response than anatomical methods alone. However, further developments are still needed, including new tracers approved for human use.
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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.
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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.
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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.
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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.
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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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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.
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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.
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This document discusses triggers for sudden cardiac arrest (SCA) and death (SCD). It notes that over 2/3 of SCD cases are unable to be predicted due to a lack of well-established risk factors. While population risk factors can identify at-risk groups, they cannot predict risk for individuals. The document explores various biological, anatomical, and environmental factors that can precipitate fatal arrhythmias and discusses how the timing of transient initiating events is critical for the development of ventricular tachyarrhythmias. It emphasizes that myocardial electrophysiological processes likely determine the onset or lack of VT/VF/SCD and that immediate access to automated external defibrillators is needed to save lives.
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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.
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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.
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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.
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At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
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Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
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It is a progressive disease of lungs.
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The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
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Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
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Boston sci
- 1. Intravascular Ultrasound for Plaque Characterization Scott R. Smith Boston Scientific Corporation The 3rd Vulnerable Plaque Symposium March 16, 2002
- 2. Who needs interventional diagnosis and treatment? Population Size Annual Risk Healthy People Huge <<1% “Risk Factors” Really Big ~1% Walking Time Bombs Still quite a few >10% Summary of National Heart, Lung, and Blood Institute Workshop on Cardiovascular Risk Assessment
- 3. Diagnosis of Vulnerable Plaque selecting a population positive negative 67% positive predictive value 99% negative predictive value likelyhood ratio test 9% 5% total unaffected 14% true positive false positive 1% 86% 87% false negative true negative positive negative 18 90% 95% sensitivity specificity 10% 90% total affected Total 100 at risk 10 treated 14 saved 9 unnecessary 5 missed 1
- 4. Plaque Structure Courtesy of Dr. Renu Virmani Armed Forces Institute of Pathology
- 5. IVUS Plaque Imaging Ruptured plaque
- 6. Boston Scientific Imaging Systems Atlantis™ SR Plus Catheter Galaxy™ IVUS System Features & Intended Benefits • Tapered tip; 2.5 Fr. Crossing Profile • High definition 40MHz IVUS catheter. • 6F Guide Catheter Compatibility.
- 7. Galaxy™ System Features and Intended Benefits Time-Saving Features – Image Bookmarking – LongView™ longitudinal measurements – Pullback sled Enhanced Ease of Use – TraceAssist™ automatic lumen trace function – Angiographic compatibility – Push button control
- 8. Galaxy™ System Research Capabilities Expanded Functionality – Digital image storage – Patient database – Pre/post intervention analysis. RF Output – Direct Access to RF signal for acquisition and analysis – Future plans may include direct RF signal acquisition
- 9. Imaging vs. Analysis RF Rectified and Log compressed Low passed filtered - 10MHz One image vector
- 10. Other Imaging Modalities IVUS acoustic impedance MRI proton relaxation Thermal temperature OCT refractive index Spectroscopy chemical bonds Independence Spatial resolution Contrast
- 11. Conclusion • Intravascular Ultrasound currently widely used for intravascular imaging • Broad potential for plaque volume measurement and tissue characterization • Variety of research efforts aimed at improving tissue contrast and resolution Thanks to: – Tat Jin Teo, PhD - BSC Imaging – Renu Virmani, MD - AFIP – Jay Kokate, PhD - BSC Applied Research