SlideShare a Scribd company logo
Editorial Slides
VP Watch, March 4, 2002, Volume 2, Issue 9
Positive Remodeling, A Surrogate Marker of
Plaque Inflammation and Vulnerability?
By: Gerard Pasterkamp, M.D., Ph.D.
Inter University Cardiology Institute of the Netherlands
Determinants of Atherosclerotic
Luminal Narrowing
 In the long term:
i. Plaque formation
ii. The mode of geometrical remodelling
a) Expansive remodeling prevents whereas
b) Constrictive remodeling accelerates luminal
narrowing
 Acutely:
>> plaque rupture/erosion with subsequent
thrombus formation.
* In some cases, plaque rupture goes silent and the healing process results in
fibrous cap formation and further luminal narrowing.
Seymour Glagov:
Compensatory Enlargement of Human
Atherosclerotic Coronary Arteries
”Positive Remodeling”
<50%
stenosis
<80%
stenosis
Luminal area is not endangered until more than 40% of internal
elastic lamina is destructed and occupied by plaque.
Coronary artery disease is a disease
of arterial wall not lumen.
Arterial Remodeling
Gradual Luminal Narrowing
Expansive
Remodeling
Constrictive
Remodeling
Histological Characteristics of the
Plaque that is Prone to Rupture
Plaque Rupture
 Previous studies demonstrated that:
a. Histologically: an association between expansive
remodeling and markers for plaque vulnerability in
unruptured plaques. 1,2
b. Clinically: an association between expansive
remodeling and unstable clinical syndromes. 3,4
 As highlighted in VP Watch,
Varnava et al. studied the
associaton between de novo
atherosclerotic remodeling and
histological markers for plaque
vulnerability in plaques (n=108)
obtained from patients (n=88)
that died of coronary artery
disease.
Results:
64/108 plaques revealed expansive
remodelling.
44/108 revealed constrictive remodelling.
Lipid core was larger in expansively
remodelled plaques (39+/-21 % versus 22+/-
23%).
Macrophage count was higher in expansively
remodelled segments.
Conclusion:
I. In patients that died acutely of coronary
artery disease, expansive remodeling is
associated with a vulnerable plaque
phenotype.
II. This observation may explain why acute
coronary syndromes often originate from
locations with minor luminal stenosis (but
with outward remodelled plaques).
Questions:
1. Studies are cross-sectional, thus no causal
of prognostic inferences are allowed.
The question is what is the predictive value
of the remodelling mode for the occurrence
of plaque rupture and an acute
cardiovascular event?
 To answer this, serial (IVUS) studies are
necessary.
Questions:
2. Remodelling is a double edged sword: in
the long term expansive remodeling
prevents luminal narrowing by plaque
formation. In the short term these plaques
are more prone to rupture giving rise to an
acute cardiovascular event. How can we induce
expansive remodeling without destabilizing the
plaques?
 To answer this, good animal models are needed that
develop both types of geometrical remodeling
Questions:
3. In this study, positive (expansive)
remodeling was present in 72%, however
negative (constrictive) remodeling was
also present in 50%, the question is how
these two correlate with each other?
4. If expansive remodeling correlate with
macrophage count and thin cap and can be a
surrogate marker of vulnerability, what is the
predictive value of constrictive remodeling
(stenosis in angiography) in predicting presence
of expansive remodeling and vulnerability to
rupture in other plaques in the same patient?
Suggestion:
VP.org Editorial Suggestion:
- Please email your thoughts to:
Discussion-Group@VP.org or DG@VP.org
1- Atherosclerotic arterial remodeling and the localization of macrophages and matrix
metalloproteases 1, 2 and 9 in the human coronary artery; Atherosclerosis 2000;
150(2):245-253 ; Gerard Pasterkamp, Arjan H. Schoneveld, Dirk Jan Hijnen, Dominique P.
V. de Kleijn, Hans Teepen, A. C. van der Wal and Cornelius Borst
2- Relation of arterial geometry to luminal narrowing and histologic markers for plaque
vulnerability: the remodeling paradox, J American Coll Cardio 1998; 32(3):655-662
Gerard Pasterkamp, Arjan H. Schoneveld, Allard C. van der Wal, Christian C.
Haudenschild, Ruud J. G. Clarijs, Anton E. Becker, Berend Hillen and Cornelius Borst
3- Coronary artery disease: arterial remodelling and clinical presentation Heart 1999; 82:
461-464. P C Smits, G Pasterkamp, M A Quarles van Ufford, F D Eefting, P R Stella, P P T
de Jaegere, and C Borst
4- Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary
Syndromes
: An Intravascular Ultrasound Study; Paul Schoenhagen, Khaled M. Ziada, Samir R.
Kapadia, Timothy D. Crowe, Steven E. Nissen, and E. Murat Tuzcu; Circulation 2000 101:
598 - 603.
5 Compensatory Enlargement of Human Atherosclerotic Coronary Arteries. Seymour Glagov:
New England Journal of Medcine 1987 May 28;316(22):1371-5
References

More Related Content

What's hot

In stent retenosis pathophysiology
In stent retenosis pathophysiologyIn stent retenosis pathophysiology
In stent retenosis pathophysiology
Nilesh Tawade
 
In stent re stenosis
In stent re stenosisIn stent re stenosis
In stent re stenosis
SR,CARDIOLOGY,JIPMER,PUDUCHERRY
 
Problem associated with drug eluting stent
Problem associated with drug eluting stentProblem associated with drug eluting stent
Problem associated with drug eluting stent
PRAVEEN GUPTA
 
In stent neoatherosclerosis
In stent neoatherosclerosis In stent neoatherosclerosis
In stent neoatherosclerosis
Kunal Mahajan
 
Coronary restenosis after stent implantation
Coronary restenosis after stent implantationCoronary restenosis after stent implantation
Coronary restenosis after stent implantation
Michael M
 
Nanomedicina1
Nanomedicina1Nanomedicina1
Nanomedicina1
joanamatux
 
In stent retenosis treatment
In stent retenosis treatmentIn stent retenosis treatment
In stent retenosis treatment
Nilesh Tawade
 
Bioabsorbable Drug-Eluting Cardiac Stent Analysis
Bioabsorbable Drug-Eluting Cardiac Stent AnalysisBioabsorbable Drug-Eluting Cardiac Stent Analysis
Bioabsorbable Drug-Eluting Cardiac Stent Analysis
University of Toronto
 
Bioabsorbable Scaffolds
Bioabsorbable ScaffoldsBioabsorbable Scaffolds
Bioabsorbable Scaffolds
Ankur Batra
 
Instent restenosis
Instent restenosis Instent restenosis
Instent restenosis
Sayee Venkatesh
 
COMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSM
COMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSMCOMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSM
COMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSMguest629cef
 
Radiological pathology of cortical laminar necrosis
Radiological pathology of cortical laminar necrosisRadiological pathology of cortical laminar necrosis
Radiological pathology of cortical laminar necrosis
Professor Yasser Metwally
 
2D CFD simulation of intracranial aneurysm
2D CFD simulation of intracranial aneurysm2D CFD simulation of intracranial aneurysm
2D CFD simulation of intracranial aneurysmwalshb88
 
Coronary Stent Design- Part B
Coronary Stent Design- Part BCoronary Stent Design- Part B
Coronary Stent Design- Part B
Amir Kraitzer
 
Issues in radiological pathology: Radiological pathology of watershed infarct...
Issues in radiological pathology: Radiological pathology of watershed infarct...Issues in radiological pathology: Radiological pathology of watershed infarct...
Issues in radiological pathology: Radiological pathology of watershed infarct...
Professor Yasser Metwally
 
Prediction of Restenosis After PCI with Contemporary Drug-Eluting Stents
Prediction of Restenosis After PCI with Contemporary Drug-Eluting StentsPrediction of Restenosis After PCI with Contemporary Drug-Eluting Stents
Prediction of Restenosis After PCI with Contemporary Drug-Eluting Stents
Sociedad Latinoamericana de Cardiología Intervencionista
 
Endocarditis review
Endocarditis reviewEndocarditis review
Endocarditis reviewscott homann
 

What's hot (17)

In stent retenosis pathophysiology
In stent retenosis pathophysiologyIn stent retenosis pathophysiology
In stent retenosis pathophysiology
 
In stent re stenosis
In stent re stenosisIn stent re stenosis
In stent re stenosis
 
Problem associated with drug eluting stent
Problem associated with drug eluting stentProblem associated with drug eluting stent
Problem associated with drug eluting stent
 
In stent neoatherosclerosis
In stent neoatherosclerosis In stent neoatherosclerosis
In stent neoatherosclerosis
 
Coronary restenosis after stent implantation
Coronary restenosis after stent implantationCoronary restenosis after stent implantation
Coronary restenosis after stent implantation
 
Nanomedicina1
Nanomedicina1Nanomedicina1
Nanomedicina1
 
In stent retenosis treatment
In stent retenosis treatmentIn stent retenosis treatment
In stent retenosis treatment
 
Bioabsorbable Drug-Eluting Cardiac Stent Analysis
Bioabsorbable Drug-Eluting Cardiac Stent AnalysisBioabsorbable Drug-Eluting Cardiac Stent Analysis
Bioabsorbable Drug-Eluting Cardiac Stent Analysis
 
Bioabsorbable Scaffolds
Bioabsorbable ScaffoldsBioabsorbable Scaffolds
Bioabsorbable Scaffolds
 
Instent restenosis
Instent restenosis Instent restenosis
Instent restenosis
 
COMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSM
COMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSMCOMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSM
COMPUTATIONAL ASSESSMENT OF INTRA-CRANIAL ANEURYSM
 
Radiological pathology of cortical laminar necrosis
Radiological pathology of cortical laminar necrosisRadiological pathology of cortical laminar necrosis
Radiological pathology of cortical laminar necrosis
 
2D CFD simulation of intracranial aneurysm
2D CFD simulation of intracranial aneurysm2D CFD simulation of intracranial aneurysm
2D CFD simulation of intracranial aneurysm
 
Coronary Stent Design- Part B
Coronary Stent Design- Part BCoronary Stent Design- Part B
Coronary Stent Design- Part B
 
Issues in radiological pathology: Radiological pathology of watershed infarct...
Issues in radiological pathology: Radiological pathology of watershed infarct...Issues in radiological pathology: Radiological pathology of watershed infarct...
Issues in radiological pathology: Radiological pathology of watershed infarct...
 
Prediction of Restenosis After PCI with Contemporary Drug-Eluting Stents
Prediction of Restenosis After PCI with Contemporary Drug-Eluting StentsPrediction of Restenosis After PCI with Contemporary Drug-Eluting Stents
Prediction of Restenosis After PCI with Contemporary Drug-Eluting Stents
 
Endocarditis review
Endocarditis reviewEndocarditis review
Endocarditis review
 

Viewers also liked

Viewers also liked (19)

504 percutaneouse coronary intervention
504 percutaneouse coronary intervention504 percutaneouse coronary intervention
504 percutaneouse coronary intervention
 
Elastography
ElastographyElastography
Elastography
 
Drleakeresearch
DrleakeresearchDrleakeresearch
Drleakeresearch
 
Dropped ismrm2001-mri spio
Dropped ismrm2001-mri spioDropped ismrm2001-mri spio
Dropped ismrm2001-mri spio
 
247 ebct vs conventional risk factors
247 ebct vs conventional risk factors247 ebct vs conventional risk factors
247 ebct vs conventional risk factors
 
Embolic protection devices yadav- cleveland clinic
Embolic protection devices  yadav- cleveland clinicEmbolic protection devices  yadav- cleveland clinic
Embolic protection devices yadav- cleveland clinic
 
From pneumonia to influenza
From pneumonia to influenzaFrom pneumonia to influenza
From pneumonia to influenza
 
Esv2n28
Esv2n28Esv2n28
Esv2n28
 
Final clickable pps for vp s ymposium @aha 2001
Final clickable pps for vp s ymposium @aha 2001Final clickable pps for vp s ymposium @aha 2001
Final clickable pps for vp s ymposium @aha 2001
 
252 statin therapy influence on coronary calcification
252 statin therapy influence on coronary calcification252 statin therapy influence on coronary calcification
252 statin therapy influence on coronary calcification
 
Harvey hecht md aeha sat
Harvey hecht md aeha satHarvey hecht md aeha sat
Harvey hecht md aeha sat
 
Detection of production preliminary
Detection of production preliminaryDetection of production preliminary
Detection of production preliminary
 
167 plaque p h heterogeneity in physiological media
167 plaque p h heterogeneity in physiological media167 plaque p h heterogeneity in physiological media
167 plaque p h heterogeneity in physiological media
 
Genetic influence ppt11
Genetic influence ppt11Genetic influence ppt11
Genetic influence ppt11
 
Detection of vp with spectroscopy
Detection of vp with spectroscopyDetection of vp with spectroscopy
Detection of vp with spectroscopy
 
Esv2n14
Esv2n14Esv2n14
Esv2n14
 
242 lipid lowering
242 lipid lowering242 lipid lowering
242 lipid lowering
 
Esv2n30
Esv2n30Esv2n30
Esv2n30
 
Dna microarray application in vp research mehran
Dna microarray application in vp research  mehranDna microarray application in vp research  mehran
Dna microarray application in vp research mehran
 

Similar to Editorialslides v2n9

034 everybody has atherosclerosis
034 everybody has atherosclerosis034 everybody has atherosclerosis
034 everybody has atherosclerosis
SHAPE Society
 
Vulnerable plaque
Vulnerable plaqueVulnerable plaque
Vulnerable plaque
Amit Gulati
 
149 revisiting the basics
149 revisiting the basics149 revisiting the basics
149 revisiting the basics
SHAPE Society
 
Ac cculprit
Ac cculpritAc cculprit
Ac cculprit
SHAPE Society
 
203 pathologic substrate of coronary plaque erosion
203 pathologic substrate of coronary plaque erosion203 pathologic substrate of coronary plaque erosion
203 pathologic substrate of coronary plaque erosion
SHAPE Society
 
Stem cell transplantation for heart failure
Stem cell transplantation for heart failureStem cell transplantation for heart failure
Stem cell transplantation for heart failure
Ramachandra Barik
 
Myocardial infarction
Myocardial infarctionMyocardial infarction
Myocardial infarctionadolescent4u
 
ATHEROSCLEROSIS
ATHEROSCLEROSIS ATHEROSCLEROSIS
ATHEROSCLEROSIS
Goutamivkohir
 
Cerebrovascular atherosclerosis
Cerebrovascular atherosclerosis  Cerebrovascular atherosclerosis
Cerebrovascular atherosclerosis
NeurologyKota
 
ClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdf
ClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdfClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdf
ClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdf
Irving Torres Lopez
 
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
QUESTJOURNAL
 
Coronary Aneurysms: What Every Radiologist Should Know
Coronary Aneurysms: What Every Radiologist Should KnowCoronary Aneurysms: What Every Radiologist Should Know
Coronary Aneurysms: What Every Radiologist Should KnowGarry Choy MD MBA
 
Blister Aneurysms
Blister Aneurysms Blister Aneurysms
Blister Aneurysms
Dr Vipul Gupta
 
CEREBRAL VENOUS THROMBOSIS
CEREBRAL VENOUS THROMBOSISCEREBRAL VENOUS THROMBOSIS
CEREBRAL VENOUS THROMBOSIS
Srirama Anjaneyulu
 

Similar to Editorialslides v2n9 (20)

Esv2n32
Esv2n32Esv2n32
Esv2n32
 
034 everybody has atherosclerosis
034 everybody has atherosclerosis034 everybody has atherosclerosis
034 everybody has atherosclerosis
 
Mri spio
Mri spioMri spio
Mri spio
 
034 everybody has atherosclerosis
034 everybody has atherosclerosis034 everybody has atherosclerosis
034 everybody has atherosclerosis
 
Vulnerable plaque
Vulnerable plaqueVulnerable plaque
Vulnerable plaque
 
149 revisiting the basics
149 revisiting the basics149 revisiting the basics
149 revisiting the basics
 
Ac cculprit
Ac cculpritAc cculprit
Ac cculprit
 
203 pathologic substrate of coronary plaque erosion
203 pathologic substrate of coronary plaque erosion203 pathologic substrate of coronary plaque erosion
203 pathologic substrate of coronary plaque erosion
 
203 pathologic substrate of coronary plaque erosion
203 pathologic substrate of coronary plaque erosion203 pathologic substrate of coronary plaque erosion
203 pathologic substrate of coronary plaque erosion
 
Esv2n37 a
Esv2n37 aEsv2n37 a
Esv2n37 a
 
Stem cell transplantation for heart failure
Stem cell transplantation for heart failureStem cell transplantation for heart failure
Stem cell transplantation for heart failure
 
Myocardial infarction
Myocardial infarctionMyocardial infarction
Myocardial infarction
 
Tct mri 2001
Tct mri 2001Tct mri 2001
Tct mri 2001
 
ATHEROSCLEROSIS
ATHEROSCLEROSIS ATHEROSCLEROSIS
ATHEROSCLEROSIS
 
Cerebrovascular atherosclerosis
Cerebrovascular atherosclerosis  Cerebrovascular atherosclerosis
Cerebrovascular atherosclerosis
 
ClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdf
ClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdfClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdf
ClinicalOutcomesFollowingCoronary BifurcationPCITechniques.pdf
 
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
 
Coronary Aneurysms: What Every Radiologist Should Know
Coronary Aneurysms: What Every Radiologist Should KnowCoronary Aneurysms: What Every Radiologist Should Know
Coronary Aneurysms: What Every Radiologist Should Know
 
Blister Aneurysms
Blister Aneurysms Blister Aneurysms
Blister Aneurysms
 
CEREBRAL VENOUS THROMBOSIS
CEREBRAL VENOUS THROMBOSISCEREBRAL VENOUS THROMBOSIS
CEREBRAL VENOUS THROMBOSIS
 

More from Society for Heart Attack Prevention and Eradication

AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
AHA SHAPE Symposium 2017 Dr. Naghavi PresentationAHA SHAPE Symposium 2017 Dr. Naghavi Presentation
AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
Society for Heart Attack Prevention and Eradication
 
AHA SHAPE Symposium 2017 Dr. Kloner Presentation
AHA SHAPE Symposium 2017 Dr. Kloner PresentationAHA SHAPE Symposium 2017 Dr. Kloner Presentation
AHA SHAPE Symposium 2017 Dr. Kloner Presentation
Society for Heart Attack Prevention and Eradication
 
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland PresentationAHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
Society for Heart Attack Prevention and Eradication
 
AHA SHAPE Symposium 2017 Dr. Yen Presentation
AHA SHAPE Symposium 2017 Dr. Yen PresentationAHA SHAPE Symposium 2017 Dr. Yen Presentation
AHA SHAPE Symposium 2017 Dr. Yen Presentation
Society for Heart Attack Prevention and Eradication
 
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
AHA SHAPE Symposium 2017 Dr. Slomka PresentationAHA SHAPE Symposium 2017 Dr. Slomka Presentation
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
Society for Heart Attack Prevention and Eradication
 

More from Society for Heart Attack Prevention and Eradication (20)

AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
AHA SHAPE Symposium 2017 Dr. Naghavi PresentationAHA SHAPE Symposium 2017 Dr. Naghavi Presentation
AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
 
AHA SHAPE Symposium 2017 Dr. Kloner Presentation
AHA SHAPE Symposium 2017 Dr. Kloner PresentationAHA SHAPE Symposium 2017 Dr. Kloner Presentation
AHA SHAPE Symposium 2017 Dr. Kloner Presentation
 
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland PresentationAHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
 
AHA SHAPE Symposium 2017 Dr. Yen Presentation
AHA SHAPE Symposium 2017 Dr. Yen PresentationAHA SHAPE Symposium 2017 Dr. Yen Presentation
AHA SHAPE Symposium 2017 Dr. Yen Presentation
 
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
AHA SHAPE Symposium 2017 Dr. Slomka PresentationAHA SHAPE Symposium 2017 Dr. Slomka Presentation
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
 
Vu lplaque1 pasterkamp
Vu lplaque1 pasterkampVu lplaque1 pasterkamp
Vu lplaque1 pasterkamp
 
Vulnerable plaque vulnerable patient
Vulnerable plaque vulnerable patientVulnerable plaque vulnerable patient
Vulnerable plaque vulnerable patient
 
Vulnerable plaque overview
Vulnerable plaque overviewVulnerable plaque overview
Vulnerable plaque overview
 
Vulnerable patient talk in poland
Vulnerable patient talk in polandVulnerable patient talk in poland
Vulnerable patient talk in poland
 
Vulnerable patient slides without movies
Vulnerable patient slides without moviesVulnerable patient slides without movies
Vulnerable patient slides without movies
 
Vulnerable patient mar 04
Vulnerable patient mar 04Vulnerable patient mar 04
Vulnerable patient mar 04
 
Vulnerable (thrombogenic blood
Vulnerable (thrombogenic bloodVulnerable (thrombogenic blood
Vulnerable (thrombogenic blood
 
Vuln shape aha 2005
Vuln shape aha 2005Vuln shape aha 2005
Vuln shape aha 2005
 
Vuln plaque poster burke
Vuln plaque poster burkeVuln plaque poster burke
Vuln plaque poster burke
 
Vp watch editorial_slide 25short-
Vp watch editorial_slide 25short-Vp watch editorial_slide 25short-
Vp watch editorial_slide 25short-
 
Vp watch editorial_slide25
Vp watch editorial_slide25Vp watch editorial_slide25
Vp watch editorial_slide25
 
Vp watch editorial_slide25short-
Vp watch editorial_slide25short-Vp watch editorial_slide25short-
Vp watch editorial_slide25short-
 
Vp watch2002
Vp watch2002Vp watch2002
Vp watch2002
 
Vp symposium31602
Vp symposium31602Vp symposium31602
Vp symposium31602
 
Vpschoenhagen
VpschoenhagenVpschoenhagen
Vpschoenhagen
 

Recently uploaded

Evaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animalsEvaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animals
Shweta
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
touseefaziz1
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Savita Shen $i11
 
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
i3 Health
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
vimalpl1234
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
sisternakatoto
 
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptxPharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
SumeraAhmad5
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 UpakalpaniyaadhyayaCharaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Dr KHALID B.M
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
DR SETH JOTHAM
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
DrSathishMS1
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
MedicoseAcademics
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Oleg Kshivets
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
pal078100
 

Recently uploaded (20)

Evaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animalsEvaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of antidepressant activity of clitoris ternatea in animals
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
 
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
 
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptxPharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 UpakalpaniyaadhyayaCharaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
 

Editorialslides v2n9

  • 1. Editorial Slides VP Watch, March 4, 2002, Volume 2, Issue 9 Positive Remodeling, A Surrogate Marker of Plaque Inflammation and Vulnerability? By: Gerard Pasterkamp, M.D., Ph.D. Inter University Cardiology Institute of the Netherlands
  • 2. Determinants of Atherosclerotic Luminal Narrowing  In the long term: i. Plaque formation ii. The mode of geometrical remodelling a) Expansive remodeling prevents whereas b) Constrictive remodeling accelerates luminal narrowing  Acutely: >> plaque rupture/erosion with subsequent thrombus formation. * In some cases, plaque rupture goes silent and the healing process results in fibrous cap formation and further luminal narrowing.
  • 3. Seymour Glagov: Compensatory Enlargement of Human Atherosclerotic Coronary Arteries ”Positive Remodeling” <50% stenosis <80% stenosis Luminal area is not endangered until more than 40% of internal elastic lamina is destructed and occupied by plaque. Coronary artery disease is a disease of arterial wall not lumen.
  • 4. Arterial Remodeling Gradual Luminal Narrowing Expansive Remodeling Constrictive Remodeling
  • 5. Histological Characteristics of the Plaque that is Prone to Rupture
  • 7.  Previous studies demonstrated that: a. Histologically: an association between expansive remodeling and markers for plaque vulnerability in unruptured plaques. 1,2 b. Clinically: an association between expansive remodeling and unstable clinical syndromes. 3,4
  • 8.  As highlighted in VP Watch, Varnava et al. studied the associaton between de novo atherosclerotic remodeling and histological markers for plaque vulnerability in plaques (n=108) obtained from patients (n=88) that died of coronary artery disease.
  • 9. Results: 64/108 plaques revealed expansive remodelling. 44/108 revealed constrictive remodelling. Lipid core was larger in expansively remodelled plaques (39+/-21 % versus 22+/- 23%). Macrophage count was higher in expansively remodelled segments.
  • 10. Conclusion: I. In patients that died acutely of coronary artery disease, expansive remodeling is associated with a vulnerable plaque phenotype. II. This observation may explain why acute coronary syndromes often originate from locations with minor luminal stenosis (but with outward remodelled plaques).
  • 11. Questions: 1. Studies are cross-sectional, thus no causal of prognostic inferences are allowed. The question is what is the predictive value of the remodelling mode for the occurrence of plaque rupture and an acute cardiovascular event?  To answer this, serial (IVUS) studies are necessary.
  • 12. Questions: 2. Remodelling is a double edged sword: in the long term expansive remodeling prevents luminal narrowing by plaque formation. In the short term these plaques are more prone to rupture giving rise to an acute cardiovascular event. How can we induce expansive remodeling without destabilizing the plaques?  To answer this, good animal models are needed that develop both types of geometrical remodeling
  • 13. Questions: 3. In this study, positive (expansive) remodeling was present in 72%, however negative (constrictive) remodeling was also present in 50%, the question is how these two correlate with each other? 4. If expansive remodeling correlate with macrophage count and thin cap and can be a surrogate marker of vulnerability, what is the predictive value of constrictive remodeling (stenosis in angiography) in predicting presence of expansive remodeling and vulnerability to rupture in other plaques in the same patient?
  • 14. Suggestion: VP.org Editorial Suggestion: - Please email your thoughts to: Discussion-Group@VP.org or DG@VP.org
  • 15. 1- Atherosclerotic arterial remodeling and the localization of macrophages and matrix metalloproteases 1, 2 and 9 in the human coronary artery; Atherosclerosis 2000; 150(2):245-253 ; Gerard Pasterkamp, Arjan H. Schoneveld, Dirk Jan Hijnen, Dominique P. V. de Kleijn, Hans Teepen, A. C. van der Wal and Cornelius Borst 2- Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox, J American Coll Cardio 1998; 32(3):655-662 Gerard Pasterkamp, Arjan H. Schoneveld, Allard C. van der Wal, Christian C. Haudenschild, Ruud J. G. Clarijs, Anton E. Becker, Berend Hillen and Cornelius Borst 3- Coronary artery disease: arterial remodelling and clinical presentation Heart 1999; 82: 461-464. P C Smits, G Pasterkamp, M A Quarles van Ufford, F D Eefting, P R Stella, P P T de Jaegere, and C Borst 4- Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary Syndromes : An Intravascular Ultrasound Study; Paul Schoenhagen, Khaled M. Ziada, Samir R. Kapadia, Timothy D. Crowe, Steven E. Nissen, and E. Murat Tuzcu; Circulation 2000 101: 598 - 603. 5 Compensatory Enlargement of Human Atherosclerotic Coronary Arteries. Seymour Glagov: New England Journal of Medcine 1987 May 28;316(22):1371-5 References