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Vikas Thondapu - One of the best experts on this subject based on the ideXlab platform.

  • high spatial endothelial shear stress gradient independently predicts site of acute coronary Plaque Rupture and erosion
    Cardiovascular Research, 2021
    Co-Authors: Vikas Thondapu, Chris Mamon, Eric K W Poon, Osamu Kurihara, Hyung Oh Kim, Michele Russo, Makoto Araki, Hiroki Shinohara, Erika Yamamoto
    Abstract:

    AIMS: To investigate local haemodynamics in the setting of acute coronary Plaque Rupture and erosion. METHODS AND RESULTS: Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by Plaque Rupture (n = 19) or Plaque erosion (n = 18) was used for three-dimensional reconstruction and computational fluid dynamics simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between Plaque Rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered Plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG [odds ratio (OR) 5.29, 95% confidence interval (CI) 2.57-10.89, P < 0.001], lipid (OR 12.98, 95% CI 6.57-25.67, P < 0.001), and layered Plaque (OR 3.17, 95% CI 1.82-5.50, P < 0.001) were independently associated with Plaque Rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, P < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, P = 0.005), and OSI (OR 2.18, 95% CI 1.33-3.54, P = 0.002) independently associated with Plaque erosion. ESSG was higher at Rupture sites than erosion sites [median (interquartile range): 5.78 (2.47-21.15) vs. 2.62 (1.44-6.18) Pa/mm, P = 0.009], OSI was higher at erosion sites than Rupture sites [1.04 × 10-2 (2.3 × 10-3-4.74 × 10-2) vs. 1.29 × 10-3 (9.39 × 10-5-3.0 × 10-2), P < 0.001], but ESS was similar (P = 0.29). CONCLUSIONS: High ESSG is independently associated with Plaque Rupture while high ESSG, ESS, and OSI associate with Plaque erosion. While ESSG is higher at Rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute Plaque Rupture and erosion, respectively.

  • high spatial endothelial shear stress gradient independently predicts site of acute coronary Plaque Rupture and erosion
    Cardiovascular Research, 2020
    Co-Authors: Vikas Thondapu, Chris Mamon, Eric K W Poon, Osamu Kurihara, Hyung Oh Kim, Michele Russo, Makoto Araki, Hiroki Shinohara, Erika Yamamoto, Jouke Dijkstra
    Abstract:

    AIMS To investigate local haemodynamics in the setting of acute coronary Plaque Rupture and erosion. METHODS AND RESULTS Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by Plaque Rupture (n = 19) or Plaque erosion (n = 18) was used for 3D reconstruction and computational fluid dynamic simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between Plaque Rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered Plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG (odds ratio [OR] 5.29, 95% confidence interval [CI] 2.57-10.89, p < 0.001), lipid (OR 12.98, 95% CI 6.57-25.67 p < 0.001), and layered Plaque (OR 3.17, 95% CI 1.82-5.50, p < 0.001) were independently associated with Plaque Rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, p < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, p = 0.005) and OSI (OR 2.18, 95% CI 1.33-3.54, p = 0.002) independently associated with Plaque erosion. ESSG was higher at Rupture sites than erosion sites (median (interquartile range): 5.78 (2.47, 21.15) versus 2.62 (1.44, 6.18) Pa/mm, p = 0.009), OSI was higher at erosion sites than Rupture sites (1.04x10-2 (2.3x10-3, 4.74x10-2) versus 1.29x10-3 (9.39x10-5, 3.0x10-2), p < 0.001), but ESS was similar (p = 0.29). CONCLUSIONS High ESSG is independently associated with Plaque Rupture while high ESSG, ESS, and OSI associate with Plaque erosion. While ESSG is higher at Rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute Plaque Rupture and erosion, respectively. TRANSLATIONAL PERSPECTIVE Plaque Rupture and erosion are distinct pathological and clinical entities with possibly different optimal treatments. This study demonstrates that high endothelial shear stress gradient is independently associated with site of both Rupture and erosion, and is significantly higher in Rupture. High oscillatory shear index is independently associated with the site of erosion only, and is higher in erosion than Rupture. Larger studies are necessary to determine whether these indices may detect and distinguish Plaque Rupture and erosion in a clinical setting or to assess overall risk for acute coronary syndromes.

Erika Yamamoto - One of the best experts on this subject based on the ideXlab platform.

  • high spatial endothelial shear stress gradient independently predicts site of acute coronary Plaque Rupture and erosion
    Cardiovascular Research, 2021
    Co-Authors: Vikas Thondapu, Chris Mamon, Eric K W Poon, Osamu Kurihara, Hyung Oh Kim, Michele Russo, Makoto Araki, Hiroki Shinohara, Erika Yamamoto
    Abstract:

    AIMS: To investigate local haemodynamics in the setting of acute coronary Plaque Rupture and erosion. METHODS AND RESULTS: Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by Plaque Rupture (n = 19) or Plaque erosion (n = 18) was used for three-dimensional reconstruction and computational fluid dynamics simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between Plaque Rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered Plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG [odds ratio (OR) 5.29, 95% confidence interval (CI) 2.57-10.89, P < 0.001], lipid (OR 12.98, 95% CI 6.57-25.67, P < 0.001), and layered Plaque (OR 3.17, 95% CI 1.82-5.50, P < 0.001) were independently associated with Plaque Rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, P < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, P = 0.005), and OSI (OR 2.18, 95% CI 1.33-3.54, P = 0.002) independently associated with Plaque erosion. ESSG was higher at Rupture sites than erosion sites [median (interquartile range): 5.78 (2.47-21.15) vs. 2.62 (1.44-6.18) Pa/mm, P = 0.009], OSI was higher at erosion sites than Rupture sites [1.04 × 10-2 (2.3 × 10-3-4.74 × 10-2) vs. 1.29 × 10-3 (9.39 × 10-5-3.0 × 10-2), P < 0.001], but ESS was similar (P = 0.29). CONCLUSIONS: High ESSG is independently associated with Plaque Rupture while high ESSG, ESS, and OSI associate with Plaque erosion. While ESSG is higher at Rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute Plaque Rupture and erosion, respectively.

  • high spatial endothelial shear stress gradient independently predicts site of acute coronary Plaque Rupture and erosion
    Cardiovascular Research, 2020
    Co-Authors: Vikas Thondapu, Chris Mamon, Eric K W Poon, Osamu Kurihara, Hyung Oh Kim, Michele Russo, Makoto Araki, Hiroki Shinohara, Erika Yamamoto, Jouke Dijkstra
    Abstract:

    AIMS To investigate local haemodynamics in the setting of acute coronary Plaque Rupture and erosion. METHODS AND RESULTS Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by Plaque Rupture (n = 19) or Plaque erosion (n = 18) was used for 3D reconstruction and computational fluid dynamic simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between Plaque Rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered Plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG (odds ratio [OR] 5.29, 95% confidence interval [CI] 2.57-10.89, p < 0.001), lipid (OR 12.98, 95% CI 6.57-25.67 p < 0.001), and layered Plaque (OR 3.17, 95% CI 1.82-5.50, p < 0.001) were independently associated with Plaque Rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, p < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, p = 0.005) and OSI (OR 2.18, 95% CI 1.33-3.54, p = 0.002) independently associated with Plaque erosion. ESSG was higher at Rupture sites than erosion sites (median (interquartile range): 5.78 (2.47, 21.15) versus 2.62 (1.44, 6.18) Pa/mm, p = 0.009), OSI was higher at erosion sites than Rupture sites (1.04x10-2 (2.3x10-3, 4.74x10-2) versus 1.29x10-3 (9.39x10-5, 3.0x10-2), p < 0.001), but ESS was similar (p = 0.29). CONCLUSIONS High ESSG is independently associated with Plaque Rupture while high ESSG, ESS, and OSI associate with Plaque erosion. While ESSG is higher at Rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute Plaque Rupture and erosion, respectively. TRANSLATIONAL PERSPECTIVE Plaque Rupture and erosion are distinct pathological and clinical entities with possibly different optimal treatments. This study demonstrates that high endothelial shear stress gradient is independently associated with site of both Rupture and erosion, and is significantly higher in Rupture. High oscillatory shear index is independently associated with the site of erosion only, and is higher in erosion than Rupture. Larger studies are necessary to determine whether these indices may detect and distinguish Plaque Rupture and erosion in a clinical setting or to assess overall risk for acute coronary syndromes.

  • nonculprit Plaque characteristics in patients with acute coronary syndrome caused by Plaque erosion vs Plaque Rupture a 3 vessel optical coherence tomography study
    JAMA Cardiology, 2018
    Co-Authors: Tomoyo Sugiyama, Erika Yamamoto, Peter Libby, Krzysztof Bryniarski, Lei Xing, Hang Lee, Mitsuaki Isobe, Ikkyung Jang
    Abstract:

    Importance Patients with culprit Plaque Rupture are known to have pancoronary Plaque vulnerability. However, the characteristics of nonculprit Plaques in patients with acute coronary syndromes caused by Plaque erosion are unknown. Objective To investigate the nonculprit Plaque phenotype in patients with acute coronary syndrome according to culprit Plaque pathology (erosion vs Rupture) by 3-vessel optical coherence tomography imaging. Design, Setting, and Participants In this observational cohort study, between August 2010 and May 2014, 82 patients with acute coronary syndrome who underwent preintervention optical coherence tomography imaging of all 3 major epicardial coronary arteries were enrolled at the Massachusetts General Hospital Optical Coherence Tomography Registry database. Analysis of the data was conducted between November 2016 and July 2017. Patients were classified into 2 groups based on the culprit lesion pathology: 17 patients with culprit Plaque erosion and 34 patients with culprit Plaque Rupture. Thirty-one patients with the absence of culprit Rupture or erosion were excluded from further analysis. Exposures Preintervention 3-vessel optical coherence tomography imaging. Main Outcomes and Measures Plaque characteristics at the culprit and nonculprit lesions evaluated by optical coherence tomography. Results In 51 patients (37 men; mean age, 58.7 years), the characteristics of 51 culprit Plaques and 216 nonculprit Plaques were analyzed. In patients with culprit erosion, the mean (SD) number of nonculprit Plaques per patient was smaller (3.4 [1.9] in erosion vs 4.7 [2.1] in Rupture, P = .05). Patient-based analysis showed that none of 17 patients with culprit Plaque erosion had nonculprit Plaque Rupture, whereas 26% of the patients (9 of 34) with culprit Plaque Rupture had nonculprit Plaque Rupture (P = .02). Plaque-based analysis showed that, compared with the culprit Rupture group (n = 158), the culprit erosion group (n = 58) had lower prevalence of Plaque Rupture (0% vs 8%; P < .001), macrophage accumulation (29% vs 53%; P = .01), microvessels (21% vs 42%; P = .003), and spotty calcium (5% vs 22%; P = .006) in the nonculprit lesions. The prevalence of lipid-rich Plaque, thin-cap fibroatheroma, and thrombus did not differ between the groups. Conclusions and Relevance Compared with those with culprit Plaque Rupture, patients with acute coronary syndrome caused by culprit Plaque erosion had a smaller number of nonculprit Plaques and the lower levels of panvascular instability, affirming that distinct pathophysiologic mechanisms operate in Plaque erosion and Plaque Rupture.

Renu Virmani - One of the best experts on this subject based on the ideXlab platform.

  • what atherosclerosis findings can ct see in sudden coronary death Plaque Rupture versus Plaque erosion
    Journal of Cardiovascular Computed Tomography, 2020
    Co-Authors: Renu Virmani, Inge J Van Den Hoogen, Umberto Gianni, Rashmi Wijeratne, Hiroyuki Jinnouchi, Aloke V Finn, James P Earls, Fay Y Lin
    Abstract:

    Sudden death is the most abrupt clinical presentation of acute coronary syndrome. The presence of acute luminal thrombosis is the histopathological hallmark of sudden coronary death. There are 3 main etiologies that can give rise to an acute luminal thrombus: Plaque Rupture, Plaque erosion and, less frequently, eruptive calcified nodules. Coronary computed tomography angiography (CCTA) has the ability to identify high-risk Plaque features of coronary artery disease that are associated with future adverse cardiac events. In this report, we illustrate 2 cases of suspected sudden coronary death with a thorough description of how CCTA can be employed to detect high-risk Plaque features using histopathology as a gold standard.

  • acute coronary syndromes without coronary Plaque Rupture
    Nature Reviews Cardiology, 2016
    Co-Authors: Siddak S Kanwar, Renu Virmani, Gregg W. Stone, Takashi Akasaka, Mandeep Singh, Jeffrey W Olin, Jagat Narula
    Abstract:

    The latest advances in Plaque imaging have provided clinicians with opportunities to treat acute coronary syndrome (ACS) and provide individualized treatment recommendations based not only on clinical manifestations, angiographic characteristics, and biomarker data, but also on the findings of Plaque morphology. Although a substantial proportion of ACS events originate from Plaques with an intact fibrous cap (IFC), clinicians predominantly equate ACS with Plaque Rupture arising from thin-cap fibroatheromas. In this Review, we discuss the recent advances in our understanding of Plaque morphology in ACS with IFC, reviewing contemporary data from intravascular imaging. We also explore whether use of such imaging might provide a roadmap for more effective management of patients with ACS.

  • biomechanics and inflammation in atherosclerotic Plaque erosion and Plaque Rupture implications for cardiovascular events in women
    PLOS ONE, 2014
    Co-Authors: Ian C Campbell, Renu Virmani, Jonathan D Suever, Lucas H Timmins, Alessandro Veneziani, Raymond P Vito, John N Oshinski
    Abstract:

    Objective Although Plaque erosion causes approximately 40% of all coronary thrombi and disproportionally affects women more than men, its mechanism is not well understood. The role of tissue mechanics in Plaque Rupture and regulation of mechanosensitive inflammatory proteins is well established, but their role in Plaque erosion is unknown. Given obvious differences in morphology between Plaque erosion and Rupture, we hypothesized that inflammation in general as well as the association between local mechanical strain and inflammation known to exist in Plaque Rupture may not occur in Plaque erosion. Therefore, our objective was to determine if similar mechanisms underlie Plaque Rupture and Plaque erosion.

  • a mechanistic analysis of the role of microcalcifications in atherosclerotic Plaque stability potential implications for Plaque Rupture
    American Journal of Physiology-heart and Circulatory Physiology, 2012
    Co-Authors: Natalia Maldonado, Renu Virmani, Luis Cardoso, Adreanne Kellyarnold, Yuliya Vengrenyuk, Damien M Laudier, John T Fallon, Sheldon Weinbaum
    Abstract:

    The role of microcalcifications (μCalcs) in the biomechanics of vulnerable Plaque Rupture is examined. Our laboratory previously proposed (Ref. 44), using a very limited tissue sample, that μCalcs ...

  • ultrasonic and pathological evidence of a neo intimal Plaque Rupture in patients with bare metal stents
    Eurointervention, 2007
    Co-Authors: Steve Ramcharitar, Renu Virmani, Hector M Garciagarcia, Gaku Nakazawa, Neville Kukreja, Jurgen Ligthart, Patrick W Serruys
    Abstract:

    Case 1 A 58-year-old man was admitted to our coronary care with troponin negative unstable angina. His risk factors included, being an exsmoker for a year, treated hypertension and dyslipidaemia. Medication on admission was aspirin and a statin. ECG showed Twave inversion laterally. Nine years previously he had a bare metal stent implanted in his circumflex artery following a lateral infarction the preceding year. Angiography done during his acute presentation revealed an in-stent restenosis in the previously treated circumflex artery and a diffusely diseased marginal branch. The left anterior decending coronary (LAD) was normal and the right coronary artery (RCA) had a non-flow limiting lesion in the mid-vessel with a fractional flow reserve (FFR) of 0.79. Intravascular ultrasound (IVUS) of the circumflex artery was performed using a 20 MHz Eagle eye IVUS catheter (Volcano Therapeutics, Rancho Cordova, CA, USA). The length of the stented segment was 30mm and had a minimal luminal area (MLA) 4.6 mm2. Neo-intimal formation was visible throughout the stent (Figure 1). This gave a neointimal hyperplasia (NIH) volume of 80.3 mm3. The NIH on virtual histology had a tissue composition of necrotic core (NC) 13.6%, (0.08 mm2, 2.4 mm3), calcified tissue 16.8%, (0.10 mm2, 3.0 mm3), fibrofatty 5.8%, (0.03 mm2, 1.04 mm3), fibrotic tissue 63.9%, (0.38 mm2, 11.5 mm3). Distal to the MLA at distance of 18 mm IVUS revealed an eccentric soft neo-intimal Ruptured Plaque1,2 (Figure 1C) within the stent. The necrotic core was 22% with remnant Plaque burden of 54% at the Plaque Rupture site (Figure 1 C’). Just distal to Ruptured Plaque the vessel wall was intact and the Plaque burden was higher 65% with no necrotic core in contact with the lumen (Figure 1D”). This Ruptured lesion was subsequently managed with a drug eluting stent (DES) that also covered the MLA. The histological findings of a similar Plaque Rupture are illustrated in Case 2.

Jouke Dijkstra - One of the best experts on this subject based on the ideXlab platform.

  • high spatial endothelial shear stress gradient independently predicts site of acute coronary Plaque Rupture and erosion
    Cardiovascular Research, 2020
    Co-Authors: Vikas Thondapu, Chris Mamon, Eric K W Poon, Osamu Kurihara, Hyung Oh Kim, Michele Russo, Makoto Araki, Hiroki Shinohara, Erika Yamamoto, Jouke Dijkstra
    Abstract:

    AIMS To investigate local haemodynamics in the setting of acute coronary Plaque Rupture and erosion. METHODS AND RESULTS Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by Plaque Rupture (n = 19) or Plaque erosion (n = 18) was used for 3D reconstruction and computational fluid dynamic simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between Plaque Rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered Plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG (odds ratio [OR] 5.29, 95% confidence interval [CI] 2.57-10.89, p < 0.001), lipid (OR 12.98, 95% CI 6.57-25.67 p < 0.001), and layered Plaque (OR 3.17, 95% CI 1.82-5.50, p < 0.001) were independently associated with Plaque Rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, p < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, p = 0.005) and OSI (OR 2.18, 95% CI 1.33-3.54, p = 0.002) independently associated with Plaque erosion. ESSG was higher at Rupture sites than erosion sites (median (interquartile range): 5.78 (2.47, 21.15) versus 2.62 (1.44, 6.18) Pa/mm, p = 0.009), OSI was higher at erosion sites than Rupture sites (1.04x10-2 (2.3x10-3, 4.74x10-2) versus 1.29x10-3 (9.39x10-5, 3.0x10-2), p < 0.001), but ESS was similar (p = 0.29). CONCLUSIONS High ESSG is independently associated with Plaque Rupture while high ESSG, ESS, and OSI associate with Plaque erosion. While ESSG is higher at Rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute Plaque Rupture and erosion, respectively. TRANSLATIONAL PERSPECTIVE Plaque Rupture and erosion are distinct pathological and clinical entities with possibly different optimal treatments. This study demonstrates that high endothelial shear stress gradient is independently associated with site of both Rupture and erosion, and is significantly higher in Rupture. High oscillatory shear index is independently associated with the site of erosion only, and is higher in erosion than Rupture. Larger studies are necessary to determine whether these indices may detect and distinguish Plaque Rupture and erosion in a clinical setting or to assess overall risk for acute coronary syndromes.

  • biomechanical stress profiling of coronary atherosclerosis identifying a multifactorial metric to evaluate Plaque Rupture risk
    Jacc-cardiovascular Imaging, 2020
    Co-Authors: Pallavi Doradla, Jouke Dijkstra, Gijs Van Soest, Kenichiro Otsuka, Abhijay Nadkarni, Martin Villiger, Antonios Karanasos, Laurens J C Van Zandvoort, Felix Zijlstra, Joost Daemen
    Abstract:

    Abstract Objectives The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary Plaque morphology, likely related to the propensity of Plaque Rupture in patients. Background Plaque Rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element modeling (FEM), typically used to calculate tensile stress, is computationally intensive and impractical as a clinical tool for locating Rupture-prone Plaques. This study derived a multifactorial stress equation (MSE) that accurately computes peak stress in NCFAs by combining the influence of several morphological parameters. Methods Intravascular ultrasound and optical frequency domain imaging were conducted in 30 patients, and Plaque morphological parameters were defined in 61 NCFAs. Multivariate regression analysis was applied to derive the MSE and compute a peak stress metric (PSM) that was based on the analysis of Plaque morphological parameters. The accuracy of the MSE was determined by comparing PSM with FEM-derived peak stress values. The ability of the PSM in locating Plaque Rupture sites was tested in 3 additional patients. Results The following parameters were found to be independently associated with peak stress: fibrous cap thickness (p  Conclusions The MSE shows potential to calculate the PSM in coronary lesions rapidly. However, further studies are warranted to investigate the use of biomechanical stress profiling for the prognostic evaluation of patients with atherosclerosis.

Jonathan H Gillard - One of the best experts on this subject based on the ideXlab platform.

  • Plaque Rupture in coronary atherosclerosis is associated with increased Plaque structural stress
    Jacc-cardiovascular Imaging, 2017
    Co-Authors: Charis Costopoulos, Zhongzhao Teng, Jonathan H Gillard, Yuan Huang, Adam J Brown, Patrick A Calvert, Stephen P Hoole, Nick E J West, Martin R Bennett
    Abstract:

    Abstract Objectives The aim of this study was to identify the determinants of Plaque structural stress (PSS) and the relationship between PSS and Plaques with Rupture. Background Plaque Rupture is the most common cause of myocardial infarction, occurring particularly in higher risk lesions such as fibroatheromas. However, prospective intravascular ultrasound–virtual histology studies indicate that  Methods We analyzed Plaque structure and composition in 4,053 virtual histology intravascular ultrasound frames from 32 fibroatheromas with Rupture from the intravascular ultrasound–virtual histology in Vulnerable Atherosclerosis study and 32 fibroatheromas without Rupture on optical coherence tomography from a stable angina cohort. Mechanical loading in the periluminal region was estimated by calculating maximum principal PSS by finite element analysis. Results PSS increased with increasing lumen area (r = 0.46; p = 0.001), lumen eccentricity (r = 0.32; p = 0.001), and necrotic core ≥10% (r = 0.12; p = 0.001), but reduced when dense calcium was ≥10% (r = −0.12; p = 0.001). Ruptured fibroatheromas showed higher PSS (133 kPa [quartiles 1 to 3: 90 to 191 kPa] vs. 104 kPa [quartiles 1 to 3: 75 to 142 kPa]; p = 0.002) and variation in PSS (55 kPa [quartiles 1 to 3: 37 to 75 kPa] vs. 43 kPa [quartiles 1 to 3: 34 to 59 kPa]; p = 0.002) than nonRuptured fibroatheromas, with Rupture primarily occurring either proximal or immediately adjacent to the minimal luminal area (87.5% vs. 12.5%; p = 0.001). PSS was higher in segments proximal to the Rupture site (143 kPa [quartiles 1 to 3: 101 to 200 kPa] vs. 120 kPa [quartiles 1 to 3: 78 to 180 kPa]; p = 0.001) versus distal segments, associated with increased necrotic core (19.1% [quartiles 1 to 3: 11% to 29%] vs. 14.3% [quartiles 1 to 3: 8% to 23%]; p = 0.001) but reduced fibrous/fibrofatty tissue (63.6% [quartiles 1 to 3: 46% to 78%] vs. 72.7% [quartiles 1 to 3: 54% to 86%]; p = 0.001). PSS >135 kPa was a good predictor of Rupture in higher risk regions. Conclusions PSS is determined by Plaque composition, Plaque architecture, and lumen geometry. PSS and PSS variability are increased in Plaques with Rupture, particularly at proximal segments. Incorporating PSS into Plaque assessment may improve identification of Rupture-prone Plaques.

  • Plaque Rupture in coronary atherosclerosis is associated with increased Plaque structural stress
    Jacc-cardiovascular Imaging, 2017
    Co-Authors: Charis Costopoulos, Zhongzhao Teng, Jonathan H Gillard, Yuan Huang, Adam J Brown, Patrick A Calvert, Stephen P Hoole, Nick E J West, Martin R Bennett
    Abstract:

    AbstractObjectives: The aim of this study was to identify the determinants of Plaque structural stress (PSS) and the relationship between PSS and Plaques with Rupture.Background: Plaque Rupture is ...

  • tct 598 Plaque Rupture in coronary atherosclerosis is associated with increased Plaque structural stress
    Journal of the American College of Cardiology, 2016
    Co-Authors: Charis Costopoulos, Zhongzhao Teng, Jonathan H Gillard, Yuan Huang, Adam J Brown, Patrick A Calvert, Stephen P Hoole, Nick E J West, Martin R Bennett
    Abstract:

    Plaque Rupture is the commonest cause of myocardial infarction, occurring particularly in higher-risk lesions such as fibroatheromas. However, prospective virtual-histology intravascular ultrasound (VH-IVUS) studies indicate that <10% higher-risk Plaques cause clinical events over 3-years,

  • characterization of healing following atherosclerotic carotid Plaque Rupture in acutely symptomatic patients an exploratory study using in vivo cardiovascular magnetic resonance
    Journal of Cardiovascular Magnetic Resonance, 2011
    Co-Authors: Zhongzhao Teng, Martin J Graves, Umar Sadat, Victoria E Young, Andrew J Degnan, Fang Wang, Shengyong Chen, Jonathan H Gillard
    Abstract:

    Background Carotid Plaque Rupture, characterized by Ruptured fibrous cap (FC), is associated with subsequent cerebrovascular events. However, Ruptured FC may heal following stroke and convey decreased risk of future events. This study aims to characterize the healing process of Ruptured FC by assessing the lumen conditions, quantified by the lumen curvature and roughness, using in vivo carotid cardiovascular magnetic resonance (CMR).

  • the mechanical triggers of Plaque Rupture shear stress vs pressure gradient
    British Journal of Radiology, 2009
    Co-Authors: Valentina Taviani, Martin J Graves, Tjun Y Tang, Umar Sadat, Victoria E Young, Andrew J Patterson, Jonathan H Gillard
    Abstract:

    The aim of this study was to evaluate the mechanical triggers that may cause Plaque Rupture. Wall shear stress (WSS) and pressure gradient are the direct mechanical forces acting on the Plaque in a stenotic artery. Their influence on Plaque stability is thought to be controversial. This study used a physiologically realistic, pulsatile flow, two-dimensional, cine phase-contrast MRI sequence in a patient with a 70% carotid stenosis. Instead of considering the full patient-specific carotid bifurcation derived from MRI, only the Plaque region has been modelled by means of the idealised flow model. WSS reached a local maximum just distal to the stenosis followed by a negative local minimum. A pressure drop across the stenosis was found which varied significantly during systole and diastole. The ratio of the relative importance of WSS and pressure was assessed and was found to be less than 0.07% for all time phases, even at the throat of the stenosis. In conclusion, although the local high WSS at the stenosis may damage the endothelium and fissure Plaque, the magnitude of WSS is small compared with the overall loading on Plaque. Therefore, pressure may be the main mechanical trigger for Plaque Rupture and risk stratification using stress analysis of Plaque stability may only need to consider the pressure effect.