Uso de Índices Aterogênicos como Métodos de Avaliação das Doenças Ateroscleróticas Clínicas / Use of Atherogenic Indices as Assessment Methods of Clinical Atherosclerotic Diseases

Resumo Fundamento A busca por métodos clinicamente úteis de avaliação de doenças ateroscleróticas, com boa acurácia, de baixo custo, sem invasividade e de fácil manejo, há anos vem sendo estimulada. Dessa forma, os índices aterogênicos avaliados deste estudo podem se encaixar nesta demanda crescente. Objetivos Avaliar o potencial dos índices aterogênicos como métodos de avaliação de pacientes portadores de aterosclerose clínica. Métodos Estudo transversal de centro único, por meio do qual foram avaliados os índices de Castelli I e II, índice aterogênico plasmático (IAP), índice de combinação de lipoproteínas e a variação do índice de perfusão periférica entre 90 e 120 segundos após um estímulo vasodilatador endotélio-dependente (ΔIPP90-120) na predição de aterosclerose. A significância estatística foi estabelecida em p < 0,05. Resultados A amostra foi composta por 298 indivíduos com idade média de 63,0 ± 16,1 anos, dos quais 57,4% eram mulheres. Comparações pareadas da análise curva ROC dos índices que alcançaram área sob a curva (ASC) > 0,6 mostram que ΔIPP90-120 e IAP foram superiores aos demais índices, sem diferenças observadas entre si (diferença entre ASC = 0,056; IC95% -0,003-0,115). Ademais, tanto a ΔIPP90-120 [odds ratio (OR) 9,58; IC95% 4,71-19,46] quanto o IAP (OR 5,35; IC95% 2,30-12,45) foram preditores independentes de aterosclerose clínica. Conclusões O IAP e ΔIPP90-120 apresentaram melhor acurácia para discriminar aterosclerose clínica. Além disso, foram preditores independentes de aterosclerose clínica, evidenciando uma possibilidade promissora para o desenvolvimento de estratégias preventivas e de controle para doenças cardiovasculares. Tratam-se, portanto, de marcadores adequados para estudos multicêntricos do ponto de vista de praticidade, custo e validade externa.

Abstract Background The search for clinically useful methods to assess atherosclerotic diseases (ASCVD) with good accuracy, low cost, non-invasiveness, and easy handling has been stimulated for years. Thus, the atherogenic indices evaluated in this study may fit this growing demand. Objectives To assess the potential of atherogenic indices to evaluate patients with clinical atherosclerosis. Methods Single-center cross-sectional study, through which the Castelli I and II indices, the atherogenic index of plasma (AIP), the lipoprotein combine index, and the variation in the peripheral perfusion index between 90 and 120 seconds after an endothelium-dependent (ΔPI90-120) vasodilator stimulus were evaluated in the prediction of atherosclerosis. Statistical significance was set at p < 0.05. Results The sample consisted of 298 individuals with an average age of 63.0±16.1 years, of which 57.4% were women. Paired comparisons of the ROC curve analysis of the indices that reached the area under the curve (AUC) > 0.6 show that ΔPI90-120 and AIP were superior to other indices, and no differences were observed between them (difference between AUC = 0.056; 95%CI -0.003-0.115). Furthermore, both the ΔPI90-120 [odds ratio (OR) 9.58; 95%CI 4.71-19.46)] and AIP (OR 5.35; 95%CI 2.30-12.45) were independent predictors of clinical atherosclerosis. Conclusions The AIP and ΔPI90-120 represented better accuracy in discriminating clinical ASCVD. Moreover, they were independent predictors of clinical ASCVD, evidencing a promising possibility for developing preventive and control strategies for cardiovascular diseases. Therefore, they are markers for multicenter studies from the point of view of practicality, low cost, and external validity.

Application of Biomechanical Stress from Coronary Computed Tomography Angiography in Coronary Plaque Assessment and Prediction of Adverse Cardiovascular Events / 医用生物力学

Long-term exposure to risk factors will lead to coronary atherosclerosis, which will lead to the formation and progression of coronary plaque. Early identification of high-risk plaque characteristics will help prevent plaque rupture or erosion, thus avoiding the occurrence of acute cardiovascular events. Biomechanical stress plays an important role in progression and rupture of atherosclerotic plaques. In recent years, non-invasive coronary computed tomography angiography (CCTA) computational fluid dynamics (CFD) modeling has made it possible to acquire the corresponding biomechanical stress parameters. These coronary biomechanical stress parameters, especially wall shear stress (WSS), will aid in the development of a more accurate clinical model for predicting plaque progression and major adverse cardiovascular events ( MACE ). In this review, the biomechanical stress and the role of WSS from CCTA in atherosclerosis were introduced, and the researches on the relationship between biomechanical stress from CCTA and coronary artery diseases were discussed.

Dissecção espontânea tipo 2 variante A da artéria descendente anterior apresentando-se como síndrome de Wellens tipo A: quando a intervenção coronária percutânea é necessária / Type 2 variant A spontaneous dissection of the left anterior descending artery presenting as type A Wellens' syndrome: when percutaneous coronary intervention is needed

A dissecção espontânea da artéria coronária é definida como uma dissecção coronária epicárdica não iatrogênica, não associada à aterosclerose ou a trauma. A lesão miocárdica ocorre devido à obstrução da artéria coronária causada por hematoma intramural ou ruptura da íntima, em vez de ruptura de placa aterosclerótica ou trombo intraluminal. Relatamos um caso de dissecção espontânea tipo 2 variante A no segmento médio da artéria descendente anterior apresentando-se como síndrome de Wellens tipo A, que necessitou de intervenção coronária percutânea para alívio de angina refratária e congestão pulmonar.

Spontaneous coronary artery dissection is defined as non-iatrogenic epicardial coronary dissection, not associated with atherosclerosis or trauma. Myocardial injury occurs due to coronary artery obstruction caused by intramural hematoma or intimal disruption, rather than atherosclerotic plaque rupture or intraluminal thrombus. We report a case of type 2 variant A spontaneous coronary artery dissection in the mid left anterior descending artery, presenting with type A Wellens' syndrome, which required percutaneous coronary intervention for relief of refractory angina and pulmonary congestion.

The value of coronary CT angiography in diagnosing ischemic stenosis / 中华放射学杂志

Objective:To assess the value of coronary CT angiography(CCTA) based vessel characteristics and plaque features in diagnosing ischemic stenosis.Methods:From April 2014 to June 2021, 129 patients (including a total of 158 coronary arteries) who underwent CCTA, then completed invasive coronary angiography (ICA) as well as fractional flow reserve(FFR) within 30 days were retrospectively enrolled. All coronary arteries were divided into ischemic group (FFR≤0.80, n=77) and non-ischemic group (FFR>0.80, n=81). Vascular characteristics, high-risk plaque features, quantitative parameters and the morphology of plaque were obtained from CCTA images. Independent samples t-test, Wilcoxon rank sum test and χ 2 test were used to compare afore-mentioned variables between the ischemic group and the non-ischemic group. The logistic regression model was used to analyze the risk predictors for ischemic stenosis. Results:Compared with non-ischemic group, the stenosis degree of coronary arteries in ischemic group was more serious(72.09%±8.55% vs. 63.52%±13.49%; t=4.765, P<0.001). The proportion of left anterior descending artery(LAD) lesions in ischemic group was higher than that of non-ischemic group [88.31%(68/77)vs. 55.56%(45/81); χ 2=20.793, P<0.001]. In terms of CCTA plaque characteristics, the ischemic group demonstrated longer plaque length, smaller minimum lumen area, larger plaque burden, increased percent plaque diffuseness, and diffuse lesions were more common. As for morphological characteristics of plaque, the proportions of plaques with rectangle shape, proximal longitudinal eccentric shape and distal longitudinal eccentric shape were higher than those of non-ischemic group, whereas cosine eccentric plaques were more common in the non-ischemic group( P<0.001). Multivariate logistic regression analysis showed that the stenosis severity(OR =1.09, 95 %CI 1.04-1.14, P<0.001), LAD involvement(OR =4.23,95 %CI 1.01-17.72, P=0.049), diffuse lesion(OR =6.71,95 %CI 1.43-31.52, P=0.016), proximal longitudinal eccentric shape (OR =3.77,95 %CI 1.27-11.16, P=0.017), and distal longitudinal eccentric shape (OR =3.91,95 %CI 1.19-12.85, P=0.025) were the independent influence factors for ischemic stenosis. Conclusion:The CCTA-based stenosis degree of coronary artery, LAD involvement, diffuse lesion, proximal longitudinal eccentric shape, distal longitudinal eccentric shape were important influence factors for ischemic stenosis.

Contrast-enhanced ultrasound assesses neovascularization in carotid atherosclerotic plaques / 国际脑血管病杂志

Carotid atherosclerotic stenosis is associated with an increased risk of stroke onset and recurrence. The histopathological features of the vulnerable plaques include the presence of lipid necrotic cores, intra-plaque hemorrhage, intra-plaque neovascularization, active inflammation, and thin/ruptured fibrous caps. The intraplaque neovascularization may promote the intra-plaque hemorrhage, and is associated with the rupture of plaques, the formation of local emboli, and the distal embolism. Contrast-enhanced ultrasound can identify the vulnerable carotid plaques by evaluating intraplaque neovascularization.

Blunt-chest-trauma-induced acute myocardial infarction

Blunt chest trauma (BCT) is one of the rarest causes of acute myocardial infarction (AMI). This paper reports the case of a young married man who suffered from AMI due to BCT sustained in a fight with his wife. The histopathology examination revealed a rupture of atherosclerotic plaque with superimposed thrombus in the proximal left anterior descending artery. This report also reviews previously reported BCT-induced AMI cases in the literature.

Prevalence and morphological analysis of the atheromatous plaque in digital panoramic radiograph of a brazilian subpopulation / Prevalencia y análisis morfológico de las placas ateromatosas en radiografías panorámicas digitales de una subpoblación brasileña

This study had as a goal to analyze the prevalence of suggestive images of atheromatous calcification in the common carotid artery, aiming to relate it to age, sex, antimere and to analyze the morphology of its calcification, through digital panoramic radiographs of the jaws. It's an observational, transversal and retrospective study, on which there were analyzed 4.837 radiographs, that came from the files of a dental radiology private service in the city of Cabo de Santo Agostinho-PE, Brazil, referring to the period between 2011-2017. The morphology of the calcified atheromatous plaque was classified in: Grade I ­ normal (plaque not displayed); Grade II ­ intimal thickening; Grade III ­ simple plaque (less than 5mm thick); Grade IV ­ complex plaque (over 5mm thick) and Grade V ­ debris (irregular plaque with moving projections). The data collected was expressed in absolute values and frequency, analyzed through the chi-square, considering p< 0,05. Of the analyzed radiographs, 1.321 filled the eligibility criteria, of these 51 (3,8%0 presented suggestive image of atheromatous plaque, 71% were of the female sex (p = 0,003), 45% were at the age range between 5th and 6th decade of life (p= 0,001), most of the identified plaques were unilateral, to the left (p=0,02) and 76% were morphologically classified as grade III (less than 5mm thick). In this study, it was verified the low prevalence of suggestive images of atheromatous in carotid artery, with greater occurrence on the female sex, between the 5th and 6th decade of life, unilaterally, to the left and morphologically classified in grade III.

Este estudio tuvo como objetivo analizar la prevalencia de imágenes sugerentes de calcificación ateromatosa en la arteria carótida común, con el objetivo de relacionarla con la edad, sexo, antimería y analizar el aspecto morfológico de la calcificación, a través de radiografías panorámicas digitales de los maxilares. Se trata de un estudio observacional, transversal y retrospectivo, en el que se analizaron 4.837 radiografías, provenientes de los archivos de un servicio privado de radiología dental en la ciudad de Cabo de Santo Agostinho-PE, Brasil, referido al período 2011-2017. La morfología de la placa ateromatosa calcificada se clasificó en: Grado I - normal (no aparece placa); Grado II: engrosamiento de la íntima; Grado III: placa simple (menos de 5 mm de espesor); Grado IV: placa compleja (más de 5 mm de grosor) y grado V: Irregular o amorfo (placa irregular con proyecciones móviles). Los datos recolectados se expresaron en valores absolutos y frecuencia, analizados mediante el chi-cuadrado, considerando p <0,05. De las radiografías analizadas, 1.321 cumplieron los criterios de elegibilidad, de estas 51 (3,8% presentaron imagen sugerente de placa ateromatosa, 71% eran del sexo femenino (p = 0,003), 45% estaban en el rango de edad entre 5 y 6a década de la vida (p = 0,001), la mayoría de las placas identificadas eran unilaterales, hacia la izquierda (p = 0,02) y el 76% se clasificaron morfológicamente como grado III (menos de 5mm de espesor). verificó la baja prevalencia de imágenes sugerentes de ateromatosas en arteria carótida, con mayor ocurrencia en el sexo femenino, entre la 5ª y 6ª década de la vida, unilateralmente, hacia la izquierda y clasificadas morfológicamente en grado III.

Pollen Typhae Total Flavone Inhibits Endoplasmic Reticulum Stress-Induced Apoptosis in Human Aortic-Vascular Smooth Muscle Cells through Down-Regulating PERK-eIF2α-ATF4-CHOP Pathway / 中国结合医学杂志

OBJECTIVE@#To test the hypothesis that the inhibition of endoplasmic reticulum (ER) stress-induced apoptosis in oxidized low-density lipoproteins (ox-LDL)-induced human aortic-vascular smooth muscle cells (HA-VSMCs) was associated with suppression of the protein kinase RNA-like ER kinase (PERK)-eukaryotic translation initiation factor 2α (eIF2α)-activating transcription factor 4 (ATF4)-CCAAT/enhancer binding protein homologous protein (CHOP) signaling pathway by Pollen Typhae total flavone (PTF).@*METHODS@#Primary HA-VSMCs were cultured and identified. The cultured HA-VSMCs were randomized into 5 groups, including a normal control group, an ox-LDL group (70 μg/mL high ox-LDL), an HPTF group (70 μg/mL high ox-LDL+500 μg/mL PTF), an MPTF group (70 μg/mL high ox-LDL+250 μg/mL PTF), and a LPTF group (70 μg/mL high ox-LDL+100 μg/mL PTF) in the first part; and a normal control group, an ox-LDL group (70 μg/mL high ox-LDL), an MPTF group (70 μg/mL high ox-LDL+250 μg/mL PTF), a shRNA group (transducted with PERK shRNA lentiviral particles), a scramble shRNA group (transducted with control shRNA lentiviral particles), an MPTF+ox-LDL+shRNA group (250 μg/mL PTF+70 μg/mL high ox-LDL+PERK shRNA lentiviral particles) and an ox-LDL+shRNA group (70 μg/mL high ox-LDL+PERK shRNA lentiviral particles) in the second part. The protein expression levels of ER-associated apoptosis proteins were detected by Western blot, and their mRNA expression levels were detected by quantitative real-time reverse transcription-polymerase chain reaction. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was applied to test cell viability, and the level of apoptosis was monitored by flow cytometry.@*RESULTS@#The MTT assay and flow cytometry showed that the ox-LDL group had a significant increase in apoptosis, which was attenuated in PTF treatment groups and shRNA groups. Moreover, the ox-LDL group had increased protein and mRNA levels of binding immunoglobulin protein and ER-associated apoptosis proteins, such as PERK, eIF2α, ATF4 and CHOP, which were attenuated in PTF treatment groups and shRNA groups.@*CONCLUSIONS@#The apoptosis induced by ox-LDL had a strong relation to ER stress. The protective effect of PTF on ER stressinduced apoptosis was associated with inhibition of the PERK-eIF2α-ATF4-CHOP pathway, which might be a potential therapeutic strategy for enhancing the stability of atherosclerotic plaques.

Understanding Vulnerable Plaques: Current Status and Future Directions

The main cause of acute myocardial infarction is plaque rupture accompanied by superimposed coronary thrombosis. Thin-cap fibroatheromas (TCFAs) have been suggested as a type of lesion with a vulnerability that can cause plaque rupture. However, not only the existence of a TCFA but also the fine and complex interactions of other anatomical and hemodynamic factors, such as microcalcification in the fibrous cap, cholesterol crystal-induced inflammasome activation, the apoptosis of intraplaque macrophages, and endothelial shear stress distribution should precede a clinical event caused by plaque rupture. Recent studies are being conducted to identify these mechanisms through molecular imaging and hemodynamic assessment using computational fluid dynamics, which will result in better clinical results through selective coronary interventions.

In Vivo Stress Analysis of an Atherosclerotic Plaque at Carotid Bifurcation / 医用生物力学

Objective To investigate the in vivo stress distribution of the atherosclerotic plaque at carotid bifurcation, so as to provide references for the mechanical mechanisms of plaque rupture at carotid bifurcation and the design for further medical treatment. Methods The three-dimensional geometric model of carotid bifurcation and plaque were established according to average geometric parameters of human carotid bifurcation. Residual stress of the carotid bifurcation and plague was reestablished with “thermal-structure” coupling method, and in vivo stresses of vessels with the plaque at carotid bifurcation under blood pressure and blood flow were calculated. Results Both the maximum principal stress and elastic shear stress concentrated on the shoulder of the plaque. Elastic shear stress increased with the increase of stenosis ratio and blood pressure. Wall shear stress in the upstream of the plaque was considerably higher than that of the downstream. The distribution of oscillatory shear index(OSI) was quite the opposite. The changing patterns of the elastic shear stress and flow shear stress were quite different with the change of stenosis ratios. Conclusions Tension grew gradually from the centrality to shoulder surface of the plaque. The centrality of the plaque might bear compression when the stenosis was very severe. The periodic variation of the structural stress might cause structural fatigue of the plaque, thus increasing the rupture risk. Distinction of the component and vulnerability of the plaque between upstream and downstream might be caused by differences in hemodynamic parameters of the plaque between upstream and downstream.

Intracranial atherosclerosis in ischemic stroke with posterior circulation: A high-resolution magnetic resonance imaging study / 中国脑血管病杂志

Objective: To explore the characteristics of intracranial atherosclerosis and possible pathogenesis of posterior circulation ischaemic stroke by 3. 0 T high-resolution magnetic resonance imaging. Methods: The imaging and clinical features of intracranial atherosclerosis in 21 patients with posterior ischemic symptoms admitted in the Department of Neurology of Hebei General Hospital from December 2016 to December 2018 were retrospectively analyzed. The recruited patients were divided into the posterior circulation ischemic stroke group(10cases and 45 plaques) and the non-stroke group(11 cases and 25 plaques) according to their clinical symptoms, signs and imaging manifestations. Clinical data of all patients were collected, and high-resolution 3D time-of-flight MR angiography was used to evaluate the degree of vascular stenosis. Also, plaque characteristics including burden, enhancement, hyperintensity and morphology were counted on high-resolution Tl weighted imaging axial images. Results: The The proportion of diabetes was significantly different between the two groups (P = 0. 024). There were no significant differences in age, sex, smoking, alcohol consumption, hypertension, hyperuricemia, hyperlipidemia, hyperhomocysteinemia, stroke history and history of coronary atherosclerotic heart disease between the two groups (all P > 0. 05). The plaque burden in the posterior circulation ischemic stroke group was higher than that in the non-stroke group ([4. 5 ±1.6] vs. [2. 3 ±1.6]) with significant difference (t = 3. 190, P = 0.005). Plaque enhancement between the two groups was significant different (40.0% [18/45] vs. 16. 0% [4/25], X2 =4. 295, P = 0. 038). There was no significant difference in plaque high signal and plaque morphology between the two groups(all P > 0. 05). Conclusion: Patients in the posterior ischemic stroke group had a higher prevalence of diabetes, and intracranial atherosclerotic plaque burden and plaque enhancement were more common, suggesting that the posterior ischemic stroke group had a higher vulnerability of plaque.

Study on the Correlation between apolipoprotein and homocysteine levels with carotid atherosclerotic plaque stability and degree of stenosis / 中国综合临床

Objective To investigate the correlation between apolipoprotein and homocysteine levels with the stability of carotid plaque and the degree of stenosis??Methods One hundred elderly patients with acute cerebral infarction from January 2017 to December 2017 were collected continuously in Harbin Fourth Hospital,All patients underwent color Doppler ultrasound examination of carotid artery??They were divided into stable plaque group and unstable plaque group according to the results of color Doppler ultrasound,then according to the degree of stenosis they were divided into intimal thickening group with 23 cases, mild stenosis (stenosis degree＜50%) with 26 cases,moderate stenosis group (50%≤stenosis degree＜70%) with 28 cases,severe stenosis group (70%≤stenosis degree) with 23 cases??All the patients were selected to collect the blood of the elbow in the early morning to detect the level of apolipoprotein B and Hcy??Results Compared with unstable plaque group, smoking, drinking, hemoglobin A1c ( HbA1c), ApoB and Hcy had significant differences (all P＜0??05)??Gender,history of diabetes mellitus,history of hypertension,systolic pressure,diastolic pressure,low density lipoprotein cholesterol (LDL?C),triglyceride (TG) There was no significant difference in total cholesterol ( TC) and total cholesterol ( all P＞0??05)??Multivariate logistic regression was performed after correcting the related risk factors excluding blood lipids??The results showed that alcohol ( OR＝ 1??247 ( 95%CI: 0??626－1??958), P＝ 0??043), Hcy ( OR＝ 3??163 ( 95%CI: 1??824 －4??772),P＝0??045), bloodpressure ( OR＝1??286 ( 95%CI: 0??688－2??005), P＝0??027), HbA1c ( OR＝3??671(95%CI: 1??904－6??630),P＝0??011),ApoB (OR＝1??717(95%CI: 1??005－2??634),P＝0??036), LDL?C(OR＝1??516(95%CI: 0??968－2??489),P＝0??024),TC( OR＝1??403( 95%CI: 0??801－2??343),P＝0??030) and TG ( OR＝1??342 ( 95%CI: 0??712－2??198), P＝0??019) are independent risk factors for unstablecarotid plaque and severe carotid stenosis??Conclusion Apolipoprotein and homocysteine may be independent predictors of unstable carotid plaque and severity of carotid stenosis??

Study on effects and mechanism of interleukin 16 on pathogenesis of atherosclerosis / 国际检验医学杂志

Objective To analyze the expression of interleukin 16 (IL-16) in atherosclerosis (AS) patients, and to study the roles of IL-16in the pathogenesis of AS.Methods Thirty AS patients in Affiliated Hospital of Jining Medical College from August 2015to August 2016were randomly selected as the case group and twenty-nine healthy subjects were selected as the healthy control group.Peripheral blood of the subjects were collected.IL-16levels were determined with enzyme-linked immunosorbent assay (ELISA).Reverse transcriptase-polymerase chain reaction was applied to analyze IL-16mRNA level.IL-16expression in the atherosclerotic plaque samples was detected with immunohistochemical analysis.IL-16expression in aortic atherosclerotic plaque of AS patients and atherosclerotic ApoE-/-mice were analyzed by immunohistochemical staining.The aortic plaque changes of AS mice injected intraperitoneally with recombinant IL-16were detected.Results Both IL-16protein levels and IL-16mRNA levels were higher in case group than those of healthy control group, the difference was statistically significant (P＜0.05).The IL-16mRNA was highly expressed in the atherosclerotic plaque.The aortic plaque area of the mice underwent IL-16intraperitoneal injection were decreased while the plaque stability increased.Conclusion IL-16levels elevated in both AS patients and AS mice, which suggested that IL-16might play aprotective role against AS.

Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging

Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.

Advances in Intravascular Imaging: New Insights into the Vulnerable Plaque from Imaging Studies

The term “vulnerable plaque” denotes the plaque characteristics that are susceptible to coronary thrombosis. Previous post-mortem studies proposed 3 major mechanisms of coronary thrombosis: plaque rupture, plaque erosion, and calcified nodules. Of those, characteristics of rupture-prone plaque have been extensively studied. Pathology studies have identified the features of rupture-prone plaque including thin fibrous cap, large necrotic core, expansive vessel remodeling, inflammation, and neovascularization. Intravascular imaging modalities have emerged as adjunctive tools of angiography to identify vulnerable plaques. Multiple devices have been introduced to catheterization laboratories to date, including intravascular ultrasound (IVUS), virtual-histology IVUS, optical coherence tomography (OCT), coronary angioscopy, and near-infrared spectroscopy. With the use of these modalities, our understanding of vulnerable plaque has rapidly grown over the past several decades. One of the goals of intravascular imaging is to better predict and prevent future coronary events, for which prospective observational data is still lacking. OCT delineates microstructures of plaques, whereas IVUS visualizes macroscopic vascular structures. Specifically, plaque erosion, which has been underestimated in clinical practice, is gaining an interest due to the potential of OCT to make an in vivo diagnosis. Another potential future avenue for intravascular imaging is its use to guide treatment. Feasibility of tailored therapy for acute coronary syndromes (ACS) guided by OCT is under investigation. If it is proven to be effective, it may potentially lead to major shift in the management of millions of patients with ACS every year.

Research Progress of Angiogenesis in Atherosclerotic Plaque in Chinese Medicine and Western Medicine / 中国结合医学杂志

Angiogenesis in atherosclerotic plaque plays a critical role in the mechanism of atherosclerotic physiopathology. Present consensus shows that angiogenesis in atherosclerotic plaque is mainly resulted in hypoxia, inflammation and some pro-angiogenic factors. The homeostasis in plaque, which is hypoxic and infiltrated by inflammatory cells, may lead to angiogenesis, increase the plaque instability and the incidence rate of vascular events. This article reviews the progression of pathogenetic mechanism, physiopathological significance, relevant detecting technique and corresponding therapeutic methods of Chinese and Western medicine of angiogenesis in atherosclerotic plaque, so as to provide more theoretical basis for atherosclerotic clinical treatment.

Advances in research on correlation between microparticle and coronary athero-sclerosis / 中国免疫学杂志

The microparticle is a kind of small particle formed in the process of cell activation and apoptosis.Currently,the mi-croparticle is taken as the main medium of inflammatory reaction.However,it may also play a role of atherosclerotic plaque formation and subsequent onset,development and formation of acute coronary syndrome.Furthermore,the microparticle participates in the atherosclerotic plaque formation and rupture,coagulation startup and thrombus formation.Through the study of microparticle,the coronary atherosclerotic heart disease pathogenesis can be deeply understood.

Impact of smoking on young acute coronary syndrome patients evaluated by optical coherence tomography / 中国介入心脏病学杂志

Objective To explore the impact of smoking on coronary plaque characteristics on optical coherence tomography(OCT) in young patients with acute coronary disease(ACS).Methods We assessed the atherosclerotic plaque characteristics and vulnerability by OCT and coronary angiography in 60 ACS patients aged 45 years or younger in Beijing Anzhen Hospital, from June 2014 to June 2017. The patients were divided into the smoking group(n=33) and the non-smoking group(n=27) to compare the plaque characteristics and vulnerability.Results Smoking patients showed a less extent of fibrosis(48.55％vs. 77.8％,P=0.032)and microchannels(18.2％vs. 44.4％,P=0.033), and a greater extent of plaque rupture (24.2％vs. 3.7％,P=0.033) compared with non-smoking patients. In multivariate analysis, smoking was the only independent predictors of plaque rupture(OR 8.320, 95％CI 0.969-71.435,P=0.027) and less fibrosis (OR 0.269, 95％CI 0.086-0.837,P=0.020). Conclusions Patients who are smokers have less extensive fibrosis and a greater extent of plaque rupture, showing more extensive vulnerable plaque phenotype. Therefore, smoking is one of the major risk factors of advanced cardiovascular events in young patients.

Clinical values of serum visfatin and thrombus precursor protein in the diagnosis of lacunar infarction / 中国基层医药

Objective To explore the changes of serum visfatin and thrombus precursor protein (TpP) levels in patients with lacunar infarction,and the relationship with carotid atherosclerotic plaque ,and to determine the values of the two factors to predict lacunar infarction .Methods Carotid atherosclerosis plaques were detected in 95 cases with lacunar infarction,including 56 cases in unstable plaque group,39 cases in stable plaque group,and another 70 healthy persons were selected as control group .Serum visfatin,high-sensitivity C reactive protein (hs-CRP), interleukin-6(IL-6) and TpP levels were measured.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography.Results The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group and stable plaque group were higher than those in the control group (t =10.886,9.180,11.889,4.990,5.084,9.703,all P <0.05).The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group were (29.10 ±8.85)μg/L,(6.15 ± 2.78)mg/L and (5.98 ±2.66) pg /mL,respectively, which were higher than those in the stable plaque group [(21.47 ±8.39)μg/L,(4.37 ±2.09)mg/L and (4.64 ±2.03)pg/mL,t =4.222,3.385,2.652,all P <0.05]. Pearson linear correlation analysis and multiple linear stepwise regression analysis showed that serum visfatin levels were positively correlated with hs-CRP and IL-6.The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group and stable plaque group were higher than those in the control group (t =17.342,21.770, 18.138,11.228,15.245,14.306,all P <0.05).The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group were (18.52 ±6.43)mg/L,(25.95 ±7.98)mg/L,(18.43 ±6.10)mg/L,respectively,which were higher than those in the stable plaque group [(12.40 ±5.37) mg/L,(20.81 ±8.60) mg/L, (13.86 ± 5.04)mg/L,t =3.282,2.991,3.850,all P <0.05].Conclusion The serum levels of visfatin and TpP are highly specific,can be used as important indicators for prediction and diagnosis of lacunar infarction ,and they are related to the stability of carotid atherosclerotic plaque .

Intracranial atherosclerotic plaque enhancement associated with ischemic stroke: a study with three-dimensional high-resolution magnetic resonance vessel wall imaging / 复旦学报（医学版）

Objective To evaluate the reproducibility of three-dimensional high-resolution magnetic resonance imaging (HR-MRI) for vessel wall in demonstration of intracranial atherosclerotic plaque enhancement and to explore the relationship between plaque enhancement and ischemic stroke.Methods Fifty-two patients with ischemic stroke underwent traditional head MRI,three-dimensional time of flight magnetic resonance angiography and HR-MRI on a 3.0 T MRI scanner.Each identified intracranial plaque was classified as either culprit (the only or most stenotic lesion upstream from a stroke) or non-culprit (not the most stenotic lesion upstream from a stroke or not within the vascular territory of a stroke).The degree of plaque enhancement was graded by two independent radiologists.The degree of plaque enhancement and luminal stenosis were compared between the culprit group and the non-culprit group by using Mann-Whitney U test.Binary logistic regression analysis was performed to assess the relation between the degree of plaque enhancement and culprit plaques.Results Total 118 plaques were identified in 52 patients with ischemic stroke (52 culprit plaques and 66 non-culprit plaques).The degree of enhancement was rated as strong,moderate and none in 40,9 and 3 culprit plaques,and in 4,24 and 38 non-culprit plaques.Both intra-observer and inter-observer agreement were high for identification of plaque enhancement (kappa＞ 0.75).For culprit plaques group,the degree of plaque enhancement(Z =-7.787,P＜0.01) and luminal stenosis (Z =-5.327,P＜0.01) were significantly higher than those in the non-culprit group.Binary logistic regression analysis revealed that strong enhancement of plaques was independently associated with culprit plaques (OR:74.3,95％CI:15.0-367.1,P＜0.01).Conclusions Three-dimensional HR-MRI detects enhancement of intracranial plaques with high reproducibility.Enhancement is more common in culprit plaques and is associated with the likelihood of ischemic stroke.