Showing papers by "Ik-Kyung Jang published in 2022"
TL;DR: Jang et al. as mentioned in this paper summarized the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis, and provided a standard reference for future research and clinical application.
Abstract: Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application. Optical coherence tomography (OCT) has been widely adopted in research on coronary atherosclerosis and adopted clinically to optimize percutaneous coronary intervention. In this Review, Jang and colleagues summarize this rapidly progressing field, with the aim of standardizing the use of OCT in coronary atherosclerosis.
56 citations
TL;DR: Bacteria that were associated with vulnerable coronary plaque phenotype and greater plaque burden were identified and these bacteria were also associated with elevated inflammatory or prothrombotic biomarkers.
Abstract: Background The relationship between gut microbiota and in vivo coronary plaque characteristics has not been reported. This study was conducted to investigate the relationship between gut microbiota and coronary plaque characteristics in patients with coronary artery disease. Methods and Results Patients who underwent both optical coherence tomography and intravascular ultrasound imaging and provided stool and blood specimens were included. The composition of gut microbiota was evaluated using 16S rRNA sequencing. A total of 55 patients were included. At the genus level, 2 bacteria were associated with the presence of thin‐cap fibroatheroma, and 9 bacteria were associated with smaller fibrous cap thickness. Among them, some bacteria had significant associations with inflammatory/prothrombotic biomarkers. Dysgonomonas had a positive correlation with interleukin‐6, Paraprevotella had a positive correlation with fibrinogen and negative correlation with high‐density lipoprotein cholesterol, Succinatimonas had positive correlations with fibrinogen and homocysteine, and Bacillus had positive correlations with fibrinogen and high‐sensitivity C‐reactive protein. In addition, Paraprevotella, Succinatimonas, and Bacillus were also associated with greater plaque volume. Ten bacteria were associated with larger fibrous cap thickness. Some were associated with protective biomarker changes; Anaerostipes had negative correlations with trimethylamine N‐oxide, tumor necrosis factor α, and interleukin‐6, and Dielma had negative correlations with trimethylamine N‐oxide, white blood cells, plasminogen activator inhibitor‐1, and homocysteine, and a positive correlation with high‐density lipoprotein cholesterol. Conclusions Bacteria that were associated with vulnerable coronary plaque phenotype and greater plaque burden were identified. These bacteria were also associated with elevated inflammatory or prothrombotic biomarkers. Registration URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000041692.
6 citations
TL;DR: Biomarkers useful for detection of patients with high-risk coronary plaques defined according to intravascular imaging have been identified and may be useful to risk stratify patients and to develop targeted therapy.
3 citations
TL;DR: The authors showed that LDL particles are fundamental for atheroma formation, through their capability to penetrate the vessel endothelial surface and accumulate into the intima, and LDL accumulation, oxidation, and oxidized-LDL phagocytosis by monocyte-derived macrophages becoming foam cells represent the initial step for atherosclerotic plaque development.
3 citations
TL;DR: In this paper , the authors investigated the evolution of hemodynamic parameters on the plaque erosion site in conservatively treated patients and found that plaque erosion patients had higher ESS and ESSG values than non-erosion patients.
2 citations
TL;DR: In this paper , a novel "Transformer"-based DL model was developed that integrates information from adjacent frames emulating the cardiologists who review consecutive OCT frames to make a diagnosis and compared with the standard CNN DL model.
Abstract: Acute coronary syndromes caused by plaque erosion might be potentially managed conservatively without stenting. Currently, the diagnosis of plaque erosion requires expertise in optical coherence tomographic (OCT) image interpretation. In addition, the current deep learning (DL) approaches for OCT image interpretation are based on a single frame, without integrating the information from adjacent frames.The aim of this study was to develop a novel DL model to facilitate an accurate diagnosis of plaque erosion.A novel "Transformer"-based DL model was developed that integrates information from adjacent frames emulating the cardiologists who review consecutive OCT frames to make a diagnosis and compared with the standard convolutional neural network (CNN) DL model. A total of 237,021 cross-sectional OCT images from 581 patients were used for training and internal validation, and 65,394 images from 292 patients from another dataset were used for external validation. Model performances were evaluated using the area under the receiver-operating characteristic curve (AUC).For the frame-level diagnosis of plaque erosion, the Transformer model showed superior performance than the CNN model, with an AUC of 0.94 compared with 0.85 in the external validation. For the lesion-level diagnosis, the Transformer model showed improved diagnostic performance compared with the CNN model, with an AUC of 0.91 compared with 0.84 in the external validation.This newly developed Transformer model will help cardiologists diagnose plaque erosion with high accuracy in patients with acute coronary syndromes.
2 citations
TL;DR: Age related sex differences in culprit plaque morphology and vulnerability were identified in patients with acute coronary syndrome: prevalence of plaque rupture and vulnerability increased with age in women but not in men.
Abstract: Background: Despite the significant decline in cardiovascular mortality in women over the past several decades, sex differences in the underlying pathology of acute coronary syndromes remain poorly understood. Previous postmortem studies have demonstrated sex differences in coronary plaque morphology with a higher prevalence of plaque erosion in young women and more plaque rupture in older women after menopause, whereas men showed no increase in prevalence of plaque rupture with age. However, in vivo data are limited. Methods: This study included patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging of the culprit lesion. The culprit plaque was categorized as plaque rupture, plaque erosion or culprit plaque with calcification, and stratified by age. Features of plaque vulnerability at culprit lesion were also analyzed. Results: In 1368 patients (women=286), women and men had a similar distribution of culprit plaque morphology (plaque rupture versus plaque erosion). However, significant sex differences were found in the underlying mechanisms of acute coronary syndrome among different age groups: women showed a significant ascending trend with age in plaque rupture (P<0.001) and the features of plaque vulnerability such as lipid plaque (P<0.001), thin-cap fibroatheroma (P=0.005), and microstructures including macrophages, cholesterol crystals, and calcification (P=0.026). No trend was observed in men. Conclusions: Age related sex differences in culprit plaque morphology and vulnerability were identified in patients with acute coronary syndrome: prevalence of plaque rupture and vulnerability increased with age in women but not in men. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01110538 and NCT03479723.
1 citations
1 citations
TL;DR: In this paper , the authors proposed to combine different intravascular imaging methods to identify the most vulnerable plaques, which are prone to cause acute coronary syndrome, and thus they may allow us to introduce proper treatment before plaque destabilization.
Abstract: The introduction into clinical practice of intravascular imaging, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and their derivatives, allowed for the in vivo assessment of coronary atherosclerosis in humans, including insights into plaque evolution and progression process. Intravascular ultrasound, the most commonly used intravascular modality in many countries, due to its low resolution cannot assess many features of vulnerable plaque such as lipid plaque or thin-cap fibroatheroma. Thus, novel methods were introduced to facilitate this problem including virtual histology intravascular ultrasound and later on near-infrared spectroscopy and OCT. Howbeit, none of the currently used modalities can assess all known characteristics of plaque vulnerability; hence, the idea of combining different intravascular imaging methods has emerged including NIRS-IVUS or OCT-IVUS imaging. All of those described methods may allow us to identify the most vulnerable plaques, which are prone to cause acute coronary syndrome, and thus they may allow us to introduce proper treatment before plaque destabilization.
1 citations
TL;DR: PCAT attenuation at culprit plaque, culprit vessel, and pan-coronary levels was higher in ACS patients than in SAP patients, and Vascular inflammation appears to play a crucial role in the development of ACS.
Abstract: Background: Vascular inflammation has been recognized as one of the key factors in the pathogenesis of acute coronary syndromes (ACS). Pericoronary adipose tissue (PCAT) attenuation by computed tomography angiography has emerged as a marker specific for coronary artery inflammation. We examined the relationship between clinical presentation and coronary artery inflammation assessed by PCAT attenuation and coronary plaque characteristics. Methods: Patients with ACS or stable angina pectoris (SAP) who underwent preintervention coronary computed tomography angiography and optical coherence tomography were enrolled. PCAT attenuation was measured around the culprit lesion and in the proximal 40 mm of all coronary arteries. PCAT attenuation and optical coherence tomography findings were compared between patients with ACS versus SAP. Results: Among 471 patients (ACS: 198, SAP: 273), PCAT attenuation was higher in ACS patients than in SAP patients both at the culprit plaque level (−67.5±9.6 Hounsfield unit [HU] versus −71.5±11.0 HU, P<0.001) and at the culprit vessel level (−68.3±7.7 HU versus −71.1±7.9 HU, P<0.001). The mean PCAT attenuation of all 3 coronary arteries was also significantly higher in ACS patients than in SAP patients (−68.8±6.3 HU versus −70.5±7.1 HU, P=0.007). After adjusting patient characteristics, not only thin-cap fibroatheroma (OR: 3.41; 95% CI: 1.89–6.17) and macrophages (OR: 3.32; 95% CI: 1.76–6.26) but also PCAT attenuation around the culprit plaque (OR: 1.03; 95% CI: 1.00–1.05) was associated with the clinical presentation of ACS. Conclusions: PCAT attenuation at culprit plaque, culprit vessel, and pan-coronary levels was higher in ACS patients than in SAP patients. Vascular inflammation appears to play a crucial role in the development of ACS. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04523194
1 citations
TL;DR: In this article , the authors examined the relationship between layered plaques detected by OCT and plaque burden detected by intravascular ultrasound (IVUS) in patients with acute coronary syndromes (ACS).
Abstract:
Introduction:
Layered plaque is a signature of previous subclinical plaque destabilization and healing, which can be identified by optical coherence tomography (OCT). Silent plaque rupture or erosion with formation of a layer might contribute to rapid step-wise progression of plaque. We examined the relationship between layered plaques detected by OCT and plaque burden detected by intravascular ultrasound (IVUS) in patients with acute coronary syndromes (ACS).
Methods:
Patients presented with ACS who underwent preintervention OCT and IVUS were included in the analysis. Layered plaque was identified by OCT, and plaque burden was measured by IVUS around the culprit lesion. IVUS findings were compared between patients with layered plaque versus those without layered plaque.
Results:
Among 150 patients, total atheroma volume (TAV) (183.27 mm
3
[114.2 mm
3
to 275.0 mm
3
] vs. 119.27 mm
3
[68.9 mm
3
to 185.5 mm
3
], p=0.004), percent atheroma volume (PAV) (60.06 % [54.7 % to 60.1 %] vs. 53.69 % [46.8 % to 60.6 %], p=0.001), and plaque burden (PB) (86.51 % [81.7 % to 85.7 %] vs. 82.58 % [77.9 % to 85.4 %], p=0.001) were significantly higher in patients with layered plaques than non-layered plaques (Figure). When multi, single, and non-layered plaques were compared, TAV (188.69 mm
3
[122.1 mm
3
to 293.6 mm
3
] vs. 137.85 mm
3
[100.1 mm
3
to 208.4 mm
3
] vs. 119.27 mm
3
[68.9 mm
3
to 185.5 mm
3
], p=0.021), PAV (62.12 % [56.8 % to 67.8 %] vs. 57.52 % [48.9 % to 60.1 %] vs. 53.69 % [46.8 % to 60.6 %] p<0.001), and PB (87.44 % [81.8 % to 89.3 %] vs. 84.7 % [77.9 % to 88.0 %] vs. 82.58 % [77.9 % to 85.4 %], p=0.018) were significantly greater in multi-layered plaques than others.
Conclusions:
This study demonstrates that layered plaques, compared to non-layered plaques, have significantly greater plaque burden in patients with ACS, indicating plaque disruption and healing process, rather than gradual smooth muscle proliferation, significantly contributes to plaque progression at the culprit lesion in patients with ACS.
TL;DR: In this article , a blinded study of histologically identified OCT human plaque composition by leading international OCT core labs was presented, which indicated that participants can accurately identify combined lipid categories (lipid pool, TCFA, and necrotic core), fibrous tissue and calcium.
Abstract:
Introduction:
Intravascular optical coherence tomography (OCT) provides a high-resolution representation of coronary atherosclerosis. However, the accuracy of OCT image interpretation is unknown. We present a blinded study of histologically identified OCT human plaque composition by leading international OCT core labs.
Hypothesis:
Human readers are unable to accurately identify all plaque compositions.
Methods:
Seven recognized OCT core labs (Japan, Netherlands, Switzerland, USA) participated. Each laboratory was provided 51 OCT image clips recorded from ex vivo human coronary arteries within 24 hours of death and had regions of interest processed for H&E stain. Nine plaque components were identified and are listed in Results. Each OCT core lab was asked to blindly read OCT images and complete a questionnaire indicating one of nine possible plaque types. Kappa coefficient (
k
) was used (
k
< 0.5 poor agreement,
k
> 0.5 high agreement) to measure intra-reader agreement; the median
k
is reported for each plaque component.
Results:
High agreement was demonstrated in identifying stable plaque including fibrous (0.93), calcium (0.83), layered plaque (1.0), and ThCFA (0.63), in contrast to unstable plaque including calcified nodule (0.50), lipid pool (0.35), macrophages/foam cells (0.35), TCFA (0.39), and necrotic core (0.22). When categories were restricted to Fibrous, Calcium, and Lipids, with Lipids expanded to include lipid pool, TCFA, and necrotic core, similar to an OCT core lab definition,
k
for Lipids increased to 0.61.
Conclusions:
Results suggest that participating OCT core labs can accurately identify combined lipid categories (lipid pool, TCFA, and necrotic core), fibrous tissue and calcium. However, accuracy is reduced when reading more sophisticated unstable plaque components. Study results emphasize the need for the development of OCT plaque composition analysis with artificial intelligence.
TL;DR: In this article , the authors developed a deep learning (DL) model for the diagnosis of layered plaque in OCT images and compared with the standard convolutional neural network (CNN) model.
Abstract: Healed coronary plaques, morphologically characterized by a layered phenotype, are signs of previous plaque destabilization and healing. Recent optical coherence tomography (OCT) studies demonstrated that layered plaque is associated with higher levels of local and systemic inflammation and rapid plaque progression. However, the diagnosis of layered plaque needs expertise in OCT image analysis and is susceptible to inter-observer variability. We developed a deep learning (DL) model for an accurate diagnosis of layered plaque. A Visual Transformer (ViT)-based DL model that integrates information from adjacent frames emulating the cardiologists who review consecutive OCT frames to make a diagnosis was developed and compared with the standard convolutional neural network (CNN) model. A total of 237,021 cross-sectional OCT images from 581 patients collected from 8 sites were used for training and internal validation, and 65,394 images from 292 patients collected from another site were used for external validation. In the five-fold cross-validation, the ViT-based model provided better performance (area under the curve [AUC]: 0.860; 95% confidence interval [CI]: 0.855-0.866) than the standard CNN-based model (AUC: 0.799; 95% CI: 0.792-0.805). The ViT-based model (AUC: 0.845; 95% CI: 0.837-0.853) also surpassed the standard CNN-based model (AUC: 0.791; 95% CI: 0.782-0.800) in the external validation. The ViT-based DL model can accurately diagnose a layered plaque, which could help risk stratification for cardiac events.
TL;DR: Although exercise favorably associates with reduced CAD risk, the precise mechanism by which physical activity reduces coronary event risk remains incompletely understood— especially at the level of coronary atherosclerotic plaque.
Abstract: The beneficial protection of physical activity from coronary artery disease (CAD) has been known since the 1950s London Bus Study demonstrated that stair climbing bus conductors had half the rate of myocardial infarction when compared with their sedentary bus driving counterparts.1 A recent metaanalysis showed that exercisebased cardiac rehabilitation substantially reduces mortality for patients hospitalized for CAD.2 Despite this reported association, the precise mechanism by which physical activity reduces coronary event risk remains incompletely understood— especially at the level of coronary atherosclerotic plaque. Plaque rupture is the most frequent mechanism for acute coronary syndromes. Ruptured plaques have morphological characteristics, which include large lipid pools, thin fibrous caps, macrophage infiltration, microvessels, cholesterol crystal, and positive remodeling.3 Although exercise favorably associates with reduced CAD risk, a highresolution answer to how exercise training directly influences coronary plaques remains unclear.
TL;DR: The prevalence of lipid plaques increased with age particularly in women with hyperlipidemia and hypertension, and patients with diabetes and positive family history had a higher prevalence at young age.
Abstract:
An incidence of cardiovascular events increases with age in women. The relationship between cardiovascular risk factors, and the underlying pathology and the prevalence of lipid plaques has not been systematically studied in different age groups in women presented with acute coronary syndromes (ACS).
We investigated the underlying pathology and the prevalence of lipid plaques in culprit lesions by optical coherence tomography (OCT) in women with different risk factors.
A total of 382 women who underwent pre-intervention OCT imaging were included. The underlying pathology and the prevalence of lipid plaques in the culprit lesion was compared between women with and without cardiovascular risk factors (i.e. hypertension, smoking, hyperlipidemia, diabetes mellitus, family history and chronic kidney disease) in three different age groups (<60 yr, 60–70 yr, >70 yr).
The relative prevalence of plaque erosion was higher in younger women (<60 yr) and decreased with age (from 51% to 28%, p<0.001). There was no significant difference in the prevalence of lipid plaques between women with and without risk factors, except a higher prevalence of lipid plaques in current smokers compared to non-smokers (79% vs. 63%, p=0.003). In women with hyperlipidemia, the prevalence of lipid plaques was modest in young ages (<60 yr), but increased steeply with age (p<0.001). The increasing age trend for lipid plaque was also observed in women with hypertension (p=0.03) and current smokers (p=0.01). In women with diabetes mellitus and family history, the prevalence of lipid plaques was high even in young ages (<60 yr) and did not increase with age.
The prevalence of plaque erosion was higher in younger women (<60 yr) and decreased with age. Current smokers had significantly higher prevalence of lipid plaque. Patients with diabetes and positive family history had a higher prevalence of lipid plaque at young age. The prevalence of lipid plaques increased with age particularly in women with hyperlipidemia and hypertension.
Type of funding sources: Foundation.