Aims: Smaller low-density lipoprotein (LDL) particle size has been suggested to result in the development of endothelial dysfunction, atherosclerosis, and in-stent restenosis (ISR); however, little ...is known regarding the impact of the LDL particle size on the neointima formation leading to ISR after everolimus-eluting stent (EES) implantation. Methods: In this study, we have included 100 patients to examine the relationship between an LDL-C/apolipoprotein B (Apo B) ≤ 1.2, reportedly representing the LDL particle size, and the neointimal characteristics using optical coherence tomography (OCT) and coronary angioscopy (CAS) during the follow-up coronary angiography (CAG) period (8.8±2.5 months) after EES implantation. We divided them into two groups: LDL-C/Apo B ≤ 1.2 group (low LDL-C/Apo B group, n=53) and LDL-C/Apo B ＞1.2 group (high LDL-C/Apo B group, n=47). Results: The low LDL-C/Apo B group had a significantly larger neointimal volume (12.8±5.3 vs. 10.3±4.9 mm3, p=0.021) and lower incidence of a neointimal homogeneous pattern (71 vs. 89 %), higher incidence of a neointimal heterogeneous pattern (25 vs. 9 %) (p=0.006) and higher prevalence of macrophage accumulation (9 vs. 2 %) (p=0.030) as assessed via OCT, and, as per the CAS findings, a higher prevalence of yellow grade ≥ 2 (grade 2; adjusted residual: 2.94, grade 3; adjusted residual: 2.00, p=0.017) than the high LDL-C/Apo B group. Conclusions: A low LDL-C/Apo B ratio was found to be strongly associated with neointimal proliferation and neointimal instability evidenced chronically by OCT and CAS. An LDL-C/Apo B ≤ 1.2 will be of aid in terms of identifying high-risk patients after EES implantation.
Methods A total of 34 patients with coronary artery disease (68%), 7 AoV stenosis (AS, 21%) and 2 aortic aneurysm (6%) were imaged with AAS. Using the real-time raw images, yellow grade (YG:0-3) and ...prevalence of significant thickening or opening restriction of AoV, and the number of yellow plaque (YPs) within the ascending aorta (A-Ao) were assessed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aims: Wall shear stress (WSS) has been considered a major determinant of aortic atherosclerosis. Recently, non-obstructive general angioscopy (NOGA) was developed to visualize various atherosclerotic ...pathologies, including in vivo ruptured plaque (RP) in the aorta. However, the relationship between aortic RP and WSS distribution within the aortic wall is unclear. This study aimed to investigate the relationship between aortic NOGA-derived RP and the stereographic distribution of WSS by computational fluid dynamics (CFD) modeling using three-dimensional computed tomography (3D-CT) angiography. Methods: We investigated 45 consecutive patients who underwent 3D-CT before coronary angiography and NOGA during coronary angiography. WSS in the aortic arch was measured by CFD analysis based on the finite element method using uniform inlet and outlet flow conditions. Aortic RP was detected by NOGA. Results: Patients with a distinct RP showed a significantly higher maximum WSS value in the aortic arch than those without aortic RP (56.2±30.6 Pa vs 36.2±19.8 Pa, p=0.017), no significant difference was noted in the mean WSS between those with and without aortic RP. In a multivariate logistic regression analysis, the presence of a maximum WSS value more than a specific value was a significant predictor of aortic RP (odds ratio 7.21, 95% confidence interval 1.78-37.1, p=0.005). Conclusions: Aortic RP detected by NOGA was strongly associated with a higher maximum WSS in the aortic arch derived by CFD using 3D-CT. The maximum WSS value may have an important role in the underlying mechanism of not only aortic atherosclerosis, but also aortic RP.
IntroductionClinical trials reported that there were no significant differences in 12-month outcome between durable polymer everolimus-eluting stent (DP-EES) and bioabsorbable polymer ...everolimus-eluting stent (BP-EES). However, in-stent bioreactions after BP-EES implantation are still unclear.HypothesisWe compared the in-stent responses between BP-EES and DP-EES in a low-density lipoprotein receptor knockout (LDLR) miniature pig with human-like unstable coronary plaques. We evaluated the safety of the recent drug-eluting stent, and whether antiplatelet drugs can be discontinued early in an unstable coronary plaque animal model.MethodsPromus-PREMIER stents as DP-EES or SYNERGY stents as BP-EES were randomly deployed in the coronary arteries with unstable plaque developed in the three-month-old LDLRminiature pigs. The animals were given aspirin (81 mg) and clopidogrel (75 mg) orally 3 days prior to implantation and then daily throughout the follow-up period. One month after stent implantation, in-vivo optical coherence tomography (OCT) assessment was performed and the stent-implanted arteries were dissected for histologic examination.ResultsOCT analysis showed the neointima in the BP-EES was homogenous and thinner (neointima area, 1.90 ± 0.03 mm vs 2.05 ± 0.07 mm, P = 0.042; mean neointima thickness, 0.22 ± 0.00 mm vs. 0.24 ± 0.00 mm, P = 0.001) than that in the DP-EES. Histological analysis revealed fibrin deposits and inflammatory cells infiltration in the peri-strut region in the BP-EES implanted arteries were less than the DP-EES.ConclusionsOur results showed that the BP-EES might less injure coronary arteries than the DP-EES and stable neointima might be covered early after BP-EES implantation. These results can be considered to be important evidence in the early termination of antiplatelet drugs.
IntroductionAcute kidney injury (AKI) is an independent predictor of mortality in patients with acute coronary syndrome (ACS). Although baseline renal function is associated with development of AKI, ...biological markers for predicting the onset of AKI in patients with ACS have not fully investigated. Urinary liver-type fatty acid-binding protein (L-FABP), which is produced in the proximal tubule by renal hypoxia and oxidative stress, is a candidate biomarker for early detection of AKI, with variable performance characteristics depending on clinical settings.MethodsWe evaluated consecutive 258 patients with ACS. Urinary L-FABP , estimated glomerular filtration rate (eGFR)-creatinine, and eGFR-cystatin C were measured at baseline, immediate after and 24 hours after coronary angiography with contrast agent administration. AKI was defined as an increase of >0.3 mg/dl in serum creatinine level within 2 days after procedure.ResultsAKI was detected in 20 patients (7.8%). Patients with AKI had significantly higher urinary L-FABP level (68.0 m g/gCr vs 3.1 m g/gCr, p <0.001), lower eGFR-creatinine (33.0 mg/dl vs 72.1 mg/dl, p <0.001), lower eGFR-cystatin C (39.5 mg/l vs 79.4 mg/l, p <0.001) and higher urinary albuminuria level (1440 vs 42 mg/gCr, p <0.001) at baseline compared of those with non-AKI. Receiver operating characteristic (ROC) analysis showed baseline urinary L-FABP level exhibited 85.7% sensitivity and 96.0% specificity, at cutoff value of 29.7 m g/gCr. We used propensity score analyses to balance measurable confounders between patients with and without AKI, including age, left ventricular ejection fraction, inflammation marker, renal function, and albuminuria. In logistic regression adjustment with the propensity score, urinary L-FABP level of >29.7 m g/gCr at baseline was an independent predictor of AKI (odds ratio 40.0. 95% confidence interval 4.4-457.7, p=0.001). In the ROC analysis, AUC for baseline eGFR-creatinine, eGFR-cystatin C, and urinary L-FABP were 0.89, 0.88, and 0.93, respectively. The combination of baseline eGFR-creatinine and urinary L-FABP had a higher predictive value for AKI than each on its own (AUC; 0.96, p <0.001).ConclusionsUrinary L-FABP level might be a useful biomarker for predicting the onset of AKI in patients with ACS.
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