Ultrasonography, Interventional

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Original Article

Adiponectin in Relation to Coronary Plaque Characteristics on Radiofrequency Intravascular Ultrasound and Cardiovascular Outcome

Bárbara Campos Abreu Marino et al. Nermina Buljubasic Martijn Akkerhuis Jin M. Cheng … Hector M. Garcia-Garcia Evelyn Regar Robert-Jan van Geuns Patrick W. Serruys Eric Boersma Isabella Kardys

Abstract

Background:

Prospective data on the associations of adiponectin with in-vivo measurements of degree, phenotype and vulnerability of coronary atherosclerosis are currently lacking.

Objective:

To investigate the association of plasma adiponectin with virtual histology intravascular ultrasound (VH-IVUS)-derived measures of atherosclerosis and with major adverse cardiac events (MACE) in patients with established coronary artery disease.

Methods:

In 2008-2011, VH-IVUS of a non-culprit non-stenotic coronary segment was performed in 581 patients undergoing coronary angiography for acute coronary syndrome (ACS, n = 318) or stable angina pectoris (SAP, n = 263) from the atherosclerosis-intravascular ultrasound (ATHEROREMO-IVUS) study. Blood was sampled prior to coronary angiography. Coronary plaque burden, tissue composition, high-risk lesions, including VH-IVUS-derived thin-cap fibroatheroma (TCFA), were assessed. All-cause mortality, ACS, unplanned coronary revascularization were registered during a 1-year-follow-up. All statistical tests were two-tailed and p-values < 0.05 were considered statistically significant.

Results:

In the full cohort, adiponectin levels were not associated with plaque burden, nor with the various VH-tissue types. In SAP patients, adiponectin levels (median[IQR]: 2.9(1.9-3.9) µg/mL) were positively associated with VH-IVUS derived TCFA lesions, (OR[95%CI]: 1.78[1.06-3.00], p = 0.030), and inversely associated with lesions with minimal luminal area (MLA) ≤ 4.0 mm² (OR[95%CI]: 0.55[0.32-0.92], p = 0.025). In ACS patients, adiponectin levels (median[IQR]: 2.9 [1.8-4.1] µg/mL)were not associated with plaque burden, nor with tissue components. Positive association of adiponectin with death was present in the full cohort (HR[95%CI]: 2.52[1.02-6.23], p = 0.045) and (borderline) in SAP patients (HR[95%CI]: 8.48[0.92-78.0], p = 0.058). In ACS patients, this association lost statistical significance after multivariable adjustment (HR[95%CI]: 1.87[0.67-5.19], p = 0.23).

Conclusion:

In the full cohort, adiponectin levels were associated with death but not with VH-IVUS atherosclerosis measures. In SAP patients, adiponectin levels were associated with VH-IVUS-derived TCFA lesions. Altogether, substantial role for adiponectin in plaque vulnerability remains unconfirmed.

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Editorial

Adiponectin in Relation to Coronary Plaque Characteristics on Radiofrequency Intravascular Ultrasound and Cardiovascular Outcome

José Mariani Junior

Inflammation is a complex and necessary component of the response to biological, chemical, or physical stimuli, and the cellular and molecular events that initiate and regulate the interactions between the various players in the inflammatory process of the atherosclerotic lesions remain a source of ongoing investigation.

The European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis – Intravascular Ultrasound (ATHEROREMO-IVUS) study aimed to investigate the relations of genetic profile and novel circulating and inflammatory biomarkers with coronary plaque phenotype and vulnerability as determined by intravascular ultrasound (IVUS). Results from this trial have been helping us to improve our knowledge on the role of genetic profile and circulating inflammatory biomarkers in relation to the development of atherosclerosis and vulnerable plaques.

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Image

Crescent Moon Image as a Peculiar Complication During Percutaneous Coronary Intervention of an In-Stent Chronic Total Occlusion

Mohsen Mohandes et al. Jordi Guarinos Cristina Moreno Sergio Rojas Alfredo Bardají

Case

55-year-old male with history of ischemic cardiomyopathy with previous percutaneous coronary intervention (PCI) in the anterior descending coronary artery (LAD) middle segment was admitted to our hospital for chest pains. A new coronary angiogram showed in-stent chronic total occlusion (ISCTO) of LAD receiving collaterals from right coronary artery (RCA). Left circumflex (LCX) was totally occluded and RCA presented a significant mid-segment lesion. Complete percutaneous revascularization was planned. First attempt to recanalize the LAD failed because the lesion obstructed the passage of the balloon, so a second dedicated attempt was planned. Bilateral injection using radial and femoral arteries was used, and a Confianza Pro 9 (Asahi Intecc, Japan) guidewire was progressively advanced through the ISCTO () and the wire’s position in true lumen was verified by contralateral injection. Considering the lesion, which impeded the balloon’s passage, a microcatheter Tornus (Asahi Intecc, Japan) was utilized to penetrate and advance through and past the occlusion (). After balloon predilatation, intravascular ultrasound sonography (IVUS) verified the position of the wire in a very short segment into true lumen, but outside the previously implanted stent (). Several drug eluting stents (DES) were implanted and the artery was successfully recanalized, although a very distal embolization was detected (). A new IVUS examination showed partial crush of the previous stent in the shape of a crescent moon ().

[…]

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Artigo Original

Intracoronary ultrasound-guided stenting improves outcomes: a meta-analysis of randomized trials

Graciele Sbruzzi et al. Alexandre Schaan de Quadros Rodrigo Antonini Ribeiro Aníbal Pereira Abelin … Otávio Berwanger Rodrigo Della Meã Plentz Beatriz DAgord Schann

BACKGROUND: Intracoronary ultrasound (IVUS) has been used as an adjunctive method in order to optimize implantation of stents. However, the impact of this method in some outcomes is controversial. OBJECTIVE: To systematically review the impact of routine IVUS-guided coronary stent as compared to angiographic-guided, on clinical and angiographic outcomes. METHODS: A search of databases (MEDLINE, Cochrane CENTRAL, EMBASE) and references of published studies, from 1982 to 2010, was conducted. Randomized clinical trials (RCTs) that compared angiography plus IVUS-guided (IVUS) vs. angiography alone guided (ANGIO) coronary stent implantation were included. Minimum follow-up was 6 months and the outcomes assessed were major adverse cardiac events (MACE), target lesion revascularization (TLR) and angiographic restenosis. Two reviewers independently extracted the data. Summary risk ratio and 95% confidence intervals (CI) were calculated with random-effects models. The GRADE approach was used to determine the overall quality of evidence for each outcome. RESULTS: Out of 3,631 articles identified, 8 RCTs evaluating a total of 2,341 patients were included. There was a 27% reduction in angiographic restenosis (95%CI: 3%-46%) and a 38% reduction in TLR (95%CI: 17%-53%) in favor of IVUS vs. ANGIO. However, MACE were not reduced by IVUS (RR: 0.79; 95%CI: 0.61-1.03). The MACE data represent only 47% of the optimal information size required to reliably detect a plausible treatment effect. CONCLUSIONS: We observed that IVUS-guided coronary stenting provides significant reductions in TLR and angiographic restenosis compared to angiographically-guided stenting, but it does not reduce MACE.

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Artigo Original

Subclinical coronary artery disease in patients with type 1 Diabetes Mellitus undergoing hemodialysis

Dinaldo Cavalcanti de Oliveira et al. Fabio Sandoli de Brito Junior Rosley Weber Alvarenga Fernandes João Roberto de Sa Valter Correia de Lima

BACKGROUND: In patients with type 1 diabetes mellitus, atherosclerosis occurs earlier in life and coronary artery disease (CAD) constitutes the major cause of death. OBJECTIVE: Evaluate the prevalence and anatomic characteristics of coronary artery disease (CAD) in type 1 diabetic patients with chronic renal failure undergoing hemodialysis. METHODS: This is a descriptive study of 20 patients with type 1 diabetes mellitus undergoing hemodialysis without known CAD. CAD was assessed by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). QCA was performed in all lesions >30%, visually. All proximal 18-mm segments of the coronary arteries were analyzed by IVUS. All other coronary segments with stenosis >30% were also analyzed. RESULTS: Angiography detected 29 lesions >30% in 15 patients (75%). Eleven (55%) of the lesions were >50% and 10 (50%) >70%. Thirteen patients had all 3 major arteries interrogated by IVUS. Atherosclerosis was present in all patients and in all 51 proximal 18-mm segments analyzed. The mean vessel diameter of these segments was significantly larger at the IVUS than at the QCA, for all vessels. IVUS images of 25 (86.2%) of the 29 lesions >30% were obtained. Fibrotic plaques were common (48%) and 60% had intermediate vessel remodeling. CONCLUSION: CAD was present in all vessels of all type 1 diabetic patients undergoing hemodialysis. These findings are in agreement with other autopsy, angiography and IVUS studies. Additionally, they indicate the need for additional epidemiological and imaging studies to better understand and treat such a complex and serious clinical condition affecting young people.

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Case Report

Endoprosthesis implantation at the entry pathway of the right atrium monitored by intracardiac ultrasound

Rogério Tadeu Tumelero et al. Norberto Toazza Duda Alexandre Pereira Tognon Saulo Martins Coccio Filho

Obstructions of the upper venous system may be due to spontaneous thrombosis or the presence of hemodialysis or chemotherapy catheters, or even the presence of extrinsic compression due to intra-thoracic tumors. The use of endoprosthesis for the treatment of these obstructions has become common practice, and its indications include situations of risk for pulmonary embolism, superior vena cava syndrome, and loss of vascular access. Within this context, the use of intracardiac ultrasound may be useful in evaluating the extension and severity of the obstructive lesion, besides providing important information about the mural and intraluminal morphology of the venous system. The authors report the case of a patient with superior vena cava syndrome caused by thrombosis at the entry pathway of the right atrium, besides discussing the subject by means of literature review.

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Artigo Original

The usefulness of intracoronary ultrasound in the treatment decision-making of patients with ambiguous lesions in the left main coronary artery

Vinicius Daher Vaz et al. Andrea Claudia Leão de Souza Abizaid Alexandre Antonio Cunha Abizaid Fausto Feres … Rodolfo Staico Luiz Alberto Piva Mattos Ibraim Pinto Luiz Fernando Leite Tanajura Amanda G. M. R. Sousa José Eduardo M. R. Sousa

OBJECTIVE: To evaluate the safety and efficacy of surgical treatment approach vs. conservative approach in patients with ambiguous lesions in the left main coronary artery (LMCA), based on intracoronary ultrasound (ICUS) findings. METHODS: Sixty-six consecutive patients with angiographically ambiguous lesions were included and submitted to ICUS assessment. They were divided in two groups, according to the ICUS findings. Group I was maintained under clinical treatment [minimal lumen area (MLA) > 6.0 mm² and/or minimal lumen diameter (MLD) > 2.5 mm] and Group II was submitted to revascularization (MLA < 6.0 mm² and/or MLD < 2.5 mm). The occurrence of major cardiac events (death, acute myocardial infarction and/or revascularization of the target lesion) was assessed during follow-up. RESULTS: Forty-one (62%) patients were allocated in Group I and 25 (38%) in Group II. Mean follow-up was 42.1 months. The coronary angiography did not differentiate the two groups regarding lesion severity (MLD 1.98 mm in Group I vs. 1.72 mm in Group II; p = 0.75) in opposition to ICUS (MLD 3.41 mm in Group I vs. 2.01 mm in Group II; p < 0.001). There was no death or myocardial infarction in Group I. The survival rate free of major cardiac events was 95% in Group I vs. 87.5% in Group II (p=ns). CONCLUSION: Treatment decision-making of patients with ambiguous lesions in the LMCA guided by ICUS findings showed to be safe and effective.

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