Chen Yundai

Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis

AIMS The prevalence of plaque rupture at the culprit lesion identified by optical coherence tomography (OCT) in different clinical subset of patients undergoing coronary angiography and its clinical predictors remain to be defined. METHODS All studies including patients with OCT evaluation of the culprit coronary plaque were included. The prevalence of culprit plaque rupture (CPR) and thin-cap fibro-atheroma (TCFA) were the primary endpoints. The factors associated with these findings were studied in a subset of patients with different clinical presentations [ST-elevation myocardial (STEMI) vs. nonST-elevation myocardial infarction (NSTEMI) vs. unstable angina (UA) vs. stable angina pectoris (SAP)]. RESULTS One hundred and fifty citations were initially appraised at the abstract level and 23 full-text studies were assessed. The mean prevalence of CPR and TCFA was 48.1% (40.5-55.8) and 48.7% (37.4-60.1), respectively. The prevalence of CPR and TCFA were higher in STEMI (70.4 and 76.6%) than in NSTEMI (55.6 and 56.3%) and UA (39.1 and 52.9%) or SAP (6.2 and 22.8%). In the overall population at meta-regression analysis, TCFA and current smoking were the only predictors of CPR (B 3.6:2.0-5.1, P < 0.001 and 0.06:0.02-0.1, P = 0.002, respectively). The factors associated with CPR were different depending on clinical presentation. Hypertension was the only clinical predictor for STEMI (B 3.3: 1.2.-5.3 P = 0.001), while advanced age (B 0.12: 0.02-0.22, P = 0.021), diabetes mellitus (B 0.04: 0.01-0.08, P = 0.012), and hyperlipidaemia (B 0.07:0.02-0.11, P = 0.005) were the predictors in NSTEMI and UA. No clinical predictor was found in SA. CONCLUSIONS Our analysis showed high rates of CPR and TCFA detected by OCT in CAD patients, especially in those with ACS, although their prevalence is not negligible in stable patients. TCFA seems to be a strong predictor of CPR in all the ACS scenarios.

Assessment of coronary plaque characteristics by optical coherence tomography in patients with diabetes mellitus complicated with unstable angina pectoris.

BACKGROUND Diabetic patients are characterised by poorer prognosis and more cardiovascular complications compared with non-diabetic patients, which may be due to metabolic abnormalities and atherosclerotic plaque characteristics. METHODS Patients with unstable angina pectoris were enrolled in the study and divided into diabetes mellitus (DM) (patients, n=25; plaques, n=42) and non-DM (patients, n=53; plaques, n=65) groups according to their DM history. Optical coherence tomography (OCT) examinations were performed on all patients, and images were analysed by two independent investigators. Fibrous cap thickness was measured at the thinnest point of each plaque. The presence of plaque disruption, dissection, erosion, thrombosis and calcification were also noted. RESULTS Calcified plaques in the DM group were significantly greater than those in the non-DM group (42.9% vs. 23.1%; p=0.03). Thin-cap fibroatheroma (TCFA) were detected, and no significant difference was found in the frequencies (42.9% vs. 52.3%; p=0.34) and fibrous cap thickness (57.08 ± 6.20 μm vs. 56.11 ± 9.23 μm, p=0.74) between the DM and non-DM groups. Thrombus and plaque erosion were similar in the two groups, but the frequency of dissection in the DM group was greater than that in the non-DM group (21.4% vs. 7.7%, p=0.04). The high sensitivity C-reactive protein between the two groups was similar (0.44 ± 0.20mg/dl vs. 0.46 ± 0.15 mg/dl, p=0.83). CONCLUSION Higher calcification and dissection were detected in diabetic patients with unstable angina pectoris, and the difference in coronary plaque characteristics can explain the difference in clinical prognoses between DM and non-DM patients.

Accuracy of 128-slice dual-source CT using high-pitch spiral mode for the assessment of coronary stents: first in vivo experience.

OBJECTIVE To investigate the accuracy of 128-slice dual-source CT using high-pitch spiral mode (HPS) for the assessment of coronary stents. METHODS We conducted a prospective study on patients with previous stent implantation due to recurred suspicious symptoms of angina with positive findings at stress testing scheduled for coronary angiography (CA), while dual source computed tomography (DSCT) examinations were randomly done by one of the three different scan modes [HPS, sequential mode (SEQ), low-pitch spiral mode (LPS)] one week before CA examinations. The image quality, radiation dose and stent patency of DSCT were evaluated blinded to the results of CA. RESULTS 180 patients with total 256 stents were enrolled in this study. There was no significant difference on the image quality of DSCT by HPS (1.4±0.5), SEQ (1.5±0.5) and LPS (1.3±0.6) (P>0.05). The noise of images reconstructed with B26f kernel in HPS is significantly increased than in SEQ/LPS (P<0.05), while no significant difference with images reconstructed with B46f kernel (P>0.05). Heart rate (HR) variability had a slight impact on the image quality for HPS (P<0.05), not for LPS/SEQ (P>0.05). In the assessment of stent restenosis compared with CA on per-stent basis, there was no significant difference on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DSCT using HPS (100%, 97.1%, 83.3%, 100%), LPS (92.3%, 95.9%, 80%, 98.6%) and SEQ (93.3%, 97.3%, 87.5%, 98.6%) (P>0.05). The effective dose of DSCT by HPS (1.0±0.5mSv) is significant less than that by SEQ (3.0±1.4mSv) or LPS (13.0±5.4mSv) (P<0.01). CONCLUSIONS DSCT using HPS provides good diagnostic accuracy on coronary stent patency compared with CA, similar to that by SEQ/LPS, whereas with lower effective dose in patients with HR lower than 65bpm.

e0320 Impact of plaque morphology on intimal hyperplasia after stenting assessed by optical coherence tomography

Objective The objective of this study was to evaluate whether the plaque morphology can affect the in-stent neointimal hyperplasia. Methods 74 patients (93 stents) with OCT post-stent implantation were included in the study. Cross-sectional OCT images were analysed at 1-mm intervals (every 15 frames), and 302 cross-sectional images with lipid or calcific lesions under the stent struts were selected. The struts in these sections were divided into four groups according to the plaque conditions under the struts: group 1—struts on the normal vessel, group 2—on the fibrotic lesion, group 3—on the calcific lesion, group 4—on the lipid rich lesion. The neointimal hyperplasia thickness on the stent struts were measured by OCT. Results The plaque conditions under 806 struts could be detected clearly by OCT. Among them, 157 struts were on the normal vascular wall (the intimal thickness were less than 250 μm by OCT), 344 struts were on the fibrotic lesions, 145 struts on calcific lesions and 160 struts on lipid lesions. The neointimal thickness were 0.132±0.081 μm, 0.148±0.091 μm, 0.150±0.105 μm and 0.166±0.088 μm respectively in group 1–4. The p value was 0.011. Conclusions The plaque type has impact on the in-stent neointimal hyperplasia. The underlying lipid or calcific components in plaque may promote neointimal hyperplasia after stent implantation.

Clinical, Laboratory and Imaging Features of High Altitude Pulmonary Edema in Tibetan Plateau

Objective To analyze characteristics of high altitude pulmonary edema (HAPE) in Chinese patients.Methods We performed a retrospective study of 98 patients with HAPE. We reviewed the medical records and summarized the clinical, laboratory and imaging characteristics of these cases, and compared the results on admission with those determined before discharge.Results Forty-eight (49.0%) patients developed HAPE at the altitude of 2800 m to 3000 m. Ninty-five (96.9%) patients were man. Moist rales were audible from the both lungs, and moist rales over the right lung were clearer than those over the left lung in fourteen patients. The white blood cells [(12.83±5.55) versus (8.95±3.23) ×10 9/L, P=0.001)] as well as neutrophil counts [(11.34±3.81) versus (7.49±2.83)×10 9/L, P=0.001)] were higher, whereas the counts of other subsets of white blood cells were lower on admission than those after recovery (all P<0.05). Serum levels of alkaline phosphatase (115.8±37.6 versus 85.7±32.4 mmol/L, P=0.020), cholinesterase (7226.2±1631.8 versus 6285.3±1693.3 mmol/L, P=0.040), creatinine (85.2±17.1 versus75.1±12.8 mmol/L, P=0.021), uric acid (401.9±114.2 versus 326.0±154.3 mmol/L, P=0.041), and uric glucose (7.20±1.10 versus 5.51±1.11 mmol/L, P=0.001) were higher, but carbondioxide combining power (CO2CP, 26.7±4.4 versus 28.9±4.5 mmol/L, P=0.042) and serous calcium (2.32±0.13 versus 2.41±0.10 mmol/L, P=0.006) were lower on admission. Arterial blood gas results showed hypoxemia and respiratory alkalosis on admission. Conclusions In the present research, men were more susceptible to HAPE than women, and in the process of HAPE, the lesions of the right lung were more serious than those of the left lung. Some indicators of routine blood test and blood biochemistry of HAPE patients changed.

GW25-e0731 The Triage of Coronary Artery Occlusion and its Long-term Prognosis-A Propensity-Matched Study

Without doubt the immediate angiographic results of coronary occlusion are dramatic. The occluded artery becomes patent almost instantaneously after balloon dilatation. However, the long-term outcomes remain in dispute. It is especially true when the comparison was made between successful and failed

GW25-e4456 Molecular mechanism and characterization of maternally inherited essential hypertension

Objectives: To explore the alter of central aortic pressure and parameters, crPWV after joint buck hypoglycemic. Methods: 280 patients with essential hypertension and type 2 diabetes aged from 60 to 79 years old were recruited, and 240 patients were randomized into four groups after 2 months of screening, namely, strengthen antihypertensive and strengthen hypoglycemic group, strengthen antihypertensive and conventional hypoglycemic group, standard buck and strengthen hypoglycemic group, standard buck and conventional hypoglycemic group. Strengthen hypoglycemic group was therapied by gliclazide. Insulin and other could be added when necessary. Conventional hypoglycemic group only taked antidiabetic drugs except gliclazide. All the subjects were collected blood and urine samples at the baseline and the end of the study. Basic clinical datas of all patients such as age, weight, height, BP, HR, ECG and others were collected. Central aortic pressures and carotid-radial pulse wave velocity (crPWV) were carried out noninvasively by using SphygmoCor device. Results: The rates of decline of CSP (16.96 8.19mmHg), CDP (2.03 1.67mmHg), CPP (11.68 2.05mmHg), CMSP (10.75 7.74mmHg), CMDP (7.04 12.66mmHg), CESP (10.38 11.40mmHg),P1 Height (11.27 10.86) on group I was greater than the other 3 groups after treatmen (P<0.05); The rate of decline ofCSP (9.37 8.05mmHg/ 5.58 9.01mmHg), CPP (7.17 2.51mmHg/5.01 2.36mmHg), CMSP (5.79 8.33 mmHg/5.14 8.96mmHg), CESP (4.86 11.97mmHg/5.08 12.75mmHg), P1 Height (6.74 8.43/6.98 3.39) and AI (10.29 18.13%/6.47 19.31%) on group II and III were greater than group IV after treatmen (P<0.05) The rate of decline of CSP, CMSP on group II were greater than grpup III, P<0.05. The rate of decline of crPWV (4.66 4.93m/s) on group I was greater than the other 3 groups after treatment (P<0.05). Conclusions: The central aortic pressure and its reflected waves, the flexible functions of vascular were be improved by combined therapy.

GW24-e3707 Transcatheter aortic valve implantation in a patient with severe symptomatic aortic stenosis and 2-years follow-up

Objectives Transcatheter aortic valve implantation (TAVI) is a promising new technology which is typically used to treat elderly patients with severe aortic stenosis who cannot undergo surgical aortic valve replacement due to high risk factors. Methods We hereby present the case of a 70-year-old woman patient with severe aortic stenosis who underwent decompensated heart failure. This patient was judged inoperable and then scheduled for transfemoral CoreValve Revalving System implantation. Results This patient was judged inoperable and then scheduled for transfemoral CoreValve Revalving System implantation. The procedural was successful, no complication, the gradient from ventrical to aortic artery dispeared. At 2 years of follow-up, heart function improve. There was no flow disturbance around the valve and no gradient from ventrical to aortic artery. There was no stroke and arrhythmia. Conclusions This patient is one of the earliest to accept the TAVI in China, the clinical outcome is favorable.

GW24-e2524 Enhanced diagnostic accuracy of in-stent patency in low-dose high-pitch dual-source CT angiography with iterative image reconstruction

Objectives Traditional filtered back projection (FBP) play a major role in defining the quality and integrity of medical imaging using computed tomography. Recent studies demonstrated that sinogram affirmed iterative reconstructions (SAFIRE) can produce higher-resolution images with greater robustness for the reduction of various imaging artefacts. The aim of this study was to assess the diagnostic accuracy of in-stent restenosis (>50% luminal narrowing) using low-dose high-pitch dual-source CT coronary angiography (Flash CTCA) with SAFIRE in symptomatic patients referred for conventional coronary angiography (CCA). Methods 137 stents in 70 patients (average heart rate was 57 ± 8 bpm), were prospectively evaluated. The interval between stenting and inclusion in the study was 21 ± 12 months. Before scheduled CCA, Flash CTCA was performed between September 2011 and December 2012. In-stent noise, signal-to-noise ratio (SNR) and stent-lumen attenuation increase ratio (SAIR), as well as subjective image quality score, were measured and compared between SAFIRE reconstruction (group A) and FBP reconstruction (group B). CCA was served as the standard of reference to further analyse accuracy of both groups on detecting in-stent restenosis. Results Of the 137 stents, group A were superior to group B on in-stent noise (22.5 ± 8.6 vs. 36.1 ± 13.9; P < 0.05), SNR (20.1 ± 7.4 vs. 16.4 ± 6.3; P < 0.05), SAIR (21.7 ± 11.5 vs. 33.4 ± 24.1%; P < 0.05), and image quality score (3.2 ± 0.73 vs. 2.5 ± 1.1; P < 0.05). On a stent-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of group A were 90%, 92%, 81%, 96% and 92% respectively, and those of group B were 87%, 86%, 71%, 94% and 86% respectively, which showing no significant difference (P > 0.05). However, in subgroup of smaller stent (< = 3 mm; n = 78), comparing SAFIRE with FBP, specificity (86% vs. 73%), positive predictive value (77% vs. 61%) and accuracy (86% vs. 76%) improved significantly (P < 0.05); Sensitivity (85% vs. 81%) and negative predictive value (92% vs. 88%) did not differ (P > 0.05). CCTA average effective dose was (1.41 ± 0.45) mSv. Conclusions Low-dose high-pitch dual-source CT angiography can be performed well in the detection of in-stent patency. Iterative image reconstruction significantly improves diagnostic accuracy of in-stent restenosis even in smaller stents.

GW24-e0024 Endothelial antagonist attenuates diabetic cardiac complications in mice

Objectives To investigate the potential protective effect of Bosentan in diabetic cardiac complications. Methods Male C57BL/6 mice with 6-week old were divided into 3 groups (N = 20) : Control group, DM group (diabetes group) and DM-B group (diabetes with Bosentan group). STZ was injected as 200 mg/Kg for single dose, i.p. (intraperitoneal injection). Fasting blood glucose (FBG) was measured at 0-, 1-, 2-week after STZ injection to confirm that diabetic model was made. Bosentan (100 mg/Kg) and placebo was given i.g. (intragastric administration) once a day immediately after STZ injection for 18 weeks. Cardiac fibrosis was evaluated by morphometric analysis and electron microscopy. The differences of mRNA expression were compared by real-time PCR. Cardiac systolic function was evaluated by echocardiography. Results After 18 weeks of diabetic situation, FBG of DM-B mice was significantly higher than that of Control mice and was similar with that of DM mice (DM mice vs. control mice, P < 0.001; DM-B vs. control mice, P < 0.001; DM mice vs. DM-B mice, P > 0.05). Pathological analysis with Masson’s Trichrome staining showed significant fibrotic changes in diabetic myocardium, and the fibrosis was ameliorated by Bosentan. Electron microscopy study revealed a disruption of sarcomere and myofibril structure in myocardium of DM mice, which is partially prevented by Bosentan. Furthermore, area of interstitial fibrosis is markedly lower in DM-B mice. This lower area of interstitial fibrosis is associated with higher expression of cardiac VEGF mRNA (a potent angiogenic factor) in DM-B mice than DM mice (P < 0.01). The heart of DM-B mice also showed lower expression of fibrotic genes (TGF-ß, CTGF and Collagen-1) than DM mice (P < 0.01). Furthermore, cardiac systolic function (fractional shortening, FS) of DM and DM-B mice decreased after 18 weeks of diabetes (DM vs Control mice, P < 0.001). However, the impairment of cardiac function (FS) was significantly ameliorated, even nearly normalised by Bosentan (DM-B vs Control mice, P > 0.05). Conclusions These findings indicate the potential usefulness of an ET receptor antagonist Bosentan in the amelioration of diabetic cardiac complications (myocardial fibrosis and cardiac dysfunction) without affecting blood glucose. This may provide a promising therapeutical strategy for diabetic heart disease.