NATO Advanced Study Institutes ; Series A : Life science : Vol. 51
266 s. : il.
BACKGROUND AND AIM: Carotid plaque progression contributes to increasing stroke risk. The study aims to identify factors influencing carotid plaque thickness progression after changing the preventive treatment to the 'treating arteries instead of risk factors' strategy, that is, change in treatment depending on the progression of atherosclerosis. METHODS: The study participants who completed sonographic controls over the course of 3 years were enrolled to the analysis. Duplex sonography of cervical arteries was performed in 6-month intervals with measurement of carotid plaque thickness. Plaque thickness measurement error (σ) was set as 3 SD. Only evidently stable and progressive plaques (defined as plaque thickness difference between initial and final measurements of ˂σ and >2σ, respectively) were included to analysis. Univariate and multivariate logistic regression analysis was performed to identify factors influencing plaque progression. RESULTS: A total of 1391 patients (466 males, age 67.2±9.2 years) were enrolled in the study. Progressive plaque in at least one carotid artery was detected in 255 (18.3%) patients. Older age, male sex, greater plaque thickness, coronary heart disease, vascular surgery/stenting history and smoking were more frequently present in patients with progressive plaque (p˂0.05 in all cases). Multivariate logistic regression analysis identified only the plaque thickness (OR 1.850 for left side, 95% CI 1.398 to 2.449; and OR 1.376 for right side, 95% CI 1.070 to 1.770) as an independent factor influencing plaque progression. CONCLUSION: Carotid plaque thickness corresponding to stenosis severity is the only independent risk factor for plaque thickness progression after optimising the prevention treatment. TRIAL REGISTRATION NUMBER: NCT02360137.
- MeSH
- Carotid Arteries diagnostic imaging MeSH
- Plaque, Atherosclerotic * complications MeSH
- Atherosclerosis * complications MeSH
- Stroke * diagnostic imaging epidemiology etiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Risk Factors MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Study MeSH
Základním principem léčby kardiovaskulárních onemocnění je léčba aterosklerózy. V klinických studiích bylo prokázáno, že statiny ve vysoké dávce, konkrétně atorvastatin 80 mg a rosuvastatin 40 mg, vedou k regresi nebo alespoň k zastavení progrese aterosklerózy u většiny nemocných.
- Keywords
- aterom,
- MeSH
- Arteries drug effects MeSH
- Plaque, Atherosclerotic MeSH
- Atherosclerosis drug therapy prevention & control MeSH
- Drug Evaluation MeSH
- Cardiovascular Diseases prevention & control MeSH
- Clinical Trials as Topic MeSH
- Coronary Vessels drug effects MeSH
- Humans MeSH
- Lipids MeSH
- Disease Progression MeSH
- Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
Subendoteliální ukládání apolipoproteinu B s vysokým obsahem lipoproteinů do predisoponovaných úseků tepny je hlavní mechanizmus vzniku koronární aterosklerózy. Místní biologickou odpovědí na tyto uložené a následně modifikované lipoproteiny je chronická zánětlivá reakce zprostředkovaná především makrofágy a T buňkami. Hypolipidemická léčba statiny vede ke stabilizaci koronárních plátů a snížení výskytů klinických epizod destabilizace koronární nemoci. Pomocí novějších přesných zobrazovacích metod, jako je intrakoronární ultrazvuk, virtuální histologie, NMR či optická koherenční tomografie, se ukázalo, že snížení LDL cholesterolu při intenzivní statinové léčbě vede i k prokazatelné regresi koronárních plátů. Právě ukončená studie Glagov prokázala možnost dalšího snížení LDL pomocí kombinační léčby dostatečnými dávkami statinu a inhibitory PCSK9, došlo k poklesu LDL na nižší hodnoty než u srovnatelných studií se statiny. Tomu odpovídá i pokles objemu plátu při sledování pomocí intrakoronárního ultrazvuku.
Subendothelial accumulation of apo-lipoprotein B with high content of lipoproteins in the predisposed sections of the artery with diffuse intimal thickening is the main mechanism of the development of coronary atherosclerosis. A local biological response to these stored and subsequently modified lipoproteins is a chronic inflammation mediated primarily by macrophages and T cells. Lipid lowering by high intensity statin treatment leads to the stabilization of coronary plaques and reduction of the occurrences of clinical episodes of destabilisation of coronary disease. Using the newer high precision imaging techniques such as intracoronary ultrasound, virtual histology, optical coherence tomography and NMR showed that the reduction of LDL-cholesterol using high intensity statin therapy leads to demonstrable regression of coronary plaques. Just completed GLAGOV study demonstrated the possibility of further lowering of LDL cholesterol by combination therapy of high intensity statins with PCSK9 inhibitor evolocumab. Further decline in LDL levels as compared to previous studies was observed with corresponding regression of the plaque volume as demonstrated by intracoronary ultrasound.
- Keywords
- studie GLAGOV, evolocumab,
- MeSH
- Plaque, Atherosclerotic * drug therapy physiopathology MeSH
- Remission Induction MeSH
- Cholesterol, LDL drug effects MeSH
- Humans MeSH
- Antibodies, Monoclonal therapeutic use MeSH
- Coronary Artery Disease * etiology drug therapy physiopathology MeSH
- PCSK9 Inhibitors MeSH
- Proprotein Convertase 9 * MeSH
- Randomized Controlled Trials as Topic MeSH
- Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Cíl: Automaticky předpovídat stabilitu aterosklerotického plátu v karotidě ze standardních transverzálních ultrazvukových obrazů v B-modu za použití hlubokého učení. Spolehlivý prediktor by snížil potřebu klinických kontrol i farmakologické či chirurgické léčby. Metody: Automaticky byla lokalizována oblast zájmu obsahující karotidu. Adversariální metoda segmentace byla natrénována na kombinaci malého kompletně anotovaného datasetu a většího slabě anotovaného datasetu. Multikriteriální regrese s automatickou adaptací vah byla použita k predikci série klinicky relevantních atributů, vč. nárůstu tloušťky plátu během 3 let. Výsledky: Současnou šíři plátu bylo možno odhadnout s vysokou korelací (ρ = 0,32) a velmi vysokou statistickou signifikancí. Odhadovaný budoucí nárůst šíře plátu byl korelován méně (ρ = 0,22), ale stále statisticky významně (p < 0,01). Korelace mezi automatickým a expertním hodnocením echogenicity, hladkosti a kalcifikací byla ještě nižší. Závěr: Potvrdili jsme závislost mezi vzhledem plátu v ultrazvukovém obraze a pravděpodobností jeho budoucího růstu, ale je příliš slabá, než aby byla využitelná v klinické praxi jako jediný prediktor stability plátu.
Aim: To automatically predict the stability of carotid artery plaque from standard B-mode transversal ultrasound images using deep learning. A reliable predictor would reduce the need for follow-up examination and pharmacological and surgical treatment. Methods: A region of interest containing the carotid artery was automatically localized. An adversarial segmentation method was trained on a combination of a small pixelwise annotated dataset and a larger weakly annotated dataset. A multicriterion regression with automatic weight adaptation was applied to predict a series of clinically relevant attributes, including the plaque width increase over 3 years. Results: The current plaque width could be estimated with a high correlation (ρ = 0.32) and a very high statistical significance. The estimated future increase of the plaque width was correlated less (ρ = 0.22) but statistically significantly (P < 0.01). The correlation between automatic and expert assessments of echogenicity, smoothness and calcification was even smaller. Conclusion: We confirmed a relationship between the plaque appearance in ultrasound and the probability of its future growth, but it is too weak to be used in clinical practice as the sole predictor of the plaque stability.
- MeSH
- Algorithms MeSH
- Plaque, Atherosclerotic * diagnostic imaging pathology MeSH
- Deep Learning MeSH
- Humans MeSH
- Computing Methodologies MeSH
- Prognosis MeSH
- Regression Analysis MeSH
- Statistics as Topic MeSH
- Ultrasonography, Carotid Arteries * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Clinical Study MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVES: Transcranial color-coded duplex sonography (TCCS) enables to measure blood flow characteristics in cerebral vessels, including vascular resistance and pulsatility. The study aims to identify factors influencing pulsatility (PI) and resistance (RI) indices measured using TCCS in patients with carotid atherosclerosis. METHODS: Self-sufficient patients with atherosclerotic plaque causing 20-70% carotid stenosis were consecutively enrolled to the study. All patients underwent duplex sonography of cervical arteries and TCCS with measurement of PI and RI in the middle cerebral artery, neurological, and physical examinations. Following data were recorded: age, gender, height, weight, body mass index, systolic and diastolic blood pressure, occurrence of current and previous diseases, surgery, medication, smoking, and daily dose of alcohol. Univariant and multivariant logistic regression analysis were used for identification of the factors influencing RI and PI. RESULTS: Totally 1863 subjects were enrolled to the study: 139 healthy controls (54 males, age 55.52 ± 7.05 years) in derivation cohort and 1724 patients (777 males, age 68.73 ± 9.39 years) in validation cohort. The cut off value for RI was 0.63 and for PI 1.21. Independent factors for increased RI/PI were age (odds ratio [OR] = 1.108/1.105 per 1 year), occurrence of diabetes mellitus (OR = 1.767/2.170), arterial hypertension (OR = 1.700 for RI only), width of the carotid plaque (OR = 1.260 per 10% stenosis for RI only), and male gender (OR = 1.530 for PI only; P ˂.01 in all cases). CONCLUSIONS: The independent predictors of increased cerebral arterial resistance and/or pulsatility in patients with carotid atherosclerosis were age, arterial hypertension, diabetes mellitus, carotid plaque width, and male gender.
Ateroskleróza a její komplikace jsou nejčastější příčinou úmrtí ve vyspělých zemích. Je podrobně popsána patofyziologie vývoje aterosklerózy. Mnohem méně je však známo, do jaké míry jde o reverzibilní proces. Řada provedených angiografickych studií se statiny prokázala zpomalení progrese aterosklerotickeho postižení věnčitých tepen. Ale teprve intravaskulární ultrazvuk byl schopen přinést detailní popis změn aterosklerotickeho plátu při léčbě statiny. Bylo prokázáno zastavení progrese aterosklerózy a u objemných plátů dokonce i regrese. Kromě změn velikosti aterosklerotických plátů byly popsány i změny ve složení plátů. Při léčbě statiny dochází k úbytku lipidů v plátu, hovoříme o tak zvané stabilizaci plátu. Pláty jsou méně náchylné ke vzniku ruptury a následnému rozvoji akutního koronárního syndromu. Kromě statinů, které ovlivňují zejména LDL cholesterol, se pozornost stále více zaměřuje na látky schopné zvýšit hladinu HDL cholesterolu, neboť jeho hlavním úkolem je transport cholesterolu z periferie zpět do jater. Zdá se, že zvýšení HDL cholesterolu by mohlo vést k mnohem výraznější regresi aterosklerotických plátů a spolu se zastavením progrese plátů statiny k výraznému zlepšení našich možností, jak konzervativně ovlivnit aterosklerotické postižení v koronárním i periferním cévním řečišti.
Atherosclerosis and its complications represent the most frequent cause of death in the developed countries. Pathophysiology of the atherosclerosis development has been described in details. Much less is known what is the extent of reversibility of pathophysiological changes. Several angiographic studies háve proved that statin adminis- tration can slow down the progression of the coronary arteries atherosclerosis. However, only intravascular ultrasound analysis is able to give a detailed description of atherosclerotic plaque development during the treatment with statins. Studies háve shown apparent stagnation of atherosclerosis progression and in voluminous plaques also signs of regression. Beside changes in the size of atherosclerotic plaques, alteration in their chemical composition was described. During the treatment with statins, amount of lipids in plaque decreases, which indicates the stabilisation of plaques. Plaques are less prone to a rupture and to the subsequent development of an acute coronary syndrome. Beside statins, which influence námely LDL cholesterol, attention is given to drugs enabling to elevate HDL cholesterol level, because it is the way in which cholesterol is transported from tissues back to the liver. It appears that elevation of HDL cholesterol level could bring about more effective regression of atherosclerotic plaques and together with stagnation of the plaque progression it can significantly improve the conservative methods in the treatment of atherosclerotic disease of the coronary and peripheral arterial systém
BACKGROUND: There is no study focusing on changes in coronary atherosclerosis during dual lipid-lowering therapy with statin and ezetimibe. METHODS AND RESULTS: Eighty-nine patients with stable angina randomized in a 1:1 ratio to Group A (aggressive therapy: atorvastatin 80mg, ezetimibe 10mg) and Group S (standard therapy) were analyzed. Treatment period was 12 months. Coronary arteries were examined by intravascular ultrasound and virtual histology. We found a decrease in the percent atheroma volume (PAV) (-0.4%) in Group A compared with an increase (+1.4%) in Group S (P=0.014) and this was accompanied by an increased frequency of combined atherosclerosis regression (increased lumen volume+decreased PAV) in group A (40.5%) compared with group S (14.9%) (P=0.007). The target low-density lipoprotein cholesterol level <2mmol/L, presence of at least 4 of 5 atherosclerotic risk factors, and decreased level of vascular cellular adhesive molecule were independent predictors of plaque regression. There were no significant differences in plaque composition between the 2 groups over the study duration. However, during analysis of the 2 groups together, fibrous and fibro-fatty tissues decreased and dense calcification and necrotic core increased during follow-up. CONCLUSIONS: Dual lipid-lowering therapy starts atherosclerosis regression, but does not lead to significant changes in plaque composition. The continuous shift in plaque from fibro and fibro-fatty to necrotic with calcification was present in both groups.
- MeSH
- Anticholesteremic Agents therapeutic use MeSH
- Plaque, Atherosclerotic drug therapy pathology ultrasonography MeSH
- Azetidines therapeutic use MeSH
- Cholesterol metabolism MeSH
- Ultrasonography, Interventional MeSH
- Single-Blind Method MeSH
- Drug Therapy, Combination MeSH
- Coronary Vessels metabolism pathology ultrasonography MeSH
- Heptanoic Acids therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Lipoproteins metabolism MeSH
- Cell Adhesion Molecules metabolism MeSH
- Coronary Artery Disease drug therapy pathology ultrasonography MeSH
- Disease Progression MeSH
- Pyrroles therapeutic use MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Research Support, N.I.H., Extramural MeSH
Autoři podávají přehled studií hodnotících regresi koronární aterosklerózy se zaměřením na aspekty zobrazovacích technik. Dále detailně hodnotí výsledky dosažené ve studii GLAGOV, která hodnotila regresi při terapii evolokumabem.
Authors summarize trials assessing regression of coronary atherosclerosis. Special interest is devoted to imagine techniques. Authors describe in a detail methodology and results of GLAGOV trial.
- Keywords
- studie GLAGOV,
- MeSH
- Anticholesteremic Agents MeSH
- Plaque, Atherosclerotic diagnostic imaging pathology MeSH
- Diagnostic Techniques, Cardiovascular MeSH
- Ezetimibe therapeutic use MeSH
- Clinical Trials as Topic MeSH
- Humans MeSH
- Coronary Artery Disease * diagnostic imaging drug therapy physiopathology MeSH
- Ultrasonography MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
