Joo Myung Lee1, Gilwoo Choi2, Doyeon Hwang3, Jonghanne Park3, Hyun Jin Kim4, Joon-Hyung Doh5, Chang-Wook Nam6, Sang-Hoon Na7, Eun-Seok Shin8, Charles A Taylor9, Bon-Kwon Koo10. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 2. HeartFlow, Inc., Redwood City, California; Department of Surgery, Stanford University Medical Center, Stanford, California. 3. Department of Medicine, Seoul National University Hospital, Seoul, South Korea. 4. HeartFlow, Inc., Redwood City, California. 5. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea. 6. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea. 7. Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, South Korea; Institute of Aging, Seoul National University, Seoul, South Korea. 8. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. Electronic address: ses@uuh.ulsan.kr. 9. HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California. 10. Department of Medicine, Seoul National University Hospital, Seoul, South Korea; Institute of Aging, Seoul National University, Seoul, South Korea. Electronic address: bkkoo@snu.ac.kr.
Abstract
OBJECTIVES: This study sought to investigate the impact of longitudinal lesion geometry on the location of plaque rupture and clinical presentation and its mechanism. BACKGROUND: The relationships among lesion geometry, external hemodynamic forces acting on the plaque, location of plaque rupture, and clinical presentation have not been comprehensively investigated. METHODS: This study enrolled 125 patients with plaque rupture documented by intravascular ultrasound. Longitudinal locations of plaque rupture were identified and categorized by intravascular ultrasound. Patients' clinical presentations and TIMI (Thrombolysis In Myocardial Infarction) flow grade in an initial angiogram were compared according to the location of plaque rupture. Longitudinal lesion asymmetry was quantitatively assessed by the luminal radius change over the segment length (radius gradient [RG]). Lesions with a steeper radius change in the upstream segment compared with the downstream segment (RGupstream > RGdownstream) were defined as upstream-dominant lesions. RESULTS: On the basis of the site of maximum rupture aperture, 56.0%, 16.0%, and 28.0% of the patients had upstream, minimal lumen area, and downstream rupture, respectively. Patients with upstream rupture more frequently presented with ST-segment elevation myocardial infarction (45.7%, 40.0%, 22.9%; p = 0.030) and with TIMI flow grade <3 (32.9%, 20.0%, 17.1%; p = 0.042). According to the ratio of upstream and downstream RG, 69.5% of lesions were classified as upstream-dominant lesions, and 30.5% were classified as downstream-dominant lesions. Among the 66 upstream-dominant lesions, 65 cases (98.5%) had upstream rupture, and the RG ratio (RGupstream/RGdownstream) was an independent predictor of upstream rupture (odds ratio: 1.481; 95% confidence interval: 1.035 to 2.120; p = 0.032). Upstream-dominant lesions more frequently manifested with ST-segment elevation myocardial infarction than did downstream-dominant lesions (48.5% vs. 24.1%; p = 0.026). CONCLUSIONS: Both clinical presentation and degree of flow limitation were associated with the location of plaque rupture. Longitudinal lesion asymmetry assessed by RG, which can affect regional distribution of hemodynamic stress, was associated with the location of rupture and with clinical presentation.
OBJECTIVES: This study sought to investigate the impact of longitudinal lesion geometry on the location of plaque rupture and clinical presentation and its mechanism. BACKGROUND: The relationships among lesion geometry, external hemodynamic forces acting on the plaque, location of plaque rupture, and clinical presentation have not been comprehensively investigated. METHODS: This study enrolled 125 patients with plaque rupture documented by intravascular ultrasound. Longitudinal locations of plaque rupture were identified and categorized by intravascular ultrasound. Patients' clinical presentations and TIMI (Thrombolysis In Myocardial Infarction) flow grade in an initial angiogram were compared according to the location of plaque rupture. Longitudinal lesion asymmetry was quantitatively assessed by the luminal radius change over the segment length (radius gradient [RG]). Lesions with a steeper radius change in the upstream segment compared with the downstream segment (RGupstream > RGdownstream) were defined as upstream-dominant lesions. RESULTS: On the basis of the site of maximum rupture aperture, 56.0%, 16.0%, and 28.0% of the patients had upstream, minimal lumen area, and downstream rupture, respectively. Patients with upstream rupture more frequently presented with ST-segment elevation myocardial infarction (45.7%, 40.0%, 22.9%; p = 0.030) and with TIMI flow grade <3 (32.9%, 20.0%, 17.1%; p = 0.042). According to the ratio of upstream and downstream RG, 69.5% of lesions were classified as upstream-dominant lesions, and 30.5% were classified as downstream-dominant lesions. Among the 66 upstream-dominant lesions, 65 cases (98.5%) had upstream rupture, and the RG ratio (RGupstream/RGdownstream) was an independent predictor of upstream rupture (odds ratio: 1.481; 95% confidence interval: 1.035 to 2.120; p = 0.032). Upstream-dominant lesions more frequently manifested with ST-segment elevation myocardial infarction than did downstream-dominant lesions (48.5% vs. 24.1%; p = 0.026). CONCLUSIONS: Both clinical presentation and degree of flow limitation were associated with the location of plaque rupture. Longitudinal lesion asymmetry assessed by RG, which can affect regional distribution of hemodynamic stress, was associated with the location of rupture and with clinical presentation.
Authors: Anubodh S Varshney; Ahmet U Coskun; Gerasimos Siasos; Charles C Maynard; Zhongyue Pu; Kevin J Croce; Nicholas V Cefalo; Michelle A Cormier; Dimitris Fotiadis; Kostas Stefanou; Michail I Papafaklis; Lampros Michalis; Stacie VanOosterhout; Abbey Mulder; Ryan D Madder; Peter H Stone Journal: Atherosclerosis Date: 2020-12-28 Impact factor: 5.162
Authors: Chongying Jin; Ryo Torii; Anantharaman Ramasamy; Vincenzo Tufaro; Callum D Little; Klio Konstantinou; Yi Ying Tan; Nathan A L Yap; Jackie Cooper; Tom Crake; Constantinos O'Mahony; Roby Rakhit; Mohaned Egred; Javed Ahmed; Grigoris Karamasis; Lorenz Räber; Andreas Baumbach; Anthony Mathur; Christos V Bourantas Journal: Front Cardiovasc Med Date: 2022-05-26