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BMC Medical Imaging Oct 2023We aimed to perform a qualitative synthesis of evidence on the role of Ga-Pentixafor PET in atherosclerosis.
OBJECTIVE
We aimed to perform a qualitative synthesis of evidence on the role of Ga-Pentixafor PET in atherosclerosis.
METHODS
A systematic search of the PubMed and Embase databases for studies reporting the evaluation of atherosclerotic lesions by Ga-Pentixafor PET was performed with a search time frame from database creation to 2022-12-26. The diagnostic test evaluation tool QUADAS-2 was used to evaluate the quality of the included literature and to perform descriptive analyses of relevant outcome indicators.
RESULTS
A total of 6 studies with 280 patients were included. One study reported only imaging outcome metrics, while the other five studies reported imaging outcome metrics and clinical correlation metrics. For imaging outcomes, three studies reported imaging results for Ga-Pentixafor PET only, and the other three studies reported imaging results for comparative analysis of Ga-Pentixafor PET with F-FDG PET. For clinical correlation, three studies reported the correlation between tracer uptake and cardiovascular risk factors, one study reported the correlation between tracer uptake and plaque calcification, and one study reported the correlation between all three: tracer uptake, cardiovascular risk factors, and plaque calcification.
CONCLUSION
Ga-Pentixafor PET has a good imaging effect on atherosclerotic lesions, and it is a promising imaging modality that may replace F-FDG PET for atherosclerosis imaging in the future. In patients with atherosclerosis, there is a clear clinical correlation between cardiovascular risk factors, tracer uptake, and plaque calcification.
Topics: Humans; Gallium Radioisotopes; Fluorodeoxyglucose F18; Clinical Relevance; Receptors, CXCR4; Atherosclerosis; Plaque, Atherosclerotic; Positron Emission Tomography Computed Tomography; Calcinosis
PubMed: 37884885
DOI: 10.1186/s12880-023-01134-y -
Frontiers in Neurology 2018Vessel-wall magnetic resonance imaging (MRI) has been suggested as a valuable tool for assessing intracranial arterial stenosis with additional diagnostic features....
Vessel-wall magnetic resonance imaging (MRI) has been suggested as a valuable tool for assessing intracranial arterial stenosis with additional diagnostic features. However, there is limited conclusive evidence on whether vessel-wall MR imaging of intracranial atherosclerotic plaques provides valuable information for predicting vulnerable lesions. We conducted this systematic review and meta-analysis to evaluate which characteristics of intracranial-plaque on vessel-wall MRI are markers of culprit lesions. The MEDLINE, EMBASE, and Cochrane Library of Clinical Trials databases were searched for studies reporting the association between vessel-wall MRI characteristics of intracranial plaque and corresponding stroke events. Odds ratios (ORs) for the prevalence of stroke with intracranial-plaque MRI characteristics were pooled in a meta-analysis using a random-effects model. Twenty studies were included in this review. We found a significant association between plaque enhancement (OR, 10.09; 95% CI, 5.38-18.93), positive remodeling (OR, 6.19; 95% CI, 3.22-11.92), and plaque surface irregularity (OR, 3.94; 95% CI, 1.90-8.16) with stroke events. However, no significant difference was found for the presence of eccentricity (OR, 1.22; 95% CI, 0.51-2.91). Based on current evidence, intracranial plaque contrast enhancement, positive remodeling, and plaque irregularity on MRI are associated with increased risk of stroke events. Our findings support the design of future studies on intracranial-plaque MRI and decision making for the management of intracranial atherosclerotic plaques.
PubMed: 30559708
DOI: 10.3389/fneur.2018.01032 -
Stroke Aug 2019Background and Purpose- The clinical utility of positron emission tomography (PET) imaging in evaluating carotid artery plaque vulnerability remains unclear. Two tracers... (Meta-Analysis)
Meta-Analysis
Background and Purpose- The clinical utility of positron emission tomography (PET) imaging in evaluating carotid artery plaque vulnerability remains unclear. Two tracers of recent interest for carotid plaque imaging are F-fluorodeoxyglucose (F-FDG) and F-sodium fluoride (F-NaF). We performed a systematic review and meta-analysis evaluating the association between carotid artery F-FDG or F-NaF uptake and recent or future cerebral ischemic events. Methods- A systematic review of Ovid MEDLINE, Ovid EMBASE, and the Cochrane library was conducted from inception to December 2017 for articles evaluating PET tracer uptake in recently symptomatic versus asymptomatic carotid arteries, and articles evaluating carotid uptake in relation to future ischemic events. Cerebral ischemic events were defined as ipsilateral strokes, transient ischemic attacks, or amaurosis fugax. We quantitatively pooled studies by a random-effects model when 3 or more studies were amenable for analysis. We assessed the standardized mean difference between tracer uptake in the symptomatic versus asymptomatic carotid artery using Cohen's d metric. Results- After screening 4144 unique articles, 13 prospective cohort studies assessing carotid artery F-FDG uptake in patients with recent cerebral ischemia were eligible for review. Eleven cohorts of 290 subjects scanned with F-FDG were eligible for meta-analysis. We found that carotid arteries ipsilateral to recent ischemic events had significantly higher F-FDG uptake than asymptomatic arteries (Cohen's d =0.492; CI=0.130-0.855; P=0.008) as well as significant heterogeneity (Cochran's Q =31.5; P=0.0005; I=68.3%). Meta-regression was not performed due to the limited number of studies in the analysis. Only 2 studies investigating F-NaF PET imaging, and another 2 articles investigating ischemic event recurrence were found. Conclusions- Recent ipsilateral cerebral ischemia may be associated with increased carotid F-FDG uptake on PET imaging regardless of degree of carotid stenosis, although significant heterogeneity was found, and these results should be interpreted with caution. Emerging evidence suggests a similar association may be present with F-NaF plaque uptake. More studies are warranted to provide definitive conclusions on the utility of F-FDG or F-NaF in carotid plaque evaluation before investigating carotid PET as a diagnostic tool for cerebral ischemic events.
Topics: Brain Ischemia; Carotid Stenosis; Humans; Neuroimaging; Plaque, Atherosclerotic; Positron-Emission Tomography
PubMed: 31272325
DOI: 10.1161/STROKEAHA.118.023987 -
Frontiers in Cardiovascular Medicine 2024The diagnostic performance and clinical validity of automatic intracoronary imaging (ICI) tools for atherosclerotic plaque assessment have not been systematically...
BACKGROUND
The diagnostic performance and clinical validity of automatic intracoronary imaging (ICI) tools for atherosclerotic plaque assessment have not been systematically investigated so far.
METHODS
We performed a scoping review including studies on automatic tools for automatic plaque components assessment by means of optical coherence tomography (OCT) or intravascular imaging (IVUS). We summarized study characteristics and reported the specifics and diagnostic performance of developed tools.
RESULTS
Overall, 42 OCT and 26 IVUS studies fulfilling the eligibility criteria were found, with the majority published in the last 5 years (86% of the OCT and 73% of the IVUS studies). A convolutional neural network deep-learning method was applied in 71% of OCT- and 34% of IVUS-studies. Calcium was the most frequent plaque feature analyzed (26/42 of OCT and 12/26 of IVUS studies), and both modalities showed high discriminatory performance in testing sets [range of area under the curve (AUC): 0.91-0.99 for OCT and 0.89-0.98 for IVUS]. Lipid component was investigated only in OCT studies ( = 26, AUC: 0.82-0.86). Fibrous cap thickness or thin-cap fibroatheroma were mainly investigated in OCT studies ( = 8, AUC: 0.82-0.94). Plaque burden was mainly assessed in IVUS studies ( = 15, testing set AUC reported in one study: 0.70).
CONCLUSION
A limited number of automatic machine learning-derived tools for ICI analysis is currently available. The majority have been developed for calcium detection for either OCT or IVUS images. The reporting of the development and validation process of automated intracoronary imaging analyses is heterogeneous and lacks critical information.
SYSTEMATIC REVIEW REGISTRATION
Open Science Framework (OSF), https://osf.io/nps2b/.Graphical AbstractCentral Illustration.
PubMed: 38742173
DOI: 10.3389/fcvm.2024.1332925 -
Frontiers in Cardiovascular Medicine 2022Multiple guidelines suggest the ω-3 polyunsaturated fatty acids (ω-3 PUFAs) help to prevent major vascular events of coronary heart disease (CHD), but the data on...
BACKGROUND AND PURPOSE
Multiple guidelines suggest the ω-3 polyunsaturated fatty acids (ω-3 PUFAs) help to prevent major vascular events of coronary heart disease (CHD), but the data on large trials of ω-3 fatty acids are controversial. We reviewed the available evidence to determine the effect of ω-3 PUFAs on coronary atherosclerosis.
MATERIALS AND METHODS
Literature were from online databases. Randomized controlled trials (RCTs) or observational studies were acceptable. Quantitative data synthesis was conducted using R version 4.1.2. Each outcome was calculated using standardized mean difference (SMD) in a random-effect model. Sensitivity analysis was conducted for each outcome. A total of 21 RCTs and 1 observational study with 2,277 participants were included.
RESULTS
Meta-analysis indicated a benefit of ω-3 PUFAs on coronary atherosclerosis, namely, (1) ω-3 PUFAs can reduce the atherosclerotic plaque volume (SMD -0.18; 95% CI -0.31 to -0.05); (2) ω-3 PUFAs can help reduce the loss of the diameter of the narrowest segments of coronary arteries in patients with CHD (SMD 0.29; 95% CI, 0.05-0.53); (3) ω-3 PUFAs do not have significant effect on volume of lipid plaque in coronary arteries (SMD -1.18; 95% CI -2.95 to 0.58), volume of fiber plaque (SMD 0.26; 95% CI -0.81 to 1.33), and calcified plaque (SMD 0.17; 95% CI -0.55 to 0.89); and (4) ω-3 PUFAs had no significant effect on endothelial inflammatory factors in peripheral blood.
CONCLUSIONS
We confirmed that ω-3 PUFAs benefit patients with CHD by reducing the progression of coronary atherosclerosis. We indicated that the benefits were not caused by reducing endothelial inflammations of coronary arteries.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021285139, identifier: CRD42021285139.
PubMed: 35795375
DOI: 10.3389/fcvm.2022.904250 -
Frontiers in Cardiovascular Medicine 2021Serum high-density lipoprotein cholesterol (HDL-C) levels are inversely associated with cardiovascular disease events. Yet, emerging evidence suggests that it is the...
Serum high-density lipoprotein cholesterol (HDL-C) levels are inversely associated with cardiovascular disease events. Yet, emerging evidence suggests that it is the functional properties of HDL, in particular, reverse cholesterol transport, which is a key protective mechanism mediating cholesterol removal from macrophage cells and reducing plaque lipid content. Cholesterol efflux capacity (CEC) measures the capacity of HDL to perform this function. A systematic review and meta-analysis were conducted to explore the association of CEC and adverse cardiovascular events. A comprehensive literature review of Embase, PubMed, and Web of Science Core Collection from inception to September 2019 was performed for all studies that examined the association between CEC and cardiovascular outcomes. The primary outcome was adverse cardiovascular events, which were inclusive of atherosclerotic cardiovascular disease (ASCVD) or mortality. A total of 20 trials were included. Compared with low CEC levels, high CEC levels were associated with a 37% lower risk of adverse cardiovascular events (crude RR = 0.63; 95% CI, 0.52-0.76; < 0.00001). Every SD increase of CEC was associated with a 20% lower risk of adverse cardiovascular events (HR = 0.80; 95% CI, 0.66-0.97; P = 0.02). The association remained significant after adjusting for cardiovascular risk factors, medications, and HDL-C levels (HR = 0.76; 95% CI, 0.63-0.91; = 0.004). A significant CEC-endpoint relationship was observed ( = 0.024) such that for every 0.1 unit increase in CEC, there was a 5% reduced risk for adverse cardiovascular events (RR = 0.95; 95% CI, 0.91-0.99). Higher CEC is associated with lower adverse cardiovascular outcomes. These findings warrant further research on whether CEC is merely a biomarker or a mechanism that could be targeted as a pharmacologic intervention for improving clinical outcomes. CRD42020146681; https://www.crd.york.ac.uk/prospero/.
PubMed: 34966797
DOI: 10.3389/fcvm.2021.774418 -
AJNR. American Journal of Neuroradiology Aug 2020Severe carotid stenosis carries a high risk of stroke. However, the risk of stroke with nonstenotic carotid plaques (<50%) is increasingly recognized. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe carotid stenosis carries a high risk of stroke. However, the risk of stroke with nonstenotic carotid plaques (<50%) is increasingly recognized.
PURPOSE
We aimed to summarize the risk of TIA or stroke in patients with nonstenotic carotid plaques.
DATA SOURCES
We performed a comprehensive systematic review and meta-analysis in patients with acute ischemic stroke in whom carotid imaging was performed using MEDLINE and the Cochrane Database, including studies published up to December 2019.
STUDY SELECTION
Included studies had >10 patients with <50% carotid plaques on any imaging technique and reported the incidence or recurrence of ischemic stroke/TIA. High-risk plaque features and the risk of progression to stenosis >50% were extracted if reported.
DATA SYNTHESIS
We identified 31 studies reporting on the risk of ipsilateral stroke/TIA in patients with nonstenotic carotid plaques. Twenty-five studies ( = 13,428 participants) reported on first-ever stroke/TIA and 6 studies ( = 122 participants) reported on the recurrence of stroke/TIA.
DATA ANALYSIS
The incidence of first-ever ipsilateral stroke/TIA was 0.5/100 person-years. The risk of recurrent stroke/TIA was 2.6/100 person-years and increased to 4.9/100 person-years if intraplaque hemorrhage was present. The risk of progression to severe stenosis (>50%) was 2.9/100 person-years (8 studies, = 448 participants).
LIMITATIONS
Included studies showed heterogeneity in reporting stroke etiology, the extent of stroke work-up, imaging modalities, and classification systems used for characterizing carotid stenosis.
CONCLUSIONS
The risk of recurrent stroke/TIA in nonstenotic carotid plaques is not negligible, especially in the presence of high-risk plaque features. Further research is needed to better define the significance of nonstenotic carotid plaques for stroke etiology.
Topics: Aged; Carotid Arteries; Female; Humans; Incidence; Ischemic Attack, Transient; Male; Middle Aged; Plaque, Atherosclerotic; Risk Factors; Stroke
PubMed: 32646945
DOI: 10.3174/ajnr.A6613 -
Biomedicine & Pharmacotherapy =... Jul 2020The vascular endothelium plays a vital role in regulating normal vascular function. Endothelial lining maintains the balance of thrombolytic and fibrinolytic...
The vascular endothelium plays a vital role in regulating normal vascular function. Endothelial lining maintains the balance of thrombolytic and fibrinolytic microenvironment in the vasculature. Alterations of vascular endothelium referred to as endothelial dysfunction, caused the pathological changes in vessel wall such activation of proinflammatory and procoagulatory that initiate atherosclerosis. The concept that endothelial dysfunction plays a critical role in the initiation of atherosclerosis due to vascular inflammation gained tremendous attention. Diabetes mellitus is a metabolic-related disease that caused high mortality and morbidity, leading to its cardiovascular complication over the past decade. Atherosclerosis is the leading cardiovascular complication in diabetes mellitus. Despite metabolic and glycemic control, atherosclerotic plaque progression remains an enormous problem in diabetes mellitus complications. Thus, new inroads therapeutic approach in preventing complications that induced inflammation in endothelial cells could help prevent the disease progression. Signal peptide-CUB-EGF like domain-containing protein 2 (SCUBE2) expressed in vascular endothelium and reported to involve in inflammation. A recent study reported an increased SCUBE2 expression in diabetes mellitus and correlated with high expression of endothelin-1 (ET-1), a proinflammatory endothelial cell-derived peptide. Moreover, this gene showed to increase during atherosclerosis development. The present systematic review will summarize the involvement of SCUBE2 in vascular endothelium function changes and vascular complication, particularly in diabetes mellitus and atherosclerosis.
Topics: Adaptor Proteins, Signal Transducing; Atherosclerosis; Blood-Brain Barrier; Calcium-Binding Proteins; Diabetic Angiopathies; Endothelium, Vascular; Hedgehog Proteins; Humans
PubMed: 32278240
DOI: 10.1016/j.biopha.2020.110129 -
Journal of Stroke and Cerebrovascular... Apr 2024The clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques... (Meta-Analysis)
Meta-Analysis
Differences in intracranial atherosclerosis plaque between posterior circulation and anterior circulation on high-resolution magnetic resonance imaging: A systematic review and meta-analysis.
OBJECTIVE
The clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques (PCAPs) are distinct. We aimed to compare the differences in vulnerability, morphology, and distribution between ACAPs and PCAPs based on hign-resolution magnetic resonance imaging (HR-MRI).
MATERIALS AND METHODS
The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results.
RESULTS
There were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups.
CONCLUSION
There were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.
Topics: Humans; Plaque, Atherosclerotic; Magnetic Resonance Imaging; Stroke; Magnetic Resonance Spectroscopy; Intracranial Arteriosclerosis
PubMed: 38316284
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107616 -
BMJ Open Apr 2022To determine associations between carotid atherosclerosis assessed by ultrasound and the Mini-Mental State Examination (MMSE), a measure of global cognitive function. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine associations between carotid atherosclerosis assessed by ultrasound and the Mini-Mental State Examination (MMSE), a measure of global cognitive function.
DESIGN
Systematic review and meta-analysis.
METHODS
MEDLINE and EMBASE databases were searched up to 1 May 2020 to identify studies assessed the associations between asymptomatic carotid atherosclerosis and the MMSE. Studies reporting OR for associations between carotid plaque or intima-media thickness (cIMT) and dichotomised MMSE were meta-analysed. Publication bias of included studies was assessed.
RESULTS
A total of 31 of 378 reviewed articles met the inclusion criteria; together they included 27 738 participants (age 35-95 years). Fifteen studies reported some evidence of a positive association between measures of atherosclerosis and poorer cognitive performance in either cross-sectional or longitudinal studies. The remaining 16 studies found no evidence of an association. Seven cross-sectional studies provided data suitable for meta-analysis. Meta-analysis of three studies that assessed carotid plaque (n=3549) showed an association between the presence of plaque and impaired MMSE with pooled estimate for the OR (95% CI) being 2.72 (0.85 to 4.59). An association between cIMT and impaired MMSE was reported in six studies (n=4443) with a pooled estimate for the OR (95% CI) being 1.13 (1.04 to 1.22). Heterogeneity across studies was moderate to small (carotid plaque with MMSE, I=40.9%; cIMT with MMSE, I=4.9%). There was evidence of publication bias for carotid plaque studies (p=0.02), but not cIMT studies (p=0.2).
CONCLUSIONS
There is some, limited cross-sectional evidence indicating an association between cIMT and poorer global cognitive function assessed with MMSE. Estimates of the association between plaques and poor cognition are too imprecise to draw firm conclusions and evidence from studies of longitudinal associations between carotid atherosclerosis and MMSE is limited.
PROSPERO REGISTRATION NUMBER
CRD42021240077.
Topics: Adult; Aged; Aged, 80 and over; Atherosclerosis; Carotid Arteries; Carotid Artery Diseases; Carotid Intima-Media Thickness; Cognition; Cross-Sectional Studies; Humans; Middle Aged; Plaque, Atherosclerotic; Risk Factors
PubMed: 35440451
DOI: 10.1136/bmjopen-2021-055131