How can we identify the plaque at risk of rupture or thrombosis
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Transcript of How can we identify the plaque at risk of rupture or thrombosis
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Hypothesis
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r = -0.63
p = 0.0001
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Flexible guide wire
Collapsed basket
Shaft
A penny!
0.014” Diameter
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Basket CatheterBasket Catheter
Wires with built-in Thermocouples
0.0014” Flexible Guide wire
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PRESSURE WIRE
HUMAN STUDY
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CLINICAL:
RISK FACTORS:
59Y Female with
Cardiomyopathy and Angina
Smoker
Family history of CAD
LAD
Thermal Mapping in RCA Using Pressure Wire
39.65
39.66
39.67
39.68
39.69
39.7
39.71
39.72
39.73
1 26 51 76 101
126
151
176
201
226
251
276
301
326
351
376
401
426
451
476
501
526
# of Measurements
Tem
per
atu
re (
C)
DISTAL END
STENOSES90%
OSTIUM
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stenosis
Distal end
CLINICAL:
39 y male with
MI
RISK FACTORS:
Hypertension
DM
Family history
Thermal Mapping of LCX using Pressure Wire
38.765
38.775
38.785
38.795
38.805
38.815
38.825
38.835
38.845
1 126 251 376 501 626 751 876 1001 1126# of Measurements
Te
mp
(C
)
STENOSIS
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CLINICAL:
RISK FACTORS:
44y male
Angina
Kidney insuff
Smoker
DM
Hypertension
Obesity
normal
normal
1 cm
Temperature Mapping in LAD(William Flusche)
38.32
38.33
38.34
38.35
38.36
38.37
38.38
38.39
38.4
1
119
237
355
473
591
709
827
945
1063
1181
1299
1417
1535
No of Measurements
Tem
p (
C)
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LAD:100% PROXIMAL OCCLUSION
LCA:70% MID STENOSIS
RCA:SMALL ,NON DOMINANT CLINICAL:
RISK FACTORS:
68 MALE
Angina
MI
HYPERTENSION
OBESITY
DM
0.5 cm
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RANGE OF TEMPERATURE
00.020.040.060.080.1
0.120.140.16
1 2 3 4 5 6 7 8 9 10
oC
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of Atherosclerotic Plaques and its Correlation with
•Morteza Naghavi MD,•Reji John MD, Said Siadaty MD,
•Sameh Naguib MD, Roxana Grasu MD, •KC Kurian MD, Mohammad Madjid MD,•James T. Willerson MD, Ward Casscells
MD,
The University of Texas-Houston Texas Heart Institute
pH HeterogeneitypH Heterogeneity
Temperature HeterogeneityTemperature Heterogeneity
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pH
9.00
8.88
8.75
8.63
8.50
8.38
8.25
8.13
8.00
7.88
7.75
7.63
7.50
7.38
7.25
7.13
7.00
6.88
6.75
6.63
No
of p
oint
s w
ith th
e sa
me
ph
140
120
100
80
60
40
20
0
pH Distribution in 48 Human Carotid Plaques
This histogram demonstrates distribution of pH measured in 858 points in 48 carotid plaques of 48 patients. A marked variation
ranging from 6.5 to 8.9 is seen.
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Watanabe Rabbit Aorta
pH
9.5
9.0
8.5
8.0
7.5
7.0
6.5
6.0
5.5
pH Heterogeneity in 9 Watanabe Rabbit Aortas
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2220231717191026252428N =
11 human umbilical artery
pH
9.59.39.18.98.78.58.38.17.97.77.5
7.37.16.96.76.56.36.15.95.75.5
pH Heterogeneity in 11 Human Umbilical Arteries
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calcif ied&thrombosedLipid Rich
pH
9.0
8.5
8.0
7.5
7.0
6.5
pH in Lipid Rich Yellow Areas vs. Calcified areas
Areas with large lipid core exhibit higher temperature and lower pH
p < 0.01
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Correlation of pH and Temperature in Human Carotid Plaques Varied by the Areas
We see a marked inverse correlation between temperature and pH of plaques that varies by macroscopic characteristics of plaques.
p < 0.01
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Fluorescence Single-Emission Imaging Microscopy of a Predominantly Lipid Rich Plaque Shows
Significant Microscopic pH Heterogeneity Mostly Acidic
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Catheter Tipped with a Side Looking Silvered Conical 0.5 mm Mirror
cm0.5mm
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Conclusions
1.1. Temperature at the lumen of living carotid plaques Temperature at the lumen of living carotid plaques correlates with density of inflammatory cells, and correlates with density of inflammatory cells, and inversely with cap thickness.inversely with cap thickness.
2.2. Differences of more than 0.3 C were seen in all Differences of more than 0.3 C were seen in all specimens but only a minority had differences of 2specimens but only a minority had differences of 2o o C or C or more.more.
3.3. Large differences in temperatures were more often Large differences in temperatures were more often found in patients who were younger, symptomatic, found in patients who were younger, symptomatic, female, and not taking aspirin.female, and not taking aspirin.
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Conclusionscontinued
4.4. These temperature differences can be detected These temperature differences can be detected by infrared cameras. by infrared cameras.
5.5. Compared to normal arteries, inflamed and Compared to normal arteries, inflamed and lipid-rich plaques are acidic, while calcified and lipid-rich plaques are acidic, while calcified and thrombosed plaques are alkaline.thrombosed plaques are alkaline.
6.6. Plaque pH correlates moderately and inversely Plaque pH correlates moderately and inversely with plaque temperature.with plaque temperature.
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Conclusionscontinued
7.7. Stefanadis and colleagues have reported that hot Stefanadis and colleagues have reported that hot plaques confer higher risk; it will be important to plaques confer higher risk; it will be important to determine whether plaque prognosis is best determined determine whether plaque prognosis is best determined by T, by T, ∆∆T, pH, T, pH, ∆∆pH or a combination.pH or a combination.
8.8. Heating to 41Heating to 41ooC decreases expression of pro-C decreases expression of pro-inflammatory genes.inflammatory genes.
9.9. Heating to 42-43Heating to 42-43ooC causes apoptosis, mainly of C causes apoptosis, mainly of macrophages.macrophages.
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Conclusionscontinued
10.10. Near-IR Spectroscopy can estimate plaque Near-IR Spectroscopy can estimate plaque protein/lipid ratios and may also provide protein/lipid ratios and may also provide inferences as to concentrations of plaque Hinferences as to concentrations of plaque H++, , NO, glucose, ONO, glucose, O2 2 and oxidants.and oxidants.
11.11. IR and near IR may predict plaque behaviour IR and near IR may predict plaque behaviour alone or in combination with ultrasound, alone or in combination with ultrasound, angioscopy, magnetic resonance or angioscopy, magnetic resonance or immunoscintigraphyimmunoscintigraphy
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