Journal of cardiovascular medicine
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Intraplaque hemorrhage (IPH) is an important co-factor for plaque progression and rupture. So far noninvasive MRI has shown promise for the in-vivo identification of IPH and for the prediction of plaque instability. Intravascular imaging techniques such as intravascular ultrasound or optical coherence tomography (OCT) cannot distinguish between IPH and other plaque components. ⋯ Microvessels are known to be the main source of blood extravasation due to their anatomically compromised structure. Coronary plaques with a high microvessel density undergo rapid plaque progression and are often associated with other features of plaque instability such as inflammatory cells. The combination of data from both MRI and OCT studies will allow a better understanding of the mechanism of plaque destabilization and the pathophysiology of cardiovascular events.
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J Cardiovasc Med (Hagerstown) · Oct 2012
ReviewFrom intraplaque haemorrhages to plaque vulnerability: biological consequences of intraplaque haemorrhages.
Intraplaque hemorrhages are mainly related to inward neoangiogenesis, initiated from the adventitia by lipid-dependent outwardly convected signals, and by the immaturity of these neovessels, allowing leaks and hemorrhages. Repeated intraplaque hemorrhages play a major role in the evolution of thrombotic occlusive disease, similar to the role of intraluminal thrombus in the progression of abdominal aortic aneurysm toward rupture. Red blood cells (RBCs) are an important source of unesterified cholesterol, because their membranes are particularly cholesterol rich. ⋯ These proteases concentrate in the hemorrhagic/necrotic core rendered plaque highly vulnerable. An adaptive immune response takes place in the adventitia, in regard of hemorrhagic plaques, in relation to outwardly convected oxidized or proteolyzed neoantigens, and chemokinic signals. Finally, intraplaque hemorrhages and thrombi are the site of weak pathogen entrapment, which promote all these oxydative and proteolytic phenomenons.
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An 8-year-old asymptomatic child was referred for surgical repair of coronary sinus atrial septal defect resulting in significant left-to-right shunt and right chamber volume overload. The septal fenestration was located near to its drainage site into the right atrium. Due to this seemingly favourable anatomy, transcatheter closure of the septal defect was performed using an Amplatzer Septal Occluder device. The echocardiographic postprocedural evaluation imaged the occluding device almost perpendicular to the atrial septum, seemingly floating above the mitral valve orifice, like an alien spaceship inside the heart.
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J Cardiovasc Med (Hagerstown) · Oct 2012
ReviewPathology of plaque haemorrhage and neovascularization of coronary artery.
Intraplaque haemorrhage (IPH) is thought to play crucial roles in plaque progression and plaque rupture, resulting in acute coronary syndromes, which are the leading causes of morbidity and mortality in the developed countries. IPH is a common finding in atherosclerotic plaques. In the past decade, the use of anti-Glycophorin A antibodies that specifically and uniquely label membranes of the red cells triggered a cascade of pathologic and experimental studies concordantly documenting not only the presence but also the major role of IPH in plaque progression and complications. ⋯ Although the mechanisms by which IPH impacts plaque progression and plaque rupture gradually become clear, several questions such as causes of angioneogenesis, identification and treatment of plaques with angioneogenesis are still unanswered. Further studies are needed to resolve these issues; however, the investigation of IPH without a histopathological approach is unconceivable. This review will focus on the pathology of IPH and plaque neovascularization, pathophysiology and potential clinical impact.
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J Cardiovasc Med (Hagerstown) · Oct 2012
ReviewIntraplaque neovascularization and hemorrhage: markers for cardiovascular risk stratification and therapeutic monitoring.
Atherosclerotic disease results in major clinical events and remains a leading cause of morbidity and mortality in the western World. Atherosclerotic plaques have a heterogeneous presentation. Atherosclerotic plaques with a vulnerable phenotype have been associated with an increased risk for cardiovascular complications. ⋯ Pharmacological interventions showed an inhibiting effect of lipid-lowering drugs on plaque neovascularization. Imaging modalities such as contrast-enhanced ultrasound or MRI are able to visualize intraplaque neovascularization and hemorrhage noninvasively. Consequently, detection of intraplaque neovascularization and hemorrhage visualized with noninvasive imaging might improve the stratification of 'high-risk' patients.