Abstract:Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a complex and diverse disease with great heterogeneity in pathophysiologic mechanisms and treatment prognosis. It is difficult to fully clarify the mechanism by conventional examination. Optical coherence tomography (OCT) visualizes the microstructure of vascular plaques with high resolution and identifies vulnerable plaques more accurately. The aim of this review is to use this technique to delve into the morphological features of MINOCA for a more comprehensive understanding of disease progression. Accurate characterization of plaques and identification of vulnerable plaques can help develop individualized treatment plans, improve prognosis, and reduce mortality.

Abstract:Coronary vulnerable plaque is associated with adverse cardiovascular events in patients with coronary atherosclerotic heart disease. The development of intravascular imaging has provided a new perspective on the biological factors of the development of atherosclerotic plaques. By identifying the imaging features most likely to lead to adverse cardiovascular events, it can timely identify high-risk patients in clinic, and carry out active prevention and treatment, so as to improve the patients’ life quality.

Abstract:Aim To study the construction of carotid vulnerable plaque risk model and its relationship with cognitive impairment and prognosis in patients with acute cerebral infarction (ACI). Methods 180 patients with carotid vulnerable plaques in Lianyungang First Peoples Hospital from July 2018 to July 2020 were selected as observation group, and another 180 patients with unstable plaques who underwent physical examination were selected as control group. The unstable plaque integral ratio, the maximum length of plaques, the maximum thickness of plaques, ulcer plaques, area stenosis, peak flow velocity at stenosis and resistance index were compared to study the construction of carotid vulnerable plaque risk model and its relationship with cognitive impairment and prognosis in patients with ACI. Results There were significant differences between the two groups in unstable plaque integral ratio, maximum plaque length, maximum plaque thickness, ulcer plaque, area stenosis, peak flow velocity at stenosis and resistance index (P＜0.05). Multivariate analysis showed that high unstable plaque integral ratio, maximum plaque length, maximum plaque thickness, ulcer plaque, peak flow velocity at area stenosis and resistance index were the risk factors for carotid vulnerable plaque. The incidence of cognitive impairment (χ2＝11.432, P＝0.001) and poor prognosis (χ2＝14.362, P＝0.000) in the observation group was significantly higher than those in the control group. Correlation analysis showed that carotid vulnerable plaques in ACI patients were significantly correlated with cognitive impairment and prognosis. Conclusions Carotid vulnerable plaque is significantly correlated with cognitive impairment and prognosis in patients with ACI. High unstable plaque integral ratio, maximum plaque length, maximum plaque thickness, ulcer plaque, area stenosis, peak flow velocity at stenosis and resistance index are all risk factors for carotid vulnerable plaque, it is suggested that clinical intervention should be carried out in time for such patients.

Abstract:Vulnerable plaque refers to the plaque with poor stability in the arterial wall, which is easy to rupture and fall off, leading to the formation of in situ thrombus or multiple microemboli. Carotid atherosclerotic vulnerable plaque is the main pathogenic mechanism of ischemic stroke, and carotid plaque vulnerability increases the occurrence of cerebral ischemic events. Therefore, early identification of vulnerable plaques is of great significance for intervening high-risk factors for stroke and improving stroke prognosis. In addition to various imaging techniques, circulating biomarkers provide an adjunct to the identification of vulnerable carotid plaques. This article reviews previous studies, discussing novel biomarkers capable of identifying carotid vulnerable plaques.

Abstract:Vascular plaque stability is a major factor contributing to the development of acute coronary syndrome, and optical coherence tomography (OCT) with ultra-high spatial resolution has a unique advantage in the identification of vulnerable plaques. This paper reviews the clinical progress of OCT in the identification of vulnerable plaques in patients with acute coronary syndrome in recent years.

Abstract:Aim To investigate the modeling methods and application of atherosclerotic vulnerable plaque (VP) animal model. Methods The related literature about VP animal modeling published in CNKI, Pubmed and Wanfang databases from October 2016 to October 2021 were retrieved. The modeling animals, modeling methods, modeling cycles, model evaluation methods and corresponding detection indexes in the literatures were statistically analyzed. Results The most commonly used experimental animals were mice with apolipoprotein E gene deficient at 6～12 weeks, New Zealand white rabbits at 12～16 weeks, and familial hypercholesterolemia pigs at 34 weeks. Modeling methods were followed by high-fat and high-cholesterol diet induction, arterial ligation, or combined with aortic endothelial balloon strain, chemical triggering, immune induction, etc. The modeling cycle ranged from 8 weeks to 1 year, with 12 to 18 weeks being the most. The evaluation methods were mostly pathological staining, combined with enzyme-linked immunosorbent assay, Western blot, real-time fluorescence quantitative PCR, flow cytometry and other methods; color Doppler ultrasound, cardiac perfusion imaging and in vivo live cell tracking technology were used for VP live detection. Conclusion High-fat and high-cholesterol diet feeding, or combined with surgical injury to establish VP model has good reproducibility. If a cost-effective in vivo detection method can be developed, the research efficiency of atherosclerotic diseases will be greatly improved.

Abstract:MicroRNA (miRNA) is a kind of evolutionarily highly conserved noncoding small molecule single stranded RNA (about 18-24 nucleotides), which negatively regulates gene expression at posttranscriptional level. Vulnerable plaques refer to plaques that are easy to form thrombus or may rapidly develop into criminal lesions in the process of atherosclerosis. Research shows that miRNA is involved in almost all steps of atherosclerosis, including endothelial cell and vascular smooth muscle cell injury and dysfunction, monocyte infiltration and platelet dysfunction, and plays a beneficial or harmful role. MiRNA will also become a new field to further study the mechanism of bidirectional regulation of vulnerable plaque by traditional Chinese medicine.

Abstract:Cardiovascular disease remains the major cause of death in China. Atherosclerosis (As) has been a crucial pathological foundation of cardiovascular diseases. It is known that the vulnerable plaques in coronary artery are instability high-risk plaques with a tendency to thrombosis who develop rapidly, which act as the pathologic mechanism of acute coronary syndrome (ACS) and ischemic stroke. Although the current anti-atherosclerosis therapy could reduce 30%～45% of acute myocardial infarction and stroke, residual risk of vulnerable plaques remains high. Therefore, it is critical to reach a better understanding of the pathogenesis for plaque vulnerability to identify and treat adverse cardiovascular events.

Abstract:Aim To identify the correlation between chitinase protein 40 (YKL-40) levels including high sensitive C reactive protein (hs-CRP) and the fibrous cap thickness of fibrofatty plaque in coronary culprit 1esions. Methods Clinical data of 60 patients with selective coronary artery angiography diagnosed coronary artery disease were retrospectively analyzed. According to type of coronary disease, patients were divided into 3 subgroups:SAP group (containing 22 stable angina patients), UAP group (containing 28 unstable angina patients), and AMI group (containing 10 acute myocardial infarction patients). Serum hs-CRP and YKL-40 levels were measured before subsequent procedures. The characteristics of the culprit lesions were detected by optical coherence tomography (OCT) before interventional treatment, and the correlation between hs-CRP, YKL-40 and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were analyzed. Results (1)The serum levels of hs-CRP and YKL-40 were significantly higher in AMI group than in SAP and UAP group (all P<0.05), and higher in UAP group than in SAP group (all P<0.05). (2)The fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were smaller in AMI and UAP group than in SAP group (all P<0.05), and there was no significant difference between AMI group and UAP group (P>0.05). Proportion of thin-cap fibroatheroma plaque (all P<0.05), plaque rupture and thrombosis were significantly higher in AMI group than in SAP and UAP group (all P<0.05). Proportion of calcification in plaque was lower in AMI group than in SAP group (P<0.05), and there was no significant difference between AMI group and UAP group (P>0.05). (3)Pearson correlation analysis showed that serum levels of hs-CRP (r=－0.265, P<0.05) and YKL-40 (r=－0.524, P<0.01) were negatively correlated with fibrous cap thickness of fibrofatty plaques. Spearman correlation analysis showed that serum levels of hs-CRP and YKL-40 were positively correlated with plaque rupture (r=0.462 and r=0.499, P<0.01) and thrombosis (r=0.218 and r=0.263, P<0.05). (4)Multiple Logistic regression analysis showed that serum levels of YKL-40 at baseline was independently related to thin-cap fibroatheroma plaque (OR=6.341, P<0.01). Conclusions The serum levels of hs-CRP and YKL-40 in AMI patients were much higher than that in SAP and UAP patients, higher in UAP patients than in SAP patients. Prevalence of thin-cap fibroatheroma plaque, plaque rupture and thrombosis was significantly higher in the AMI patients, while the prevalence of calcification in plaque was more often in SAP patients. Increased serum levels of YKL-40 were independent risk factor of thin-cap fibroatheroma plaque formation.

Abstract:Aim To study the correlation between lipoprotein(a) [Lp(a)] level and coronary vulnerable plaque based on optical coherence tomography (OCT). Methods From January 2015 to August 2018, patients admitted to the Heart Center of the First Affiliated Hospital of Xinjiang Medical University who were diagnosed as coronary heart disease by coronary angiography were examined by OCT. The analysis of the relationship between lipoprotein (a) level and coronary vulnerable plaque were completed by multiple linear regression and other statistical methods. Results A total of 144 patients were enrolled. (1)According to the Lp(a) level, the patients were divided into two groups:Lp(a) ≤300 mg/L group (n＝99) and Lp(a) ＞300 mg/L group (n＝45). The lipid arc of plaque in Lp(a) ＞300 mg/L group was larger than that in Lp(a) ≤300 mg/L group (P＝0.021), and the incidence of vulnerable plaque was higher than that in Lp(a) ≤300 mg/L group (P＝0.001). (2)The patients were divided into vulnerable plaque group (n＝36) and non-vulnerable plaque group (n＝108) by OCT. There were significant differences in sex, smoking history, type 2 diabetes mellitus, body mass index, low density lipoprotein and Lp(a) between the two groups (all P＜0.05). Multivariate Logistic regression analysis showed that Lp(a), type 2 diabetes mellitus and low density lipoprotein were independent influencing factors of vulnerable plaque, and were predictors of vulnerable plaque occurrence. Conclusion The high level of lipoprotein (a) is independently correlated with coronary vulnerable plaques.