Feasibility of diagnosing unstable plaque in patients with acute coronary syndrome using iMap-IVUS

Objective： To compare the plaque composition between stable and unstable plaques, characterize unstable plaque by using iMap-intravascular ultrasound （IVUS）, and quantify the diagnostic criteria for unstable plaque. Methods： Thirty-three acute coronary syndrome （ACS） patients who had undergone coronary angiography and IVUS from February 19, 2014 to December 19, 2014 at Peking University People＇s Hospital were enrolled in the study. Baseline data were collected. The patients were divided into two groups according to their gray-scale IVUS imaging, stable plaque and unstable plaque. A difference-in-difference evaluation was performed using the baseline data and off-line iMap imaging results between the two groups. A receiver operating characteristic （ROC） curve was constructed to obtain the optimal cut-off value to diagnose unstable plaque. Results： Percentages of fibrotic and necrotic tissues, absolute values of lipidic, necrotic, and calcified tissues, and plaque burden were independent predictors for unstable plaque. Absolute necrotic area was the best predictor and exhibited the highest diagnostic value for plaque vulnerability （area under the curve （AUC）=0.806, P=0.000, 95% CI （0.718, 0.894））. The cut-off score for predicting unstable plaque was 4.0 mm2. Conclusions： This study attempted to propose a cut-off value based on absolute necrotic area using iMap-IVUS to predict plaque vulnerability in patients with ACS. This score might provide a valuable reference for diagnosing unstable plaque.

A case report of significant progression after FFR-guided deferred PCI

In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typically,FFR>0.80 in coronary artery indicates the lesions do not affect the coronary blood flow.

Effect of Removing Toxic Substances Combined with Activating Blood Circulation on Stabilizing the Atherosclerotic Plaque and Unstable Angina

The therapeutic effects of activating blood circulation to remove stasis of Chinese medicine （CM） in the prevention and treatment of atherosclerotic diseases such as coronary artery disease and angina are generally acknowledged. In recent years, to further improve the therapeutic effects of those Chinese herbs on such diseases, we have carried out a series of studies of CM medications with the function of clearing heat and removing toxic substances combined with activating blood circulation to remove stasis.

Uptake of citrate-coated iron oxide nanoparticles into atherosclerotic lesions in mice occurs via accelerated transcytosis through plaque endothelial cells

Very small superparamagnetic iron oxide nanoparticles （VSOPs） rapidly accumulate in atherosclerotic lesions, thereby enabling plaque visualization by magnetic resonance imaging （MRI）. This study was performed to identify the uptake mechanisms of VSOPs into atherosclerotic plaques. Low-density lipoprotein receptor-deficient （LDLR^-/-） mice with advanced atherosclerosis were analyzed using MRI and transmission electron microscopy （TEM） at various time points after intravenous administration of VSOPs. Post-mortem MRI detected VSOP labeling of atherosclerotic plaques 10 min after injection, and the signal increased over the first 3 h. TEM revealed that the intensive plaque labeling was mediated by accelerated transcytosis of VSOPs through endothelial cells overlaying atherosclerotic lesions. Experiments with endocytosis inhibitors and small interfering RNA （siRNA） revealed a dynamin-dependent mechanism involving both clathrin- and caveolin-mediated processes. In cell culture experiments, endothelial VSOP uptake was enhanced under proatherogenic flow and TNFα stimulation, conditions that are both present in plaque areas. Our study demonstrates that VSOPs enable non-invasive MRI assessment of accelerated endothelial transcytosis, an important pathomechanism in atherosclerotic plaque formation.

Red Yeast Rice Prevents Atherosclerosis through Regulating Inflammatory Signaling Pathways

Objective： To observe the effects of red yeast rice（RYR） on blood lipid levels, aortic atherosclerosis（AS）, and plaque stability in apolipoprotein E gene knockout（Apo E-/-） mice. Methods： Twentyfour Apo E-/-mice were fed with a high-fat diet starting from 6 weeks of age. Mice were randomized into three groups（n = 8 in each group）： model group（Apo E-/-group）, RYR group（Apo E-/-＋ RYR group）, and simvastatin group（Apo E-/-＋ simvastatin group）. Eight 6-week-old C57BL/6 mice were assigned as the control group and fed with a basic diet. After 36 weeks, plasma lipids and inflammatory factors were measured. Aortic atherosclerotic lesions by microscope, scanning electron microscope and transmission electron microscope were observed. Plasma levels of interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） were measured with enzymelinked immunosorbent assay. The level of high sensitivity C-reaction protein（Hs-CRP） was detected by the scattering immunoturbidimetric assay. Protein expression of matrix metalloproteinase-9（MMP-9） and nuclear factor κB（NF-κB） in aorta were tested by immunohistochemistry. Results： Compared with the model group, treatment with RYR significantly decreased the levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, lipoprotein（a）, and apolipoprotein B100 in Apo E-/-mice（P〈0.01）. Compared with the model group, treatment with RYR decreased the levels of Hs-CRP, IL-6, and TNF-α（P〈0.01）. RYR also reduced the protein levels of NF-κB and MMP-9 of the aorta. Conclusions： RYR has the anti-atherosclerotic and stabilizing unstable plaque effects. The mechanism might be related to the inflammatory signaling pathways.