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JACKSON, Robert, Abtehale AL-HUSSAINI, Shiju JOSEPH, Gijs VAN SOEST, Alice WOOD, Fernando MACAYA, Nieves GONZALO, Jamil CADE, Adriano CAIXETA, Ota HLINOMAZ, Pavel LEINVEBER, Peter O KANE, Marcos GARCIA-GUIMARAES, Bernardo CORTESE, Nilesh J. SAMANI, Javier ESCANED, Fernando ALFONSO, Thomas JOHNSON and David ADLAM. Spontaneous Coronary Artery Dissection Pathophysiological Insights From Optical Coherence Tomography. JACC-CARDIOVASCULAR IMAGING. NEW YORK: ELSEVIER SCIENCE INC, 2019, vol. 12, No 12, p. 2475-2488. ISSN 1936-878X. Available from: https://dx.doi.org/10.1016/j.jcmg.2019.01.015.

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TY  - JOUR
ID  - 1625796
AU  - Jackson, Robert - Al-Hussaini, Abtehale - Joseph, Shiju - van Soest, Gijs - Wood, Alice - Macaya, Fernando - Gonzalo, Nieves - Cade, Jamil - Caixeta, Adriano - Hlinomaz, Ota - Leinveber, Pavel - O Kane, Peter - Garcia-Guimaraes, Marcos - Cortese, Bernardo - Samani, Nilesh J. - Escaned, Javier - Alfonso, Fernando - Johnson, Thomas - Adlam, David
PY  - 2019
TI  - Spontaneous Coronary Artery Dissection Pathophysiological Insights From Optical Coherence Tomography
JF  - JACC-CARDIOVASCULAR IMAGING
VL  - 12
IS  - 12
SP  - 2475-2488
EP  - 2475-2488
PB  - ELSEVIER SCIENCE INC
SN  - 1936878X
KW  - intracoronary imaging
KW  - optical coherence tomography
KW  - spontaneous coronary artery dissection
UR  - http://dx.doi.org/10.1016/j.jcmg.2019.01.015
L2  - http://dx.doi.org/10.1016/j.jcmg.2019.01.015
N2  - OBJECTIVES This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL. BACKGROUND SCAD is an increasingly recognized cause of acute coronary syndromes, characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood. METHODS A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the absence or presence of a connection (fenestration) between the TL and FL. Indexed measurements of TL stenosis, external elastic lamina (EEL) area, FL area, and light attenuation of the FL were assessed. Vasa vasorum densities of SCAD cases were compared with those in control non-SCAD myocardial infarction cases. RESULTS In nonfenestrated cases, there was significantly larger expansion of the EEL area (9.1% vs. -1.9%; p<0.05) and a larger FL area (73.6% vs. 53.2%, respectively; p<0.05) in dissected segments. No significant differences were found between vasa vasorum density in SCAD and those in control subjects. The FL contents were heterogeneous but attenuated less light than whole blood or thrombus (4.28 +/- 0.55 mm(-1) vs. 5.08 +/- 0.56 mm(-1); p < 0.05; vs. 4.96 +/- 0.56 mm(-1); p < 0.05). CONCLUSIONS These observational data suggest that the absence of a fenestration leads to increased FL pressure and compression of the TL. Although vasa vasorum may still be implicated in pathogenesis, increased vasa vasorum density could be an epiphenomenon of vascular healing. (C) 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
ER  -

Basic information
Original name	Spontaneous Coronary Artery Dissection Pathophysiological Insights From Optical Coherence Tomography
Authors	JACKSON, Robert (826 United Kingdom of Great Britain and Northern Ireland), Abtehale AL-HUSSAINI (826 United Kingdom of Great Britain and Northern Ireland), Shiju JOSEPH (826 United Kingdom of Great Britain and Northern Ireland), Gijs VAN SOEST (528 Netherlands), Alice WOOD (826 United Kingdom of Great Britain and Northern Ireland), Fernando MACAYA (724 Spain), Nieves GONZALO (724 Spain), Jamil CADE (76 Brazil), Adriano CAIXETA (76 Brazil), Ota HLINOMAZ (203 Czech Republic, belonging to the institution), Pavel LEINVEBER (203 Czech Republic, belonging to the institution), Peter O KANE (826 United Kingdom of Great Britain and Northern Ireland), Marcos GARCIA-GUIMARAES (724 Spain), Bernardo CORTESE (380 Italy), Nilesh J. SAMANI (826 United Kingdom of Great Britain and Northern Ireland), Javier ESCANED (724 Spain), Fernando ALFONSO (724 Spain), Thomas JOHNSON (826 United Kingdom of Great Britain and Northern Ireland) and David ADLAM (826 United Kingdom of Great Britain and Northern Ireland, guarantor).
Edition	JACC-CARDIOVASCULAR IMAGING, NEW YORK, ELSEVIER SCIENCE INC, 2019, 1936-878X.

Other information
Original language	English
Type of outcome	Article in a journal
Field of Study	30201 Cardiac and Cardiovascular systems
Country of publisher	United States of America
Confidentiality degree	is not subject to a state or trade secret
WWW	URL
Impact factor	Impact factor: 12.740
RIV identification code	RIV/00216224:14110/19:00113020
Organization unit	Faculty of Medicine
Doi	http://dx.doi.org/10.1016/j.jcmg.2019.01.015
UT WoS	000500693700015
Keywords in English	intracoronary imaging; optical coherence tomography; spontaneous coronary artery dissection
Tags	14110115, rivok
Tags	International impact, Reviewed
Changed by	Changed by: Mgr. Tereza Miškechová, učo 341652. Changed: 11/3/2020 14:24.

Abstract
OBJECTIVES This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL. BACKGROUND SCAD is an increasingly recognized cause of acute coronary syndromes, characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood. METHODS A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the absence or presence of a connection (fenestration) between the TL and FL. Indexed measurements of TL stenosis, external elastic lamina (EEL) area, FL area, and light attenuation of the FL were assessed. Vasa vasorum densities of SCAD cases were compared with those in control non-SCAD myocardial infarction cases. RESULTS In nonfenestrated cases, there was significantly larger expansion of the EEL area (9.1% vs. -1.9%; p<0.05) and a larger FL area (73.6% vs. 53.2%, respectively; p<0.05) in dissected segments. No significant differences were found between vasa vasorum density in SCAD and those in control subjects. The FL contents were heterogeneous but attenuated less light than whole blood or thrombus (4.28 +/- 0.55 mm(-1) vs. 5.08 +/- 0.56 mm(-1); p < 0.05; vs. 4.96 +/- 0.56 mm(-1); p < 0.05). CONCLUSIONS These observational data suggest that the absence of a fenestration leads to increased FL pressure and compression of the TL. Although vasa vasorum may still be implicated in pathogenesis, increased vasa vasorum density could be an epiphenomenon of vascular healing. (C) 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

Abstract

OBJECTIVES This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL. BACKGROUND SCAD is an increasingly recognized cause of acute coronary syndromes, characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood. METHODS A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the absence or presence of a connection (fenestration) between the TL and FL. Indexed measurements of TL stenosis, external elastic lamina (EEL) area, FL area, and light attenuation of the FL were assessed. Vasa vasorum densities of SCAD cases were compared with those in control non-SCAD myocardial infarction cases. RESULTS In nonfenestrated cases, there was significantly larger expansion of the EEL area (9.1% vs. -1.9%; p<0.05) and a larger FL area (73.6% vs. 53.2%, respectively; p<0.05) in dissected segments. No significant differences were found between vasa vasorum density in SCAD and those in control subjects. The FL contents were heterogeneous but attenuated less light than whole blood or thrombus (4.28 +/- 0.55 mm(-1) vs. 5.08 +/- 0.56 mm(-1); p < 0.05; vs. 4.96 +/- 0.56 mm(-1); p < 0.05). CONCLUSIONS These observational data suggest that the absence of a fenestration leads to increased FL pressure and compression of the TL. Although vasa vasorum may still be implicated in pathogenesis, increased vasa vasorum density could be an epiphenomenon of vascular healing. (C) 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.