121 results on '"Feinstein SB"'
Search Results
2. Noninvasive Imaging of the Vulnerable Atherosclerotic Plaque
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Kate, GL, Sijbrands, E.J.G., Staub, D, Coll, B, ten Cate, Folkert, Feinstein, SB, Schinkel, Arend, Internal Medicine, and Cardiology
- Abstract
Atherosclerosis is an inflammatory disease, complicated by progressively increasing atherosclerotic plaques that eventually may rupture. Plaque rupture is a major cause of cardiovascular events, such as unstable angina, myocardial infarction, and stroke. A number of noninvasive imaging techniques have been developed to evaluate the vascular wall in an attempt to identify so-called vulnerable atherosclerotic plaques that are prone to rupture. The purpose of the present review is to systematically investigate the accuracy of noninvasive imaging techniques in the identification of plaque components and morphologic characteristics associated with plaque vulnerability, assessing their clinical and diagnostic value. (Curr Probl Cardiol 2010;35:556-591.)
- Published
- 2010
3. Molecular imaging of inflammation and intraplaque vasa vasorum: A step forward to identification of vulnerable plaques?
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Kate, GL, Sijbrands, E.J.G., Valkema, R., ten Cate, Folkert, Feinstein, SB, van der Steen, Ton, Daemen, MJAP, Schinkel, Arend, Kate, GL, Sijbrands, E.J.G., Valkema, R., ten Cate, Folkert, Feinstein, SB, van der Steen, Ton, Daemen, MJAP, and Schinkel, Arend
- Abstract
Current developments in cardiovascular biology and imaging enable the noninvasive molecular evaluation of atherosclerotic vascular disease. Intraplaque neovascularization sprouting from the adventitial vasa vasorum has been identified as an independent predictor of intraplaque hemorrhage and plaque rupture. These intraplaque vasa vasorum result from angiogenesis, most likely under influence of hypoxic and inflammatory stimuli. Several molecular imaging techniques are currently available. Most experience has been obtained with molecular imaging using positron emission tomography and single photon emission computed tomography. Recently, the development of targeted contrast agents has allowed molecular imaging with magnetic resonance imaging, ultrasound and computed tomography. The present review discusses the use of these molecular imaging techniques to identify inflammation and intraplaque vasa vasorum to identify vulnerable atherosclerotic plaques at risk of rupture and thrombosis. The available literature on molecular imaging techniques and molecular targets associated with inflammation and angiogenesis is discussed, and the clinical applications of molecular cardiovascular imaging and the use of molecular techniques for local drug delivery are addressed.
- Published
- 2010
4. Molecular imaging of inflammation and intraplaque vasa vasorum: a step forward to identification of vulnerable plaques?
- Author
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ten Kate GL, Sijbrands EJ, Valkema R, ten Cate FJ, Feinstein SB, van der Steen AF, Daemen MJ, Schinkel AF, ten Kate, Gerrit L, Sijbrands, Eric J G, Valkema, Roelf, ten Cate, Folkert J, Feinstein, Steven B, van der Steen, Antonius F W, Daemen, Mat J A P, and Schinkel, Arend F L
- Abstract
Current developments in cardiovascular biology and imaging enable the noninvasive molecular evaluation of atherosclerotic vascular disease. Intraplaque neovascularization sprouting from the adventitial vasa vasorum has been identified as an independent predictor of intraplaque hemorrhage and plaque rupture. These intraplaque vasa vasorum result from angiogenesis, most likely under influence of hypoxic and inflammatory stimuli. Several molecular imaging techniques are currently available. Most experience has been obtained with molecular imaging using positron emission tomography and single photon emission computed tomography. Recently, the development of targeted contrast agents has allowed molecular imaging with magnetic resonance imaging, ultrasound and computed tomography. The present review discusses the use of these molecular imaging techniques to identify inflammation and intraplaque vasa vasorum to identify vulnerable atherosclerotic plaques at risk of rupture and thrombosis. The available literature on molecular imaging techniques and molecular targets associated with inflammation and angiogenesis is discussed, and the clinical applications of molecular cardiovascular imaging and the use of molecular techniques for local drug delivery are addressed. [ABSTRACT FROM AUTHOR]
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- 2010
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5. Vasa vasorum and plaque neovascularization on contrast-enhanced carotid ultrasound imaging correlates with cardiovascular disease and past cardiovascular events.
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Staub D, Patel MB, Tibrewala A, Ludden D, Johnson M, Espinosa P, Coll B, Jaeger KA, Feinstein SB, Staub, Daniel, Patel, Mita B, Tibrewala, Anjan, Ludden, David, Johnson, Mahala, Espinosa, Paul, Coll, Blai, Jaeger, Kurt A, and Feinstein, Steven B
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- 2010
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6. Contrast-enhanced ultrasound imaging of periadventitial vasa vasorum in human carotid arteries.
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Magnoni M, Coli S, Marrocco-Trischitta MM, Melisurgo G, De Dominicis D, Cianflone D, Chiesa R, Feinstein SB, and Maseri A
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- 2009
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7. Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized trial.
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Mazzone T, Meyer PM, Feinstein SB, Davidson MH, Kondos GT, D'Agostino RB Sr., Perez A, Provost J, Haffner SM, Mazzone, Theodore, Meyer, Peter M, Feinstein, Steven B, Davidson, Michael H, Kondos, George T, D'Agostino, Ralph B Sr, Perez, Alfonso, Provost, Jean-Claude, and Haffner, Steven M
- Abstract
Context: Carotid artery intima-media thickness (CIMT) is a marker of coronary atherosclerosis and independently predicts cardiovascular events, which are increased in type 2 diabetes mellitus (DM). While studies of relatively short duration have suggested that thiazolidinediones such as pioglitazone might reduce progression of CIMT in persons with diabetes, the results of longer studies have been less clear.Objective: To evaluate the effect of pioglitazone vs glimepiride on changes in CIMT of the common carotid artery in patients with type 2 DM.Design, Setting, and Participants: Randomized, double-blind, comparator-controlled, multicenter trial in patients with type 2 DM conducted at 28 clinical sites in the multiracial/ethnic Chicago metropolitan area between October 2003 and May 2006. The treatment period was 72 weeks (1-week follow-up). CIMT images were captured by a single ultrasonographer at 1 center and read by a single treatment-blinded reader using automated edge-detection technology. Participants were 462 adults (mean age, 60 [SD, 8.1] years; mean body mass index, 32 [SD, 5.1]) with type 2 DM (mean duration, 7.7 [SD, 7.2] years; mean glycosylated hemoglobin [HbA1c] value, 7.4% [SD, 1.0%]), either newly diagnosed or currently treated with diet and exercise, sulfonylurea, metformin, insulin, or a combination thereof.Interventions: Pioglitazone hydrochloride (15-45 mg/d) or glimepiride (1-4 mg/d) as an active comparator.Main Outcome Measure: Absolute change from baseline to final visit in mean posterior-wall CIMT of the left and right common carotid arteries.Results: Mean change in CIMT was less with pioglitazone vs glimepiride at all time points (weeks 24, 48, 72). At week 72, the primary end point of progression of mean CIMT was less with pioglitazone vs glimepiride (-0.001 mm vs +0.012 mm, respectively; difference, -0.013 mm; 95% confidence interval, -0.024 to -0.002; P = .02). Pioglitazone also slowed progression of maximum CIMT compared with glimepiride (0.002 mm vs 0.026 mm, respectively, at 72 weeks; difference, -0.024 mm; 95% confidence interval, -0.042 to -0.006; P = .008). The beneficial effect of pioglitazone on mean CIMT was similar across prespecified subgroups based on age, sex, systolic blood pressure, duration of DM, body mass index, HbA(1c) value, and statin use.Conclusion: Over an 18-month treatment period in patients with type 2 DM, pioglitazone slowed progression of CIMT compared with glimepiride.Trial Registration: clinicaltrials.gov Identifier: NCT00225264 [ABSTRACT FROM AUTHOR]- Published
- 2006
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8. Noninvasive surrogate markers of atherosclerosis.
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Feinstein SB, Voci P, Pizzuto F, Davidson MH, Pasternak R, McKenney JM, Dujovne CA, Brown AS, Black D, Orloff D, Feinstein, Steven B, Voci, Paolo, and Pizzuto, Francesco
- Abstract
Noninvasive imaging techniques offer a unique opportunity to study the relation of surrogate markers to the development of atherosclerosis. These noninvasive imaging modalities include: (1) carotid artery, coronary, and aorta imaging; (2) left ventricular echocardiography imaging; (3) electron-beam computed tomography; (4) magnetic resonance imaging; and (5) ankle-brachial index. Because the incidence of coronary artery disease is a function of the development and progression of atherosclerosis, the use of noninvasive surrogate markers of atherosclerosis can aid in the diagnosis of cardiovascular disease through the identification of subclinical disease. Noninvasive imaging techniques provide an approach for identifying high-risk individuals who may benefit from active intervention to prevent clinical disease. [ABSTRACT FROM AUTHOR]
- Published
- 2002
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9. Effects of consumption of pomegranate juice on carotid intima-media thickness in men and women at moderate risk for coronary heart disease.
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Davidson MH, Maki KC, Dicklin MR, Feinstein SB, Witchger M, Bell M, McGuire DK, Provost JC, Liker H, and Aviram M
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- 2009
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10. Contrast-enhanced ultrasound imaging of periadventitial vasa vasorum in human carotid arteries
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Attilio Maseri, Roberto Chiesa, Stefano Coli, Davide De Dominicis, Massimiliano M. Marrocco-Trischitta, Domenico Cianflone, Steve B. Feinstein, Giulio Melisurgo, Marco Magnoni, Magnoni, M, Coli, S, Marrocco Trischitta, Mm, Melisurgo, G, De Dominicis, D, Cianflone, Domenico, Chiesa, Roberto, Feinstein, Sb, and Maseri, A.
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Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Carotid arteries ,Statistics as Topic ,Internal medicine ,Medical imaging ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Ultrasonography ,business.industry ,Vasa Vasorum ,Ultrasound ,General Medicine ,Middle Aged ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Carotid Arteries ,Intima-media thickness ,Vasa vasorum ,Case-Control Studies ,Microbubbles ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Contrast-enhanced ultrasound - Abstract
Arterial vasa vasorum (VV) are known to be involved in the atherosclerotic process. The aim of the present study was to explore whether ultrasound imaging with contrast agent is able to visualize adventitial VV in human carotid atherosclerosis. We studied with standard ultrasound 25 patients with carotid stenosis > 50% (ATS group) and 15 patients without carotid artery plaques and an intima-media thickness (IMT) < 1.0 mm (CTRL group). All patients underwent contrast ultrasound to evaluate periadventitial VV and B-flow imaging (BFI) modality was used to improve and measure periadventitial flow signal. On contrast-enhanced images, a fast microbubble flow and a homogeneous and linear periadventitial contrast signal using BFI were detectable in the adventitial area in all patients of both groups. Periadventitial signal thickness by BFI was higher in patients with atherosclerosis than in the control group (mean +/- SD: CTRL 0.80 +/- 0.06 mm; ATS 1.10 +/- 0.11 mm; P < 0.001). Moreover, considering the whole study population, the adventitial signal thickness significantly correlated with IMT values (r= 0.88, r(2)= 0.77; P < 0.0001). Periadventitial contrast signal was detected in all patients and BFI thickness was higher in patient with carotid atherosclerosis and correlated with IMT.
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- 2008
11. Contrast enhanced B-flow for evaluation of periadventitial vasa vasorum in carotid atherosclerosis
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Magnoni, M., Coli, S., Melisurgo, G., Cianflone, D., Massimiliano M. Marrocco-Trischitta, Chiesa, R., Feinstein, S. B., Maseri, A., Magnoni, M, Coli, S, Melisurgo, G, Cianflone, Domenico, Marrocco Trischitta, Mm, Chiesa, Roberto, Feinstein, Sb, and Maseri, A.
- Published
- 2006
12. Role of surrogate markers in assessing patients with diabetes mellitus and the metabolic syndrome and in evaluating lipid-lowering therapy.
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Rajaram V, Pandhya S, Patel S, Meyer PM, Goldin M, Feinstein MJM, Neems R, Liebson PR, Fiedler BM, Macioch JE, and Feinstein SB
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- 2004
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13. Correction: Soluble urokinase plasminogen activator receptor and cardiotoxicity in doxorubicin‑treated breast cancer patients: a prospective exploratory study.
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Chu J, Tung L, Atallah I, Wei C, Cobleigh M, Rao R, Feinstein SB, Usha L, Banach K, Reiser J, and Okwuosa TM
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- 2024
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14. Soluble urokinase plasminogen activator receptor and cardiotoxicity in doxorubicin-treated breast cancer patients: a prospective exploratory study.
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Chu J, Tung L, Atallah I, Wei C, Cobleigh M, Rao R, Feinstein SB, Usha L, Banach K, Reiser J, and Okwuosa TM
- Abstract
Background: Soluble urokinase plasminogen activator receptor is an inflammatory biomarker that may prognosticate cardiovascular outcomes. We sought to determine the associations between soluble urokinase plasminogen activator receptor and established markers of cardiotoxicity in breast cancer patients receiving doxorubicin., Methods: We conducted a prospective cohort study of women with newly diagnosed breast cancer receiving standard-dose doxorubicin (240 mg/m
2 ) at Rush University Medical Center and Rush Oak Park Hospital (Chicago, IL) between January 2017 and May 2019. Left ventricular ejection fraction, global longitudinal strain, and cardiac biomarkers (N-terminal prohormone B-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein) were measured at baseline and at intervals up to 12-month follow-up after end of treatment. The associations between soluble urokinase plasminogen activator receptor and these endpoints were evaluated using multivariable mixed effects linear regression., Results: Our study included 37 women (mean age 47.0 ± 9.3 years, 60% white) with a median baseline soluble urokinase plasminogen activator receptor level of 2.83 ng/dL. No participant developed cardiomyopathy based on serial echocardiography by one-year follow-up. The median percent change in left ventricular strain was -4.3% at 6-month follow-up and absolute changes in cardiac biomarkers were clinically insignificant. There were no significant associations between soluble urokinase plasminogen activator receptor and these markers of cardiotoxicity (all p > 0.05)., Conclusions: In this breast cancer cohort, doxorubicin treatment was associated with a very low risk for cardiotoxicity. Across this narrow range of clinical endpoints, soluble urokinase plasminogen activator receptor was not associated with markers of subclinical cardiotoxicity. Further studies are needed to clarify the prognostic utility of soluble urokinase plasminogen activator receptor in doxorubicin-associated cardiomyopathy and should include a larger cohort of leukemia and lymphoma patients who receive higher doses of doxorubicin., (© 2024. The Author(s).)- Published
- 2024
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15. 3D-Arterial analysis software and CEUS in the assessment of severity and vulnerability of carotid atherosclerotic plaque: a comparison with CTA and histopathology.
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Fresilli D, Di Leo N, Martinelli O, Di Marzo L, Pacini P, Dolcetti V, Del Gaudio G, Canni F, Ricci LI, De Vito C, Caiazzo C, Carletti R, Di Gioia C, Carbone I, Feinstein SB, Catalano C, and Cantisani V
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- Humans, Computed Tomography Angiography, Paraffin, Contrast Media, Ultrasonography, Doppler, Color methods, Carotid Arteries diagnostic imaging, Ultrasonography methods, Angiography, Software, Formaldehyde, Plaque, Atherosclerotic diagnostic imaging, Carotid Stenosis diagnostic imaging, Carotid Stenosis surgery
- Abstract
Purpose: Our purpose is to assess Multiparametric Ultrasound (MPUS) efficacy for evaluation of carotid plaque vulnerability and carotid stenosis degree in comparison with Computed Tomography angiography (CTA) and histology., Material and Methods: 3D-Arterial Analysis is a 3D ultrasound software that automatically provides the degree of carotid stenosis and a colorimetric map of carotid plaque vulnerability. We enrolled 106 patients who were candidates for carotid endarterectomy. Prior to undergoing surgery, all carotid artery plaques were evaluated with Color-Doppler-US (CDUS), Contrast-Enhanced Ultrasound (CEUS), and 3D Arterial analysis (3DAA) US along with Computerized Tomographic Angiography (CTA) to assess the carotid artery stenosis degree. Post-surgery, the carotid specimens were fixed with 10% neutral buffered formalin solution, embedded in paraffin and used for light microscopic examination to assess plaque vulnerability morphological features., Results: The results of the CTA examinations revealed 91 patients with severe carotid stenoses with a resultant diagnostic accuracy of 82.3% for CDUS, 94.5% for CEUS, 98.4% for 3DAA, respectively. The histopathological examination showed 71 vulnerable plaques with diagnostic accuracy values of 85.8% for CDUS, 93.4% for CEUS, 90.3% for 3DAA, 92% for CTA, respectively., Conclusions: The combination of CEUS and 3D Arterial Analysis may provide a powerful new clinical tool to identify and stratify "at-risk" patients with atherosclerotic carotid artery disease, identifying vulnerable plaques. These applications may also help in the postoperative assessment of treatment options to manage cardiovascular risks., (© 2022. The Author(s).)
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- 2022
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16. CEUS cardiac exam protocols International Contrast Ultrasound Society (ICUS) recommendations.
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Porter TR, Feinstein SB, Senior R, Mulvagh SL, Nihoyannopoulos P, Strom JB, Mathias W Jr, Gorman B, Rabischoffsky A, Main ML, and Appis A
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The present CEUS Cardiac Exam Protocols represent the first effort to promulgate a standard set of protocols for optimal administration of ultrasound enhancing agents (UEAs) in echocardiography, based on more than two decades of experience in the use of UEAs for cardiac imaging. The protocols reflect current clinical CEUS practice in many modern echocardiography laboratories throughout the world. Specific attention is given to preparation and dosing of three UEAs that have been approved by the United States Food and Drug Administration (FDA) and additional regulatory bodies in Europe, the Americas and Asia-Pacific. Consistent with professional society guidelines (J Am Soc Echocardiogr 31:241-274, 2018; J Am Soc Echocardiogr 27:797-810, 2014; Eur Heart J Cardiovasc Imaging 18:1205, 2017), these protocols cover unapproved "off-label" uses of UEAs-including stress echocardiography and myocardial perfusion imaging-in addition to approved uses. Accordingly, these protocols may differ from information provided in product labels, which are generally based on studies performed prior to product approval and may not always reflect state of the art clinical practice or guidelines., (© 2022. The Author(s).)
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- 2022
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17. Contrast-enhanced ultrasound in pediatric echocardiography.
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Kutty S, Biko DM, Goldberg AB, Quartermain MD, and Feinstein SB
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- Adolescent, Adult, Child, Contrast Media, Forecasting, Humans, Ultrasonography, Echocardiography, Heart Diseases diagnostic imaging
- Abstract
The safety and benefits of cardiac contrast-enhanced ultrasound (CEUS) have been demonstrated in children and adolescents for a variety of clinical indications, including congenital heart disease. Cardiac CEUS is performed with US and the intravenous administration of ultrasound contrast agents (UCAs). It improves transthoracic echocardiography, which can be challenging in children and adults with acoustic window limitations (e.g., from obesity) and alterations in chest wall and cardiac geometry (e.g., from prior surgical procedures). Cardiac CEUS is also used to evaluate ischemia in the follow-up of congenital and acquired heart disease. In 2019, the United States Food and Drug Administration (FDA) approved a UCA for pediatric echocardiography. This article focuses on the clinical applications of UCAs in pediatric and adult echocardiography, outlining its diagnostic value, safety and potential for future applications., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2021
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18. Pediatric contrast-enhanced ultrasound: shedding light on the pursuit of approval in the United States.
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Darge K, Back SJ, Bulas DI, Feinstein SB, Ntoulia A, Volberg FM, Wilson SR, and McCarville MB
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- Child, Humans, Ultrasonography, United States, United States Food and Drug Administration, Urination, Contrast Media, Vesico-Ureteral Reflux
- Abstract
For two decades, pediatric contrast US has been well accepted throughout Europe and other parts of the world outside the United States because of its high diagnostic efficacy and extremely favorable safety profile. This includes intravenous (IV) administration, contrast-enhanced US (CEUS) and the intravesical application, contrast-enhanced voiding urosonography (ceVUS). However, the breakthrough for pediatric contrast US in the United States did not come until 2016, when the U.S. Food and Drug Administration (FDA) approved the first pediatric indication for a US contrast agent. This initial approval covered the use of Lumason (Bracco Diagnostics, Monroe Township, NJ) for the evaluation of focal liver lesions via IV administration in children. A second pediatric indication followed shortly thereafter, when the FDA extended the use of Lumason for assessing known or suspected vesicoureteral reflux via intravesical application in children. Both initial pediatric approvals were granted without prospective pediatric clinical trials, based instead on published literature describing favorable safety and efficacy in children. Three years later, in 2019, the FDA approved Lumason for pediatric echocardiography following a clinical trial involving a total of 12 subjects at 2 sites. The story of how we achieved these FDA approvals spans more than a decade and involves the extraordinary dedication of two professional societies, namely the International Contrast Ultrasound Society (ICUS) and the Society for Pediatric Radiology (SPR). Credit also must be given to the FDA staff for their commitment to the welfare of children and their openness to compelling evidence that contrast US is a safe, reliable, radiation-free imaging option for our pediatric patients. Understanding the history of this approval process will impact the practical application of US contrast agents, particularly when expanding off-label indications in the pediatric population. This article describes the background of the FDA's approval of pediatric contrast US applications to better illuminate the potential pathways to approvals of future indications., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2021
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19. Introduction: 4th Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM and FLAUS.
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Wilson SR and Feinstein SB
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- Humans, Practice Guidelines as Topic, Ultrasonography standards, Contrast Media, Liver Neoplasms diagnostic imaging
- Published
- 2020
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20. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography.
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Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM, Becher H, and Sillesen H
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- Echocardiography, Heart Disease Risk Factors, Humans, Risk Factors, United States epidemiology, Atherosclerosis diagnostic imaging, Cardiovascular Diseases, Plaque, Atherosclerotic diagnostic imaging
- Abstract
Atherosclerotic plaque detection by carotid ultrasound provides cardiovascular disease risk stratification. The advantages and disadvantages of two-dimensional (2D) and three-dimensional (3D) ultrasound methods for carotid arterial plaque quantification are reviewed. Advanced and emerging methods of carotid arterial plaque activity and composition analysis by ultrasound are considered. Recommendations for the standardization of focused 2D and 3D carotid arterial plaque ultrasound image acquisition and measurement for the purpose of cardiovascular disease stratification are formulated. Potential clinical application towards cardiovascular risk stratification of recommended focused carotid arterial plaque quantification approaches are summarized., (Copyright © 2020 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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21. New Applications in Echocardiography for Ultrasound Contrast Agents in the 21st Century.
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Porter TR, Feinstein SB, Ten Cate FJ, and van den Bosch AE
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- Animals, Echocardiography adverse effects, Humans, Mechanical Thrombolysis methods, Microbubbles, Myocardial Ischemia diagnostic imaging, Myocardial Perfusion Imaging adverse effects, Vasodilation, Contrast Media adverse effects, Echocardiography methods, Myocardial Perfusion Imaging methods
- Abstract
Contrast echocardiography microbubbles are ultrasound-enhancing agents that were originally designed to help improve endocardial border definition, known as left ventricle opacification, and to enhance Doppler signals. Over time, contrast microbubbles are used to assess myocardial perfusion because they travel through the capillaries of the cardiac circulation. Current research provides good evidence that myocardial perfusion echocardiography improves comprehensive echocardiographic evaluations of ischemic heart disease. The approval of regulatory authorities and the availability of quantitative operator-independent analysis software will hopefully prompt physicians and sonographers to implement myocardial perfusion echocardiography into the daily workflow of echo laboratories. New diagnostic and therapeutic applications will result in improved patient care, especially in the area of sonothrombolysis, where preliminary data have already shown utilization in ST elevation myocardial infarction, improving left ventricular systolic function and reducing the need for implantable defibrillators at 6-mo follow-up. This review gives an overview of the applications of myocardial perfusion imaging with ultrasound. Each cited study had institutional review board/institutional animal care and use approval., (Copyright © 2020 World Federation for Ultrasound in Medicine & Biology. All rights reserved.)
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- 2020
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22. Contrast-Enhanced Ultrasound to Assess Carotid Intraplaque Neovascularization.
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Schinkel AFL, Bosch JG, Staub D, Adam D, and Feinstein SB
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- Aged, Female, Humans, Male, Ultrasonography methods, Carotid Arteries diagnostic imaging, Carotid Arteries pathology, Carotid Artery Diseases diagnostic imaging, Contrast Media, Neovascularization, Pathologic diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging
- Abstract
Contrast-enhanced ultrasound (CEUS) is increasingly being used to identify patients with carotid plaques that are vulnerable to rupture, so-called vulnerable atherosclerotic plaques, by assessment of intraplaque neovascularization. A complete overview of the strengths and limitations of carotid CEUS is currently not available. The aim of this systematic review was to provide a complete overview of existing publications on the role of CEUS in assessment of carotid intraplaque neovascularization. The systematic review of the literature yielded 52 studies including a total of 4660 patients (mean age: 66 y, 71% male) who underwent CEUS for the assessment of intraplaque neovascularization. The majority of the patients (76%) were asymptomatic and had no history of transient ischemic attack (TIA) or stroke. The assessment of intraplaque neovascularization was mostly performed using a visual scoring system; several studies used time-intensity curves or dedicated quantification software to optimize analysis. In 17 studies CEUS was performed in patients before carotid surgery (endarterectomy), allowing a comparison of pre-operative CEUS findings with histologic analysis of the tissue sample that is removed from the carotid artery. In a total of 576 patients, the CEUS findings were compared with histopathological analysis of the plaque after surgery. In 16 of the 17 studies, contrast enhancement was found to correlate with the presence and degree of intraplaque neovascularization on histology. Plaques with a larger amount of contrast enhancement had significantly increased density of microvessels in the corresponding region on histology. In conclusion, CEUS is a readily available imaging modality for the assessment of patients with carotid atherosclerosis, providing information on atherosclerotic plaques, such as ulceration and intraplaque neovascularization, which may be clinically relevant. The ultimate clinical goal is the early identification of carotid atherosclerosis to start early preventive therapy and prevent clinical complications such as TIA and stroke., (Copyright © 2019 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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23. Carotid intraplaque neovascularization predicts coronary artery disease and cardiovascular events.
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Mantella LE, Colledanchise KN, Hétu MF, Feinstein SB, Abunassar J, and Johri AM
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- Aged, Carotid Artery Diseases diagnostic imaging, Contrast Media, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Female, Fluorocarbons, Humans, Male, Middle Aged, Neovascularization, Pathologic diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging, Prospective Studies, Risk Assessment, Ultrasonography, Carotid Artery Diseases pathology, Coronary Artery Disease pathology, Neovascularization, Pathologic pathology, Plaque, Atherosclerotic pathology
- Abstract
Aims: It is thought that the majority of cardiovascular (CV) events are caused by vulnerable plaque. Such lesions are rupture prone, in part due to neovascularization. It is postulated that plaque vulnerability may be a systemic process and that vulnerable lesions may co-exist at multiple sites in the vascular bed. This study sought to examine whether carotid plaque vulnerability, characterized by contrast-enhanced ultrasound (CEUS)-assessed intraplaque neovascularization (IPN), was associated with significant coronary artery disease (CAD) and future CV events., Methods and Results: We investigated carotid IPN using carotid CEUS in 459 consecutive stable patients referred for coronary angiography. IPN was graded based on the presence and location of microbubbles within each plaque (0, not visible; 1, peri-adventitial; and 2, plaque core). The grades of each plaque were averaged to obtain an overall score per patient. Coronary plaque severity and complexity was also determined angiographically. Patients were followed for 30 days following their angiogram. This study found that a higher CEUS-assessed carotid IPN score was associated with significant CAD (≥50% stenosis) (1.8 ± 0.4 vs. 0.5 ± 0.6, P < 0.0001) and greater complexity of coronary lesions (1.7 ± 0.5 vs. 1.3 ± 0.8, P < 0.0001). Furthermore, an IPN score ≥1.25 could predict significant CAD with a high sensitivity (92%) and specificity (89%). The Kaplan-Meier analysis demonstrated a significantly higher proportion of participants having CV events with an IPN score ≥1.25 (P = 0.004)., Conclusion: Carotid plaque neovascularization was found to be predictive of significant and complex CAD and future CV events. CEUS-assessed carotid IPN is a clinically useful tool for CV risk stratification in high-risk cardiac patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
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24. Reciprocal Multifaceted Interaction Between HDL (High-Density Lipoprotein) and Myocardial Infarction.
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Sposito AC, de Lima-Junior JC, Moura FA, Barreto J, Bonilha I, Santana M, Virginio VW, Sun L, Carvalho LSF, Soares AAS, Nadruz W, Feinstein SB, Nofer JR, Zanotti I, Kontush A, and Remaley AT
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- Animals, Cholesterol metabolism, Endothelial Cells physiology, Glucose metabolism, Homeostasis, Humans, Lipoproteins, HDL blood, Lysophospholipids physiology, Oxidative Stress, Signal Transduction physiology, Sphingosine analogs & derivatives, Sphingosine physiology, Lipoproteins, HDL physiology, Myocardial Infarction prevention & control
- Abstract
Despite decades of therapeutic advances, myocardial infarction remains a leading cause of death worldwide. Recent studies have identified HDLs (high-density lipoproteins) as a potential candidate for mitigating coronary ischemia/reperfusion injury via a broad spectrum of signaling pathways. HDL ligands, such as S1P (sphingosine-1-phosphate), Apo (apolipoprotein) A-I, clusterin, and miRNA, may influence the opening of the mitochondrial channel, insulin sensitivity, and production of vascular autacoids, such as NO, prostacyclin, and endothelin-1. In parallel, antioxidant activity and sequestration of oxidized molecules provided by HDL can attenuate the oxidative stress that triggers ischemia/reperfusion. Nevertheless, during myocardial infarction, oxidation and the capture of oxidized and proinflammatory molecules generate large phenotypic and functional changes in HDL, potentially limiting its beneficial properties. In this review, new findings from cellular and animal models, as well as from clinical studies, will be discussed to describe the cardioprotective benefits of HDL on myocardial infarction. Furthermore, mechanisms by which HDL modulates cardiac function and potential strategies to mitigate postmyocardial infarction risk damage by HDL will be detailed throughout the review.
- Published
- 2019
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25. HDL-Targeted Therapies During Myocardial Infarction.
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Sposito AC, Carmo HR, Barreto J, Sun L, Carvalho LSF, Feinstein SB, Zanotti I, Kontush A, and Remaley A
- Subjects
- Animals, Apolipoprotein A-I blood, Dyslipidemias blood, Dyslipidemias genetics, Humans, Hypolipidemic Agents adverse effects, Lipoproteins, HDL adverse effects, Lipoproteins, HDL genetics, Molecular Mimicry, Myocardial Infarction blood, Myocardial Infarction genetics, Myocardial Reperfusion Injury blood, Myocardial Reperfusion Injury genetics, Peptides adverse effects, Treatment Outcome, Dyslipidemias therapy, Genetic Therapy adverse effects, Hypolipidemic Agents therapeutic use, Lipoproteins, HDL therapeutic use, Myocardial Infarction prevention & control, Myocardial Reperfusion Injury prevention & control, Peptides therapeutic use
- Abstract
It is now apparent that a variety of deleterious mechanisms intrinsic to myocardial infarction (MI) exists and underlies its high residual lethality. Indeed, despite effective coronary patency therapies, ischemia and reperfusion (I/R) injury accounts for about 50% of the infarcted mass. In this context, recent studies in animal models have demonstrated that coronary reperfusion with high-density lipoproteins (HDL) may reduce MI size in up to 30%. A spectrum of mechanisms mediated by either HDL-related apolipoproteins or phospholipids attenuates myocardial cell death. Hence, promising therapeutic approaches such as infusion of reconstituted HDL particles, new HDL by genomic therapy, or the infusion of apoA-I mimetic peptides have been sought as a way of ensuring protection against I/R injury. In this review, we will explore the limitations and potential therapeutic effects of HDL therapies during the acute phase of MI.
- Published
- 2019
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26. Use of ultrasound enhancing agents in transesophageal echocardiography to improve interpretive confidence of left atrial appendage thrombus.
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Doukky R, Donenberg MJ, Parker J, Kaplan J, Travers C, Soble JS, Sattar P, Krishnan K, Madias C, Tracy M, and Feinstein SB
- Subjects
- Aged, Atrial Appendage pathology, Female, Heart Diseases pathology, Humans, Male, Reproducibility of Results, Retrospective Studies, Risk Factors, Thrombosis pathology, Atrial Appendage diagnostic imaging, Contrast Media, Echocardiography, Transesophageal methods, Heart Diseases diagnostic imaging, Image Enhancement methods, Thrombosis diagnostic imaging
- Abstract
Background: The value of ultrasound enhancing agents (UEA) in patients undergoing transesophageal echocardiography (TEE) for the exclusion of left atrial appendage (LAA) thrombi prior to direct current cardioversion (DCCV) is evolving., Methods: We retrospectively identified 88 consecutive TEEs, where a commercial UEA was used during LAA interrogation. De-identified non-enhanced (pre-UEA) and enhanced cine loop images (post-UEA) from the same subjects were randomly reviewed by four expert readers in a blinded fashion., Results: In 33% of the cases, UEA use was associated with a statistically insignificant improvement in physician confidence (scale, 0-3) in determining the presence or absence of a LAA thrombus (P = 0.071). In instances where non-enhanced images yielded an uncertain interpretation or when the left atrium contained spontaneous echo contrast (SEC), UEA use was associated with an improvement in interpretive confidence in 49% (P < 0.001) and 41% of the cases (P = 0.001), respectively. Overall, the absolute rate of hypothetical decision to proceed with DCCV rose by 9% with the application of UEA (P = 0.004). In instances where non-enhanced images were interpreted with limited confidence or when SEC was present, there were absolute increases of 16% (P < 0.001) and 21% (P < 0.001) in hypothetical procession to DCCV, respectively. In cases of a combination of limited interpretive confidence and SEC, UEA use was associated with a 29% absolute increase in the rate of procession to DCCV (P < 0.001)., Conclusions: In patients undergoing TEE interrogation of the LAA, the use of UEA is associated with an increase in the level of interpretive confidence and higher rates of theoretical procession to DCCV., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
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27. In-hospital statin underutilization among high-risk patients: delayed uptake of the 2013 cholesterol guidelines in a U.S. cohort.
- Author
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Wadia SK, Belkin M, Chow KS, Nattiv J, Appis A, Feinstein SB, and Williams KA Sr
- Subjects
- Cohort Studies, Coronary Disease epidemiology, Dose-Response Relationship, Drug, Humans, Prognosis, Retrospective Studies, United States epidemiology, Coronary Disease drug therapy, Drug Prescriptions statistics & numerical data, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Patient Discharge statistics & numerical data, Practice Guidelines as Topic
- Abstract
Objectives: Clinician utilization of the 2013 cholesterol lowering guidelines remains variable and unknown. We sought to examine statin prescribing patterns and compare rates among specialists who treat high-risk cardiovascular patients admitted to the hospital., Methods: We retrospectively (via chart review) examined four specialty groups: (i) Cardiology, (ii) Cardiovascular or Vascular (CV) Surgery, (iii) Neurology, and (iv) Internal Medicine. Adult patients were included based on a discharge diagnosis of acute coronary syndrome, coronary artery bypass graft surgery, carotid endarterectomy, acute ischemic stroke, transient ischemic attack, or high-risk chest pain. Prescribing patterns were evaluated 6 months and 18 months after the release of the 2013 guidelines. High-intensity statin was defined as atorvastatin 40-80 mg or rosuvastatin 20-40 mg per day., Results: 632 patients were included in our study. The following percentages of patients were discharged on high-intensity statin (6 months; 18 months): (i) Cardiology (80%; 85%), (ii) CV Surgery (52%, 65%), (iii) Neurology (59%; 66%), and (iv) Internal Medicine (45%; 48%). Among the four groups, Cardiology was the most likely to discharge patients on high-intensity statin (p < 0.001) in 2014 and in 2015. Cardiology, CV Surgery, and Neurology significantly increased the percentage of patients on high-intensity statin from pre-admission to time of discharge in both years., Conclusion: High-intensity statin therapy is underutilized among high-risk cardiovascular patients admitted to the hospital. Variations exist in prescribing patterns of different specialties who manage high-risk populations. This data can be used to test quality improvement interventions to improve rates of high-intensity statin utilization among high-risk patients prior to hospital discharge.
- Published
- 2017
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28. The Evolution of Contrast Ultrasound: From Diagnosis to Therapy.
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Feinstein SB
- Subjects
- Contrast Media, Ultrasonography
- Published
- 2016
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29. The Use of Contrast-enhanced Ultrasonography for Imaging of Carotid Atherosclerotic Plaques: Current Evidence, Future Directions.
- Author
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Saha SA, Gourineni V, and Feinstein SB
- Subjects
- Algorithms, Evidence-Based Medicine, Humans, Reproducibility of Results, Sensitivity and Specificity, Carotid Stenosis diagnostic imaging, Contrast Media, Forecasting, Image Enhancement methods, Image Interpretation, Computer-Assisted methods, Ultrasonography trends
- Abstract
Contrast-enhanced ultrasonography (CEUS) is a rapidly evolving modality for imaging carotid artery disease and systemic atherosclerosis. CEUS coupled with diagnostic ultrasonography predicts the degree of carotid artery stenosis and is comparable with computed tomography and magnetic resonance angiography. This article reviews the literature on the evolving role of CEUS for the identification and characterization of carotid plaques with an emphasis on detection of intra-plaque neovascularization and related high-risk morphologic features notably present in symptomatic patients. CEUS carotid imaging may play a prominent additive role in risk stratifying patients and serve as a powerful tool for monitoring therapeutic interventions., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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30. Transient Ischemic Attack Caused by Contrast Echocardiography in a Patient with Platypnea-Orthodeoxia.
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Main ML, Feinstein SB, Feinstein LM, Grayburn PA, and Wilson SR
- Subjects
- Humans, Male, Dyspnea diagnostic imaging, Echocardiography adverse effects, Hypoxia diagnostic imaging, Ischemic Attack, Transient etiology
- Published
- 2016
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31. Drug and Gene Delivery using Sonoporation for Cardiovascular Disease.
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Castle J and Feinstein SB
- Subjects
- Animals, Contrast Media, Humans, Microspheres, Cardiovascular Diseases therapy, Drug Delivery Systems, Gene Transfer Techniques, Microbubbles, Ultrasonics
- Abstract
Using the improvements made in diagnostic contrast enhanced ultrasound, researchers have made significant progress in the field of ultrasound-mediated sonoporation for drug delivery. Many programs take advantage of commercial products; both ultrasound imaging systems and contrast agents to better enable translation from preclinical to first-in-man studies (Kotopoulis et al., Med Phys 40:072902, 2013). Particularly well-suited targets for this novel therapy are diseases of the cardiovascular system. This chapter will highlight several recent studies addressing treatment of both acute and chronic conditions.
- Published
- 2016
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32. Flow-mediated dilation: An evolving method.
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Quinaglia T, Matos-Souza JR, Feinstein SB, and Sposito AC
- Subjects
- Humans, Male, Aging, Brachial Artery physiopathology, Femoral Artery physiopathology, Vasodilation
- Published
- 2015
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33. Therapeutic ultrasound: Increased HDL-Cholesterol following infusions of acoustic microspheres and apolipoprotein A-I plasmids.
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Castle JW, Kent KP, Fan Y, Wallace KD, Davis CE, Roberts JC, Marino ME, Thomenius KE, Lim HW, Coles E, Davidson MH, Feinstein SB, and DeMaria A
- Subjects
- Animals, Apolipoprotein A-I biosynthesis, Biomarkers blood, Feasibility Studies, Humans, Injections, Intravenous, Male, Models, Animal, RNA, Messenger biosynthesis, Rats, Sprague-Dawley, Time Factors, Transcription, Genetic, Up-Regulation, Apolipoprotein A-I genetics, Cholesterol, HDL blood, Gene Transfer Techniques, Genetic Therapy methods, Liver metabolism, Microspheres, Plasmids administration & dosage, Ultrasonics methods
- Abstract
Background: Low levels of HDL-C are an independent cardiovascular risk factor associated with increased premature cardiovascular death. However, HDL-C therapies historically have been limited by issues relating to immunogenicity, hepatotoxicity and scalability, and have been ineffective in clinical trials., Objective: We examined the feasibility of using injectable acoustic microspheres to locally deliver human ApoA-I DNA plasmids in a pre-clinical model and quantify increased production of HDL-C in vivo., Methods: Our novel site-specific gene delivery system was examined in naïve rat model and comprised the following steps: (1) intravenous co-administration of a solution containing acoustically active microspheres (Optison™, GE Healthcare, Princeton, New Jersey) and human ApoA-I plasmids; (2) ultrasound verification of the presence of the microspheres within the liver vasculature; (3) External application of locally-directed acoustic energy, (4) induction of microsphere disruption and in situ sonoporation; (4) ApoA-I plasmid hepatic uptake; (5) transcription and expression of human ApoA-I protein; and (6) elevation of serum HDL-C., Results: Co-administration of ApoA-I plasmids and acoustic microspheres, activated by external ultrasound energy, resulted in transcription and production of human ApoA-I protein and elevated serum HDL-C in rats (up to 61%; p-value < 0.05)., Conclusions: HDL-C was increased in rats following ultrasound directed delivery of human ApoA-I plasmids by microsphere sonoporation. The present method provides a novel approach to promote ApoA-I synthesis and nascent HDL-C elevation, potentially permitting the use of a minimally-invasive ultrasound-based, gene delivery system for treating individuals with low HDL-C., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
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34. Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications.
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Appis AW, Tracy MJ, and Feinstein SB
- Abstract
Ultrasound contrast agents (UCAs) are currently used throughout the world in both clinical and research settings. The concept of contrast-enhanced ultrasound imaging originated in the late 1960s, and the first commercially available agents were initially developed in the 1980s. Today's microbubbles are designed for greater utility and are used for both approved and off-label indications. In October 2007, the US Food and Drug Administration (FDA) imposed additional product label warnings that included serious cardiopulmonary reactions, several new disease-state contraindications, and a mandated 30 min post-procedure monitoring period for the agents Optison and Definity. These additional warnings were prompted by reports of cardiopulmonary reactions that were temporally related but were not clearly attributable to these UCAs. Subsequent published reports over the following months established not only the safety but also the improved efficacy of clinical ultrasound applications with UCAs. The FDA consequently updated the product labeling in June 2008 and reduced contraindications, although it continued to monitor select patients. In addition, a post-marketing program was proposed to the sponsors for a series of safety studies to further assess the risk of UCAs. Then in October 2011, the FDA leadership further downgraded the warnings after hearing the results of the post-marketing data, which revealed continued safety and improved efficacy. The present review focuses on the use of UCAs in today's clinical practice, including the approved indications, a variety of off-label uses, and the most recent data, which affirms the safety and efficacy of UCAs.
- Published
- 2015
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35. Carotid adventitial vasa vasorum and intima-media thickness in a primary prevention population.
- Author
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Sampson UK, Harrell FE Jr, Fazio S, Nwosu S, Mercaldo N, Mensah GA, Davidson MH, Coll B, and Feinstein SB
- Subjects
- Atherosclerosis prevention & control, Carotid Artery Diseases prevention & control, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, Carotid Arteries diagnostic imaging, Carotid Intima-Media Thickness, Primary Prevention methods, Vasa Vasorum diagnostic imaging
- Abstract
Background: Vasa vasorum (VV) vessels are critical in the genesis of atherosclerosis. Therefore, we assessed measures of carotid VV, intima-media thickness (CIMT), and patient risk factors in a primary prevention population., Methods: We used multivariable linear models to evaluate the relationship between baseline covariates and a measure of carotid VV (VV ratio) and CIMT among 324 diabetics and 141 nondiabetics., Results: Median CIMT (in mm) and VV ratio among nondiabetics were 0.82 ± 0.22 and 0.80 ± 0.19, respectively, and 1.06 ± 0.19 and 1.21 ± 0.26 among diabetics (P < 0.0001). Diabetes was associated with 36% (95% CI: 24.3-48.0, P < 0.001) higher VV ratio whereas a unit change in BMI was associated with ≈1% (95% CI: 0.5-1.4, P < 0.001) change in VV ratio. A 10-year increase in age was associated with 4% (95% CI: 1-7, P = 0.005) higher CIMT. Each 10 mmHg increase in mean systolic blood pressure was associated with 2% (95% CI: 1-4, P = 0.003) higher CIMT whereas diabetes conferred 31% (95% CI: 19.1-42.1, P < 0.001) higher CIMT. Female sex was associated with a 9% (95% CI: -12.9 to -4.1, P < 0.001) lower CIMT. Low density lipoprotein (LDL) cholesterol, blood pressure, and CIMT were not significantly associated with VV ratio., Conclusion: In this cohort of patients with low CIMT, VV ratio, and CIMT were distinctly unrelated, but each independently associated with diabetes. VV ratio and CIMT relationships warrant further investigation in large-scale studies and across a spectrum of atherosclerostic states., (© 2014, Wiley Periodicals, Inc.)
- Published
- 2015
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36. Ultrasound-directed, site-specific gene delivery.
- Author
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Castle J and Feinstein SB
- Subjects
- Animals, Apolipoprotein A-I metabolism, Contrast Media, Disease Models, Animal, Humans, Hypoalphalipoproteinemias genetics, Hypoalphalipoproteinemias metabolism, Hypoalphalipoproteinemias pathology, Injections, Intravenous, Lipoproteins, HDL blood, Male, Microspheres, Rats, Rats, Sprague-Dawley, Ultrasonics, Apolipoprotein A-I genetics, Gene Transfer Techniques, Genetic Therapy methods, Hypoalphalipoproteinemias therapy, Microbubbles, Plasmids metabolism
- Abstract
With the implementation of gene therapy looming in the near term, an effective delivery system using noninvasive, nonviral-mediated methods appears as an attractive option. This novel platform technology uses gas-filled, ultrasound-directed acoustic microspheres for both diagnostic imaging and therapy and yet may provide a key component for future success in the pursuit of single-gene replacement therapy.
- Published
- 2014
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37. Presence of A Left Atrial Appendage Thrombus After Successful Surgical Closure of the Left Atrial Appendage: A Case Report.
- Author
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Bhutto J, Feinstein SB, and Krishnan K
- Abstract
A 64-year-old African American woman presented for defibrillator threshold testing (DFTs) after a recent hospitalization for ventricular fibrillation terminated by her ICD. She had a known history of non-ischemic cardiomyopathy, atrial fibrillation, rheumatic mitral valve disease s/p mitral valve replacement and a redo after subsequent endocarditis. In preparation for the DFTs, the patient underwent a transesophageal echocardiogram (TEE) to rule our left atrial (LA) or LA appendage thrombus. Patient was found to have a surgically closed appendage. Within the body of the closed appendage, a mobile thrombus was seen with clot free areas surrounding the thrombus. Doppler and contrast studies confirmed that there was no communication between the LA and the appendage. The patient underwent DFTs without complication and a follow-up TEE confirmed the presence of the clot in the non-communicating LA appendage.
- Published
- 2013
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38. The role of carotid ultrasound in assessing carotid atherosclerosis in individuals at low-to-intermediate cardiovascular risk.
- Author
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Coll B, Betriu A, Feinstein SB, Valdivielso JM, Zamorano JL, and Fernández E
- Subjects
- Adult, Age Distribution, Aged, Analysis of Variance, Cardiovascular Diseases diagnostic imaging, Cardiovascular Diseases prevention & control, Carotid Artery Diseases physiopathology, Carotid Intima-Media Thickness, Comorbidity, Cross-Sectional Studies, Female, Humans, Logistic Models, Male, Mass Screening methods, Middle Aged, Predictive Value of Tests, Prevalence, Prognosis, Risk Assessment, Role, Severity of Illness Index, Sex Distribution, Survival Analysis, Cardiovascular Diseases epidemiology, Carotid Artery Diseases diagnostic imaging, Carotid Artery Diseases epidemiology, Ultrasonography, Doppler methods
- Abstract
Introduction and Objectives: Detection of carotid atherosclerosis might help to better identify individuals susceptible to cardiovascular events. We aimed to quantify the number of participants with carotid atherosclerosis and low-to-intermediate cardiovascular risk according to the traditional risk factor scoring, and therefore with an elevated risk of cardiovascular events., Methods: Cross-sectional, observational study performed during a cardiovascular screening program. From a total of 3778 volunteers, low-to-intermediate cardiovascular risk individuals (N=2354) were identified and studied. Physical examination, blood test, and carotid ultrasound followed standard procedures. Common, bulb, and internal carotid arteries were examined and common carotid intima-media thickness was measured. SCORE risk value was calculated for all participants. Univariate and multivariate statistical analysis was performed., Results: Mean age of participants was 58.9 (15) years, 43.8% were men, 23.7% had hypertension, and 20.5% had hypercholesterolemia. The mean SCORE value was 1.47 (1.4). Both carotid intima-media thickness and the prevalence of carotid plaques increased steadily and significantly (P<.005) as advanced decades of life were analyzed. Variables significantly related with the presence of carotid atherosclerosis were age, male sex, and systolic blood pressure. Interestingly, 592 (25.1%) individuals were reclassified to a higher risk due to the presence of carotid atherosclerosis., Conclusions: There was a clear dissociation between cardiovascular risk scoring and the presence of atherosclerosis, because 1 of 4 study participants at low-to-intermediate cardiovascular risk had carotid atherosclerosis., (Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)
- Published
- 2013
- Full Text
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39. Safety of ultrasound contrast agents in patients with known or suspected cardiac shunts.
- Author
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Parker JM, Weller MW, Feinstein LM, Adams RJ, Main ML, Grayburn PA, Cosgrove DO, Goldberg BA, Darge K, Nihoyannopoulos P, Wilson S, Monaghan M, Piscaglia F, Fowlkes B, Mathias W, Moriyasu F, Chammas MC, Greenbaum L, and Feinstein SB
- Subjects
- Albumins adverse effects, Contraindications, Fluorocarbons adverse effects, Humans, Contrast Media adverse effects, Echocardiography methods, Heart Diseases diagnostic imaging
- Abstract
Contrast-enhanced ultrasound imaging is a radiation-free diagnostic tool that uses biocompatible ultrasound contrast agents (UCAs) to improve image clarity. UCAs, which do not contain dye, often salvage "technically difficult" ultrasound scans, increasing the accuracy and reliability of a front-line ultrasound diagnosis, reducing unnecessary downstream testing, lowering overall health care costs, changing therapy, and improving patient care. Two UCAs currently are approved and regulated by the US Food and Drug Administration. They have favorable safety profiles and risk/benefit ratios in adult and pediatric populations, including compromised patients with severe cardiovascular diseases. Nevertheless, these UCAs are contraindicated in patients with known or suspected right-to-left, bidirectional, or transient right-to-left cardiac shunts. These patients, who constitute 10% to 35% of the general population, typically receive no UCAs when they undergo echocardiography. If their echocardiographic images are suboptimal, they may receive inappropriate diagnosis and treatment, or they may be referred for additional diagnostic testing, including radiation-based procedures that increase their lifetime risk for cancer or procedures that use contrast agents containing dye, which may increase the risk for kidney damage. An exhaustive review of current peer-reviewed research demonstrated no scientific basis for the UCA contraindication in patients with known or suspected cardiac shunts. Initial safety concerns were based on limited rodent data and speculation related to macroaggregated albumin microspheres, a radioactive nuclear imaging agent with different physical and chemical properties and no relation to UCAs. Radioactive macroaggregated albumin is not contraindicated in adult or pediatric patients with cardiac shunts and is routinely used in these populations. In conclusion, the International Contrast Ultrasound Society Board recommends removal of the contraindication to further the public interest in safe, reliable, radiation-free diagnostic imaging options for patients with known or suspected cardiac shunts and to reduce their need for unnecessary downstream testing., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
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40. Safety of contrast-enhanced ultrasound in children for non-cardiac applications: a review by the Society for Pediatric Radiology (SPR) and the International Contrast Ultrasound Society (ICUS).
- Author
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Darge K, Papadopoulou F, Ntoulia A, Bulas DI, Coley BD, Fordham LA, Paltiel HJ, McCarville B, Volberg FM, Cosgrove DO, Goldberg BB, Wilson SR, and Feinstein SB
- Subjects
- Administration, Intravesical, Adolescent, Adult, Child, Drug-Related Side Effects and Adverse Reactions prevention & control, Extravasation of Diagnostic and Therapeutic Materials prevention & control, Female, Humans, Male, Middle Aged, Risk Assessment, Young Adult, Contrast Media adverse effects, Drug-Related Side Effects and Adverse Reactions etiology, Endosonography adverse effects, Extravasation of Diagnostic and Therapeutic Materials etiology, Injections, Intravenous adverse effects, Ultrasonography, Interventional adverse effects
- Abstract
The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.
- Published
- 2013
- Full Text
- View/download PDF
41. Ultrasound-mediated targeted drug delivery: recent success and remaining challenges.
- Author
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Castle J, Butts M, Healey A, Kent K, Marino M, and Feinstein SB
- Subjects
- Animals, Antineoplastic Agents administration & dosage, Antineoplastic Agents therapeutic use, Blood-Brain Barrier drug effects, Chemistry, Pharmaceutical, Contrast Media, Genetic Therapy methods, Humans, Microbubbles, Renal Agents administration & dosage, Renal Agents therapeutic use, Thrombolytic Therapy, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left drug therapy, Drug Delivery Systems methods, Ultrasonography, Interventional
- Abstract
The potential clinical value of developing a novel, nonviral, ultrasound-directed gene and drug delivery system is immense. Investigators soon will initiate clinical trials with the goal of treating a wide variety of maladies using noninvasive, ultrasound-based technology. The ongoing, scientific validation associated with promising preclinical success portents a novel range of therapeutics. The clinical utility and eventual clinical successes await vigorous testing. This review highlights the recent successes and challenges within the field of ultrasound-mediated drug delivery.
- Published
- 2013
- Full Text
- View/download PDF
42. Contrast-enhanced ultrasound for assessing carotid atherosclerotic plaque lesions.
- Author
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Partovi S, Loebe M, Aschwanden M, Baldi T, Jäger KA, Feinstein SB, and Staub D
- Subjects
- Humans, Atherosclerosis diagnostic imaging, Carotid Stenosis diagnostic imaging, Contrast Media, Neovascularization, Pathologic diagnostic imaging, Ultrasonography, Doppler methods
- Abstract
Objective: Contrast-enhanced ultrasound that is used to assess atherosclerotic carotid plaques improves visualization of vessel wall irregularities and provides direct visualization of intraplaque neovascularization. This article illustrates the use of contrast-enhanced ultrasound in the assessment of carotid atherosclerotic lesions., Conclusion: Contrast-enhanced ultrasound is a new, noninvasive, and safe procedure for imaging carotid atherosclerotic lesions. It is a valuable tool for evaluating the vulnerable plaque at risk for rupture and for evaluating both the development and severity of systemic atherosclerotic disease.
- Published
- 2012
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43. Detection of adventitial vasa vasorum and intraplaque neovascularization in carotid atherosclerotic lesions with contrast-enhanced ultrasound and their role in atherosclerosis.
- Author
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Partovi S, Loebe M, Noon GP, Davies MG, Karimi S, Zipp L, Feinstein SB, and Staub D
- Subjects
- Aged, Carotid Arteries pathology, Carotid Artery Diseases pathology, Female, Humans, Male, Microvessels pathology, Neovascularization, Pathologic pathology, Plaque, Atherosclerotic pathology, Predictive Value of Tests, Prognosis, Vasa Vasorum pathology, Carotid Arteries diagnostic imaging, Carotid Artery Diseases diagnostic imaging, Carotid Intima-Media Thickness, Contrast Media, Microvessels diagnostic imaging, Neovascularization, Pathologic diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging, Vasa Vasorum diagnostic imaging
- Abstract
Introduction: The development of new surrogate markers of atherosclerosis is a crucial goal in the clinical setting, as they may allow physicians to recognize unstable lesions early and identify individuals with vulnerable or unstable lesions who bear an increased risk of future cardio--and cerebrovascular complications. These surrogate markers should be capable of being measured noninvasively using safe and reliable methods. Recently, Nambi et al. demonstrated how the combined measurement of carotid intima media thickness (CIMT) and occurrence of carotid plaques improves the risk prediction of cardiovascular outcomes. These results confirm the value of carotid ultrasound (US) when combined with traditional Framingham risk factors in assessing a patient's risk for atherosclerotic disease. Contrast-enhanced ultrasound (CEUS) is a new imaging approach that is evolving and may become a standard clinical tool for further atherosclerotic risk stratification in the future. The contrast agents used in US imaging are safe, commercially available, and approved for use in echocardiography by the FDA. Thus, CEUS is technically feasible with existing approved commercial equipment and can be performed at the bedside or in an outpatient setting. However, US contrast agents are not yet approved by the FDA for visualization and assessment of the carotid artery and its associated pathologies. The cost effectiveness of CEUS has been shown in the context of gastrointestinal imaging, and CEUS of carotid atherosclerotic lesions is emerging as an approach to complement unenhanced US imaging. By providing the direct visualization of adventitial vasa vasorum (VV) and intraplaque neovascularization, CEUS is capable of depicting two new surrogate markers of atherosclerosis - namely, adventitial VV and intraplaque neovascularization.
- Published
- 2011
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44. Predictors of anterior and posterior wall carotid intima media thickness progression in men and women at moderate risk of coronary heart disease.
- Author
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Maki KC, Davidson MH, Dicklin MR, Bell M, Witchger M, and Feinstein SB
- Subjects
- Aged, Body Mass Index, Carotid Arteries diagnostic imaging, Cholesterol, HDL analysis, Coronary Disease prevention & control, Double-Blind Method, Female, Humans, Male, Middle Aged, Phytotherapy methods, Predictive Value of Tests, Randomized Controlled Trials as Topic, Risk Factors, Triglycerides analysis, Tunica Intima diagnostic imaging, Tunica Media diagnostic imaging, Ultrasonography, Carotid Arteries pathology, Coronary Disease pathology, Tunica Intima pathology, Tunica Media pathology
- Abstract
Background: The rate of carotid intima media thickness (CIMT) progression has been widely used in clinical trials as a surrogate marker for subclinical atherosclerosis., Objective: The aim of this study was to investigate relationships between coronary heart disease (CHD) risk markers and progression of CIMT in patients at moderate CHD risk., Methods: Participants included men (45-75 years) and women (55-74 years) in the control arm of a clinical trial. All had at least one major CHD risk factor and baseline posterior wall CIMT 0.7-2.0 mm, without significant stenosis. Posterior (n = 134) and anterior wall (in a subset, n = 72) CIMT were assessed with B-mode ultrasound at baseline and 12 and ∼18 months. Fasting lipoprotein lipid, apolipoprotein (Apo), inflammatory, and oxidative stress markers were evaluated., Results: Baseline CIMT was inversely associated (P < .001) with CIMT progression. After adjustment for baseline CIMT, significant predictors of anterior wall CIMT progression in linear regression analyses included glucose (P = .044), high-density lipoprotein cholesterol (HDL-C, inverse, P = .006), triglycerides (TG, P = .006), and ratios of total cholesterol (TC)/HDL-C (P = .013), TG/HDL-C (P = .005), and Apo B/HDL-C (P = .021). Posterior wall CIMT progressed on average, whereas anterior wall CIMT regressed (0.0078 vs -0.0164 mm/year, P = .014). Significant baseline CIMT-adjusted predictors of posterior wall CIMT progression included TC (P = .028), low-density lipoprotein-C (P = .035), non-HDL-C (P = .004), TG (P = .016), Apo B (P = .005), and ratios of TC/HDL-C (P < .001), TG/HDL-C (P = .015), Apo B/Apo AI (P = .012) and Apo B/HDL-C (P = .004)., Conclusion: The strongest predictors for CIMT progression in anterior and posterior walls were lower baseline CIMT, increased TG, and elevated ratios, including TC/HDL-C, TG/HDL-C and Apo B/HDL-C., (Copyright © 2011 National Lipid Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
45. More on advances in imaging angiogenesis and inflammation in atherosclerosis.
- Author
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Schinkel AF, Staub D, Ten Kate GL, van den Oord SC, Ten Cate FJ, Sijbrands EJ, and Feinstein SB
- Subjects
- Animals, Atherosclerosis pathology, Atherosclerosis physiopathology, Contrast Sensitivity, Diagnostic Imaging methods, Disease Models, Animal, Drug Delivery Systems, Endothelium, Vascular pathology, Humans, Inflammation, Plaque, Atherosclerotic pathology, Ultrasonography, Atherosclerosis diagnosis, Endothelium, Vascular diagnostic imaging, Microbubbles, Neovascularization, Pathologic, Plaque, Atherosclerotic diagnostic imaging
- Published
- 2011
- Full Text
- View/download PDF
46. Correlation of carotid artery atherosclerotic lesion echogenicity and severity at standard US with intraplaque neovascularization detected at contrast-enhanced US.
- Author
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Staub D, Partovi S, Schinkel AF, Coll B, Uthoff H, Aschwanden M, Jaeger KA, and Feinstein SB
- Subjects
- Adult, Aged, Aged, 80 and over, Albumins, Analysis of Variance, Atherosclerosis pathology, Carotid Stenosis pathology, Chi-Square Distribution, Contrast Media, Female, Fluorocarbons, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Ultrasonography, Atherosclerosis diagnostic imaging, Carotid Stenosis diagnostic imaging
- Abstract
Purpose: To correlate echogenicity and severity of atherosclerotic carotid artery lesions at standard ultrasonography (US) with the degree of intraplaque neovascularization at contrast material-enhanced (CE) US., Materials and Methods: This HIPAA-compliant study was approved by the local ethics committee, and all patients provided informed consent. A total of 175 patients (113 [65%] men, 62 [35%] women; mean age, 67 years ± 10 [standard deviation]) underwent standard and CE US of the carotid artery. Lesion echogenicity (class I to IV), degree of stenosis, and maximal lesion thickness were evaluated for each documented atherosclerotic lesion. The degree of intraplaque neovascularization at CE US was categorized as absent (grade 1), moderate (grade 2), or extensive (grade 3). Correlation of neovascularization with echogenicity, degree of stenosis, and maximal lesion thickness was made by using Spearman ρ and χ(2) test for trend., Results: In a total of 293 atherosclerotic lesions, echogenicity was inversely correlated with grade of intraplaque neovascularization (ρ = -0.199, P < .001). More echolucent lesions had a higher degree of neovascularization compared with more echogenic ones (P < .001). The degree of stenosis was significantly correlated with grade of intraplaque neovascularization (ρ = 0.157, P = .003). Lesions with higher degree of stenosis had higher grade of neovascularization (P = .008), and maximal lesion thickness increased with the grade of neovascularization (P < .001) and was significantly correlated with grade of neovascularization (ρ = 0.233, P < .001)., Conclusion: Neovascularization visualized with CE US correlates with lesion severity and with morphologic features of plaque instability, contributing to the concept that more vulnerable plaques are more likely to have a greater degree of neovascularization. Therefore, CE US may be a valuable tool for further risk stratification of echolucent atherosclerotic lesions and carotid artery stenosis of different degrees., Supplemental Material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10101008/-/DC1., (© RSNA, 2011)
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- 2011
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47. Noninvasive imaging of the vulnerable atherosclerotic plaque.
- Author
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ten Kate GL, Sijbrands EJ, Staub D, Coll B, ten Cate FJ, Feinstein SB, and Schinkel AF
- Subjects
- Carotid Artery Diseases diagnostic imaging, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Disease Progression, Humans, Magnetic Resonance Angiography, Predictive Value of Tests, Prognosis, Rupture, Sensitivity and Specificity, Tomography, X-Ray Computed, Ultrasonography, Interventional, Carotid Artery Diseases diagnosis, Coronary Artery Disease diagnosis, Diagnostic Imaging methods
- Abstract
Atherosclerosis is an inflammatory disease, complicated by progressively increasing atherosclerotic plaques that eventually may rupture. Plaque rupture is a major cause of cardiovascular events, such as unstable angina, myocardial infarction, and stroke. A number of noninvasive imaging techniques have been developed to evaluate the vascular wall in an attempt to identify so-called vulnerable atherosclerotic plaques that are prone to rupture. The purpose of the present review is to systematically investigate the accuracy of noninvasive imaging techniques in the identification of plaque components and morphologic characteristics associated with plaque vulnerability, assessing their clinical and diagnostic value., (Copyright © 2010 Mosby, Inc. All rights reserved.)
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- 2010
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48. New advances in noninvasive imaging of the carotid artery: CIMT, contrast-enhanced ultrasound, and vasa vasorum.
- Author
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Coll B, Nambi V, and Feinstein SB
- Subjects
- Biomarkers, Cardiovascular Diseases pathology, Carotid Arteries diagnostic imaging, Contrast Media, Humans, Tunica Intima diagnostic imaging, Tunica Media diagnostic imaging, Ultrasonography, Vasa Vasorum diagnostic imaging, Cardiovascular Diseases diagnostic imaging, Carotid Arteries pathology, Tunica Intima pathology, Tunica Media pathology, Vasa Vasorum pathology
- Abstract
Carotid ultrasound measurement of carotid intima-media thickness (CIMT) and detection of plaques is a useful method to better assess cardiovascular disease risk status, especially in those at intermediate risk. We discuss the use CIMT and other emerging techniques such as contrast-enhanced carotid ultrasound imaging in the evaluation of the carotid artery and its value in cardiovascular disease.
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- 2010
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49. Contrast-enhanced ultrasound for imaging vasa vasorum: comparison with histopathology in a swine model of atherosclerosis.
- Author
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Schinkel AF, Krueger CG, Tellez A, Granada JF, Reed JD, Hall A, Zang W, Owens C, Kaluza GL, Staub D, Coll B, Ten Cate FJ, and Feinstein SB
- Subjects
- Animals, Arteriosclerosis pathology, Disease Models, Animal, Disease Progression, Hyperlipoproteinemia Type II pathology, Radionuclide Imaging, Swine, Time Factors, Tunica Intima pathology, Tunica Media pathology, Ultrasonography, Vasa Vasorum pathology, Arteriosclerosis diagnostic imaging, Contrast Media, Hyperlipoproteinemia Type II diagnostic imaging, Tunica Intima diagnostic imaging, Tunica Media diagnostic imaging, Vasa Vasorum diagnostic imaging
- Abstract
Aim: To evaluate the agreement between contrast-enhanced ultrasound imaging and histopathology in an animal model of atherosclerosis., Methods and Results: Atherosclerosis was studied in both femoral arteries of four Rapacz familial hypercholesterolaemia (RFH) swine. Contrast-enhanced ultrasound imaging of the eight femoral arteries was performed at baseline and at 5, 12, 26, and 43 weeks follow-up after percutaneous transluminal stimulation of atherosclerosis to assess the progression of intima-media thickness (IMT) and the density and extent of the vasa vasorum network. Contrast-enhanced ultrasound imaging allowed an early detection of atherosclerosis and showed a significant gradual progression of atherosclerosis over time. IMT increased from 0.22 +/- 0.05 mm at baseline to 0.45 +/- 0.06 mm (P < 0.001) at follow-up. The density of the vasa vasorum network increased during follow-up and was significantly higher in advanced than in early atherosclerosis. The findings with contrast-enhanced ultrasound were confirmed by histopathological specimens of the arterial wall., Conclusion: Contrast-enhanced ultrasound is effective for in vivo detection of vasa vasorum in atherosclerotic plaques in the RFH swine model. After stimulation of atherosclerosis, contrast-enhanced ultrasound demonstrated a significantly increased IMT and significantly increased density of the vasa vasorum network in the developing atherosclerotic plaque, which was validated by histology.
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- 2010
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50. Contrast-enhanced ultrasound imaging of the vasa vasorum: from early atherosclerosis to the identification of unstable plaques.
- Author
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Staub D, Schinkel AF, Coll B, Coli S, van der Steen AF, Reed JD, Krueger C, Thomenius KE, Adam D, Sijbrands EJ, ten Cate FJ, and Feinstein SB
- Subjects
- Animals, Connective Tissue blood supply, Disease Models, Animal, Disease Progression, Humans, Neovascularization, Pathologic diagnostic imaging, Predictive Value of Tests, Rupture, Spontaneous, Time Factors, Ultrasonography, Atherosclerosis diagnostic imaging, Carotid Arteries diagnostic imaging, Connective Tissue diagnostic imaging, Contrast Media, Coronary Vessels diagnostic imaging
- Abstract
Proliferation of the adventitial vasa vasorum (VV) is inherently linked with early atherosclerotic plaque development and vulnerability. Recently, direct visualization of arterial VV and intraplaque neovascularization has emerged as a new surrogate marker for the early detection of atherosclerotic disease. This clinical review focuses on contrast-enhanced ultrasound (CEUS) as a noninvasive application for identifying and quantifying carotid and coronary artery VV and intraplaque neovascularization. These novel approaches could potentially impact the clinician's ability to identify individuals with premature cardiovascular disease who are at high risk. Once clinically validated, the uses of CEUS may provide a method to noninvasively monitor therapeutic interventions. In the future, the therapeutic use of CEUS may include ultrasound-directed, site-specific therapies using microbubbles as vehicles for drug and gene delivery systems. The combined applications for diagnosis and therapy provide unique opportunities for clinicians to image and direct therapy for individuals with vulnerable lesions., (Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
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