TY  - JOUR
AB  - AIMS: Understanding determinants of thoracic aortic morphology is crucial for precise diagnostics and therapeutic approaches. This study aimed to automatically characterize ascending aortic morphology based on 3D non-contrast-enhanced magnetic resonance angiography (NC-MRA) data from the epidemiological cross-sectional German National Cohort (NAKO) and to investigate possible determinants of mid-ascending aortic diameter (mid-AAoD). METHODS AND RESULTS: Deep learning (DL) automatically segmented the thoracic aorta and ascending aortic length, volume, and diameter was extracted from 25,073 NC-MRAs. Statistical analyses investigated relationships between mid-AAoD and demographic factors, hypertension, diabetes, alcohol, and tobacco consumption. Males exhibited significantly larger mid-AAoD than females (M:35.5±4.8mm, F:33.3±4.5mm). Age and body surface area (BSA) were positively correlated with mid-AAoD (age: male: r²=0.20, p<0.001, female: r²=0.16, p<0.001; BSA: male: r²=0.08, p<0.001, female: r²=0.05, p<0.001). Hypertensive and diabetic subjects showed higher mid-AAoD (ΔHypertension = 2.9 ± 0.5mm; ΔDiabetes = 1.5 ± 0.6mm). Hypertension was linked to higher mid-AAoD regardless of age and BSA, while diabetes and mid-AAoD were uncorrelated across age-stratified subgroups. Daily alcohol consumption (male: 37.4±5.1mm, female: 35.0±4.8mm) and smoking history exceeding 16.5 pack-years (male: 36.6±5.0mm, female: 33.9±4.3mm) exhibited highest mid-AAoD. Causal analysis (Peter-Clark algorithm) suggested that age, BSA, hypertension, and alcohol consumption are possibly causally related to mid-AAoD, while diabetes and smoking are likely spuriously correlated. CONCLUSIONS: This study demonstrates the potential of DL and causal analysis for understanding ascending aortic morphology. By disentangling observed correlations using causal analysis, this approach identifies possible causal determinants, such as age, BSA, hypertension, and alcohol consumption. These findings can inform targeted diagnostics and preventive strategies, supporting clinical decision-making for cardiovascular health.
AU  - Fay, L.*
AU  - Hepp, T.*
AU  - Winkelmann, M.T.*
AU  - Peters, A.
AU  - Heier, M.
AU  - Niendorf, T.*
AU  - Pischon, T.*
AU  - Endemann, B.*
AU  - Schulz-Menger, J.*
AU  - Krist, L.*
AU  - Schulze, M.B.*
AU  - Mikolajczyk, R.*
AU  - Wienke, A.*
AU  - Obi, N.*
AU  - Silenou, B.C.*
AU  - Lange, B.*
AU  - Kauczor, H.U.*
AU  - Lieb, W.*
AU  - Baurecht, H.*
AU  - Leitzmann, M.*
AU  - Trares, K.*
AU  - Brenner, H.*
AU  - Michels, K.B.*
AU  - Jaskulski, S.*
AU  - Völzke, H.*
AU  - Nikolaou, K.*
AU  - Schlett, C.L.*
AU  - Bamberg, F.*
AU  - Lescan, M.*
AU  - Yang, B.*
AU  - Küstner, T.*
AU  - Gatidis, S.*
C1  - 73597
C2  - 57130
CY  - Great Clarendon St, Oxford Ox2 6dp, England
SP  - 895–907
TI  - Determinants of ascending aortic morphology: Cross-sectional deep learning-based analysis on 25,073 non-contrast-enhanced NAKO MRI studies.
JO  - Eur. Heart J. Cardiovasc. Imaging
VL  - 26
IS  - 5
PB  - Oxford Univ Press
PY  - 2025
SN  - 2047-2404
ER  - 

TY  - JOUR
AB  - Progression of atherosclerotic plaque in coronary arteries is characterized by complex cellular and non-cellular molecular interactions. Within recent years, atherosclerosis has been recognized as inflammation-driven disease condition, where progressive stages are characterized by morphological changes in plaque composition but also relevant molecular processes resulting in increased plaque vulnerability. While existing intravascular imaging modalities are able to resolve key morphological features during plaque progression, they lack capability to characterize the molecular profile of advanced atherosclerotic plaque. Because hybrid imaging modalities may provide incremental information related to plaque biology, they are expected to provide synergistic effects in detecting high risk patients and lesions. The aim of this article is to review existing literature on intravascular molecular imaging approaches, and to provide clinically oriented proposals of their application. In addition, we assembled an overview of future developments in this field geared towards detection of patients at risk for cardiovascular events.
AU  - Seguchi, M.*
AU  - Aytekin, A.*
AU  - Lenz, T.*
AU  - Nicol, P.*
AU  - Klosterman, G.R.*
AU  - Beele, A.*
AU  - Sabic, E.*
AU  - Utsch, L.*
AU  - Alyaqoob, A.*
AU  - Gorpas, D.
AU  - Ntziachristos, V.
AU  - Jaffer, F.A.*
AU  - Rauschendorfer, P.
AU  - Joner, M.*
C1  - 65987
C2  - 53011
SP  - e1-e16
TI  - Intravascular molecular imaging: Translating pathophysiology of atherosclerosis into human disease conditions.
JO  - Eur. Heart J. Cardiovasc. Imaging
VL  - 24
IS  - 1
PY  - 2022
SN  - 2047-2404
ER  - 

TY  - JOUR
AB  - Aims To characterize changes in the myocardium in subjects with prediabetes, diabetes, and healthy controls with preserved left ventricular ejection fraction (LVEF) by using cardiac magnetic resonance imaging (CMR) in a sample from the general population.Methods and results Subjects without history of cardiovascular disease and preserved LVEF but established diabetes, prediabetes, and controls from a population-based cohort underwent contrast-enhanced CMR. Obtained parameters included left ventricular (LV) function and morphology, late gadolinium enhancement as well as T1-mapping and derivation of extracellular volume fraction (ECV) by modified Look-Locker inversion recovery for diffuse fibrosis in a subset of patients. Fibrosis volume and cell volume were calculated and LV remodelling index was calculated by dividing the LV mass by its end-diastolic volume. Among 343 subjects (56.1 +/- 9.2 years, 57% males), 47 subjects were classified as diabetes, 78 as prediabetes, and 218 as controls. Haematocrit values and thus ECV parameters were available in 251 subjects. LV remodelling index was significantly higher in participants with prediabetes and diabetes, independent of body mass index (BMI), hypertension, age, and sex. ECV was decreased in subjects with prediabetes and diabetes compared with healthy controls (23.1 +/- 2.4% and 22.8 +/- 3.0%, both P < 0.007). In contrast, cell volume was significantly higher in subjects with prediabetes and diabetes as compared with controls (109.1 +/- 23.8 and 114.9 +/- 32.3 mL vs. 96.5 +/- 26.9 mL, both P < 0.03, respectively). However, differences in ECV and cell volume attenuated after the adjustment for cardiometabolic risk factors, including age, sex, BMI, and hypertension.Conclusion Subjects with prediabetes and diabetes but preserved LVEF had higher LV remodelling indices, suggesting early detectable changes in the disease process, while diffuse myocardial fibrosis appears to be less relevant at this stage.
AU  - Storz, C.*
AU  - Hetterich, H.*
AU  - Lorbeer, R.*
AU  - Heber, S.D.*
AU  - Schafnitzel, A.*
AU  - Patscheider, H.*
AU  - Auweter, S.*
AU  - Zitzelsberger, T.*
AU  - Rathmann, W.*
AU  - Nikolaou, K.*
AU  - Reiser, M.*
AU  - Schlett, C.L.*
AU  - von Knobelsdorff-Brenkenhoff, F.*
AU  - Peters, A.
AU  - Schulz-Menger, J.*
AU  - Bamberg, F.*
C1  - 52420
C2  - 43957
CY  - Great Clarendon St, Oxford Ox2 6dp, England
SP  - 701-708
TI  - Myocardial tissue characterization by contrast-enhanced cardiac magnetic resonance imaging in subjects with prediabetes, diabetes, and normal controls with preserved ejection fraction from the general population.
JO  - Eur. Heart J. Cardiovasc. Imaging
VL  - 19
IS  - 6
PB  - Oxford Univ Press
PY  - 2018
SN  - 2047-2404
ER  - 

TY  - JOUR
AB  - Aims: (i) to evaluate a novel hybrid near-infrared fluorescence - intravascular ultrasound (NIRF-IVUS) system in coronary and peripheral swine arteries in vivo; (ii) to assess simultaneous quantitative biological and morphological aspects of arterial disease. Methods and results: Two 9F/15MHz peripheral and 4.5F/40MHz coronary near-infrared fluorescence (NIRF)-IVUS catheters were engineered to enable accurate co-registrtation of biological and morphological readings simultaneously in vivo. A correction algorithm utilizing IVUS information was developed to account for the distance-related fluorescence attenuation due to through-blood imaging. Corrected NIRF (cNIRF)-IVUS was applied for in vivo imaging of angioplasty-induced vascular injury in swine peripheral arteries and experimental fibrin deposition on coronary artery stents, and of atheroma in a rabbit aorta, revealing feasibility to intravascularly assay plaque structure and inflammation. The addition of ICG-enhanced NIRF assessment improved the detection of angioplasty-induced endothelial damage compared to standalone IVUS. In addition, NIRF detection of coronary stent fibrin by in vivo cNIRF-IVUS imaging illuminated stent pathobiology that was concealed on standalone IVUS. Fluorescence reflectance imaging and microscopy of resected tissues corroborated the in vivo findings. Conclusions: Integrated cNIRF-IVUS enables simultaneous co-registered through-blood imaging of disease related morphological and biological alterations in coronary and peripheral arteries in vivo. Clinical translation of cNIRF-IVUS may significantly enhance knowledge of arterial pathobiology, leading to improvements in clinical diagnosis and prognosis, and helps to guide the development of new therapeutic approaches for arterial diseases.
AU  - Bozhko, D.
AU  - Osborn, E.A.*
AU  - Rosenthal, A.
AU  - Verjans, J.W.*
AU  - Hara, T.*
AU  - Kellnberger, S.
AU  - Wissmeyer, G.
AU  - Ovsepian, S.V.
AU  - McCarthy, J.R.*
AU  - Mauskapf, A.
AU  - Stein, A.F.
AU  - Jaffer, F.A.*
AU  - Ntziachristos, V.
C1  - 50271
C2  - 42074
CY  - Oxford
SP  - 1253-1261
TI  - Quantitative intravascular biological fluorescence-ultrasound imaging of coronary and peripheral arteries in vivo.
JO  - Eur. Heart J. Cardiovasc. Imaging
VL  - 18
IS  - 11
PB  - Oxford Univ Press
PY  - 2017
SN  - 2047-2404
ER  - 

TY  - JOUR
AB  - Inflammation drives atherosclerosis complications and is a promising therapeutic target for plaque stabilization. At present, it is unknown whether local stenting approaches can stabilize plaque inflammation in vivo. Here, we investigate whether everolimus-eluting stents (EES) can locally suppress plaque inflammatory protease activity in vivo using intravascular near-infrared fluorescence (NIRF) molecular imaging. METHODS AND RESULTS: Balloon-injured, hyperlipidaemic rabbits with atherosclerosis received non-overlapping EES and bare metal stents (BMS) placement into the infrarenal aorta (n = 7 EES, n = 7 BMS, 3.5 mm diameter x 12 mm length). Four weeks later, rabbits received an injection of the cysteine protease-activatable NIRF imaging agent Prosense VM110. Twenty-four hours later, co-registered intravascular 2D NIRF, X-ray angiography and intravascular ultrasound imaging were performed. In vivo EES-stented plaques contained substantially reduced NIRF inflammatory protease activity compared with untreated plaques and BMS-stented plaques (P = 0.006). Ex vivo macroscopic NIRF imaging of plaque protease activity corroborated the in vivo results (P = 0.003). Histopathology analyses revealed that EES-treated plaques showed reduced neointimal and medial arterial macrophage and cathepsin B expression compared with unstented and BMS-treated plaques. CONCLUSIONS: EES-stenting stabilizes plaque inflammation as assessed by translational intravascular NIRF molecular imaging in vivo. These data further support that EES may provide a local approach for stabilizing inflamed plaques.
AU  - Calfon Press, M.A.*
AU  - Mallas, G.*
AU  - Rosenthal, A.
AU  - Hara, T.*
AU  - Mauskapf, A.*
AU  - Nudelman, R.N.
AU  - Sheehy, A.*
AU  - Polyakov, I.V.*
AU  - Kolodgie, F.*
AU  - Virmani, R.*
AU  - Guerrero, J.L.*
AU  - Ntziachristos, V.
AU  - Jaffer, F.A.*
C1  - 50269
C2  - 42072
SP  - 510-518
TI  - Everolimus-eluting stents stabilize plaque inflammation in vivo: assessment by intravascular fluorescence molecular imaging.
JO  - Eur. Heart J. Cardiovasc. Imaging
VL  - 18
IS  - 5
PY  - 2017
SN  - 2047-2404
ER  -