High-Risk Coronary Plaque Regression After Intensive Lifestyle Intervention in Nonobstructive Coronary Disease A Randomized Study
Tóm tắt
Objectives The authors sought to study the impact of diet and lifestyle intervention on changes in atherosclerotic plaque volume and composition. Background Lifestyle and diet modification are the leading strategies to manage coronary artery disease; however, their direct impact on atherosclerosis remains unknown. Coronary plaque composition is related to the risk of future cardiovascular events independent of stenosis severity and can be conveniently evaluated with computed tomography angiography (CTA). Methods We enrolled 92 patients (41% women; mean age 60 ± 7.7 years) with nonobstructive (<70% stenosis) coronary atherosclerosis identified by CTA. Participants were randomized (1:1) to either the DISCO (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography) intervention group (systematic follow-up by a dietitian to adhere to the Dietary Approaches to Stop Hypertension nutrition model together with optimal medical therapy [OMT]) or the control group (OMT alone). In all patients, CTA was repeated after 66.9 ± 13.7 weeks. The outcome was change (Δ) in atheroma volume and plaque composition. Based on atherosclerotic tissue attenuation ranges in Hounsfield units (HU), the following components of coronary plaque were distinguished: dense calcium (>351 HU), fibrous plaque (151 to 350 HU), and fibrofatty plaque combined with necrotic core (-30 to 150 HU), referred to as noncalcified plaque. Results Percent atheroma volume increased in the control arm (Δ = +1.1 ± 3.4%; p = 0.033) versus no significant change in the experimental arm (Δ = +1.0% ± 4.2%; p = 0.127; intergroup p = 0.851). There was a reduction in noncalcified plaque in both the experimental arm (Δ = −51.3 ± 79.5 mm3 [−1.7 ± 2.7%]; p < 0.001) and the control arm (Δ = −21.3 ± 57.7 [−0.7 ± 1.9%]; p = 0.018), which was greater in the DISCO intervention group (intergroup p = 0.045). No differences in fibrous component or dense calcium changes were observed between the groups. Conclusions Controlled diet and lifestyle intervention together with OMT may slow the progression of atherosclerosis and reduce noncalcified plaque volume compared to OMT alone. (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography [DISCO-CT]; NCT02571803)
Từ khóa
#coronary artery disease #coronary computed tomography #DASH diet #lifestyle Intervention #vulnerable plaqueTài liệu tham khảo
1 G. Montalescot U. Sechtem S. Achenbach 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology Eur Heart J 34 2013 2949 3003 Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.
2 R.H. Eckel J.M. Jakicic J.D. Ard American College of Cardiology/American Heart Association Task Force on Practice Guidelines 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 63 2014 2960 2984 Eckel RH, Jakicic JM, Ard JD, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2960-2984.
3 A. Trichopoulou C. Bamia D. Trichopoulos Mediterranean diet and survival among patients with coronary heart disease in Greece Arch Intern Med 165 2005 929 935 Trichopoulou A, Bamia C, Trichopoulos D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 2005;165:929-935.
4 S. Soltani T. Arablou A. Jayedi A. Salehi-Abargouei Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies Nutr J 19 2020 37 Soltani S, Arablou T, Jayedi A, Salehi-Abargouei A. Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Nutr J 2020;19:37.
5 R. Estruch E. Ros J. Salas-Salvadó Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts N Engl J Med 378 2018 e34 Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 2018;378:e34.
6 F. Barzi M. Woodward R.M. Marfisi L. Tavazzi F. Valagussa R. Marchioli Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial Eur J Clin Nutr 57 2003 604 611 Barzi F, Woodward M, Marfisi RM, Tavazzi L, Valagussa F, Marchioli R. Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr 2003;57:604-611.
7 M. de Lorgeril P. Salen J.L. Martin I. Monjaud J. Delaye N. Mamelle Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study Circulation 99 1999 779 785 de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779-785.
8 D.C. Lee R.R. Pate C.J. Lavie X. Sui T.S. Church S.N. Blair Leisure-time running reduces all-cause and cardiovascular mortality risk J Am Coll Cardiol 64 2014 472 481 Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol 2014;64:472-481.
9 C. Marin R. Ramirez J. Delgado-Lista Mediterranean diet reduces endothelial damage and improves the regenerative capacity of endothelium Am J Clin Nutr 93 2011 267 274 Marin C, Ramirez R, Delgado-Lista J, et al. Mediterranean diet reduces endothelial damage and improves the regenerative capacity of endothelium. Am J Clin Nutr 2011;93:267-274.
10 K. Esposito R. Marfella M. Ciotola Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial JAMA 292 2004 1440 1446 Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440-1446.
11 A.I. Kolomvotsou L.S. Rallidis K.C. Mountzouris Adherence to Mediterranean diet and close dietetic supervision increase total dietary antioxidant intake and plasma antioxidant capacity in subjects with abdominal obesity Eur J Nutr 52 2013 37 48 Kolomvotsou AI, Rallidis LS, Mountzouris KC, et al. Adherence to Mediterranean diet and close dietetic supervision increase total dietary antioxidant intake and plasma antioxidant capacity in subjects with abdominal obesity. Eur J Nutr 2013;52:37-48.
12 E.R. Miller 3rd T.P. Erlinger F.M. Sacks A dietary pattern that lowers oxidative stress increases antibodies to oxidized LDL: results from a randomized controlled feeding study Atherosclerosis 183 2005 175 182 Miller ER 3rd, Erlinger TP, Sacks FM, et al. A dietary pattern that lowers oxidative stress increases antibodies to oxidized LDL: results from a randomized controlled feeding study. Atherosclerosis 2005;183:175-182.
13 M.A. Incalza R. D'Oria A. Natalicchio S. Perrini L. Laviola F. Giorgino Oxidative stress and reactive oxygen species in endothelial dysfunction associated with cardiovascular and metabolic diseases Vascul Pharmacol 100 2018 1 19 Incalza MA, D'Oria R, Natalicchio A, Perrini S, Laviola L, Giorgino F. Oxidative stress and reactive oxygen species in endothelial dysfunction associated with cardiovascular and metabolic diseases. Vascul Pharmacol 2018;100:1-19.
14 T.F. Lüscher M. Barton Biology of the endothelium Clin Cardiol 20 1997 II-3 II-10 Luscher TF, Barton M. Biology of the endothelium. Clin Cardiol 1997;20:II-3-II-10.
15 R. Ross The pathogenesis of atherosclerosis: a perspective for the 1990s Nature 362 1993 801 809 Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993;362:801-809.
16 S.J. Nicholls Effect of two intensive statin regimens on progression of coronary disease N Engl J Med 365 2011 2078 2087 Nicholls SJ, et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med 2011;365:2078-2087.
17 S.E. Nissen S.J. Nicholls I. Sipahi Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial JAMA 295 2006 1556 1565 Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006;295:1556-1565.
18 K. Tsujita S. Sugiyama H. Sumida Impact of dual lipid-lowering strategy with ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention: the multicenter randomized controlled PRECISE-IVUS trial J Am Coll Cardiol 66 2015 495 507 Tsujita K, Sugiyama S, Sumida H, et al. Impact of dual lipid-lowering strategy with ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention: the multicenter randomized controlled PRECISE-IVUS trial. J Am Coll Cardiol 2015;66:495-507.
19 S.E. Nissen S.J. Nicholls Results of the GLAGOV trial Cleve Clin J Med 84 12 Suppl 4 2017 e1 e5 Nissen SE, Nicholls SJ. Results of the GLAGOV trial. Cleve Clin J Med 2017;84(12 Suppl 4):e1-e5.
20 P.M. Ridker J.G. MacFadyen T. Thuren CANTOS Trial Group. Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind, placebo-controlled trial Lancet 390 2017 1833 1842 Ridker PM, MacFadyen JG, Thuren T, et al. CANTOS Trial Group. Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind, placebo-controlled trial. Lancet 2017;390:1833-1842.
21 A.V. Finn M. Nakano J. Narula F.D. Kolodgie R. Virmani Concept of vulnerable/unstable plaque Atheroscler Thromb Vasc Biol 30 2010 1282 1292 Finn AV, Nakano M, Narula J, Kolodgie FD, Virmani R. Concept of vulnerable/unstable plaque. Atheroscler Thromb Vasc Biol 2010;30:1282-1292.
22 G.W. Stone A. Maehara A.J. Lansky A prospective natural-history study of coronary atherosclerosis N Engl J Med 363 2011 226 235 Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011;363:226-235.
23 I. Springer M. Dewey Comparison of multislice computed tomography with intravascular ultrasound for detection and characterization of coronary artery plaques: a systematic review Eur J Radiol 71 2009 275 282 Springer I, Dewey M. Comparison of multislice computed tomography with intravascular ultrasound for detection and characterization of coronary artery plaques: a systematic review. Eur J Radiol 2009;71:275-282.
24 H.J. Chang F.Y. Lin S.E. Lee Coronary atherosclerotic precursors of acute coronary syndromes J Am Coll Cardiol 71 2018 2511 2522 Chang HJ, Lin FY, Lee SE. Coronary atherosclerotic precursors of acute coronary syndromes. J Am Coll Cardiol 2018;71:2511-2522.
25 H.B. Park B.K. Lee S. Shin Clinical feasibility of 3D automated coronary atherosclerotic plaque quantification algorithm on coronary computed tomography angiography: comparison with intravascular ultrasound Eur Radiol 25 2015 3073 3083 Park HB, Lee BK, Shin S, et al. Clinical feasibility of 3D automated coronary atherosclerotic plaque quantification algorithm on coronary computed tomography angiography: comparison with intravascular ultrasound. Eur Radiol 2015;25:3073-3083.
26 M.A. De Graaf A. Broersen P.H. Kitslaar Automatic quantification and characterization of coronary atherosclerosis with computed tomography coronary angiography: cross-correlation with intravascular ultrasound virtual histology Int J Cardiovasc Imaging 29 2013 1177 1190 De Graaf MA, Broersen A, Kitslaar PH, et al. Automatic quantification and characterization of coronary atherosclerosis with computed tomography coronary angiography: cross-correlation with intravascular ultrasound virtual histology. Int J Cardiovasc Imaging 2013;29:1177-1190.
27 A.L. Günther A.D. Liese R.A. Bell Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus Hypertension 53 2009 6 12 Gunther AL, Liese AD, Bell RA, et al. Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension 2009;53:6-12.
28 M.F. Piepoli A.W. Hoes S. Agewall 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur Heart J 37 2016 2315 2381 Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37:2315-2381.
29 T.J. Moore W.M. Vollmer L.J. Appel Effect of dietary patterns on ambulatory blood pressure: results from the Dietary Approaches to Stop Hypertension (DASH) Trial Hypertension 34 1999 472 477 Moore TJ, Vollmer WM, Appel LJ, et al. Effect of dietary patterns on ambulatory blood pressure: results from the Dietary Approaches to Stop Hypertension (DASH) Trial. Hypertension 1999;34:472-477.
30 L.P. Svetkey D. Simons-Morton W.M. Vollmer Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial Arch Intern Med 159 1999 285 293 Svetkey LP, Simons-Morton D, Vollmer WM, et al. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch Intern Med 1999;159:285-293.
31 F.M. Sacks L.P. Svetkey W.M. Vollmer Effects on blood pressure of reduced dietary sodium the Dietary Approaches to Stop Hypertension (DASH) diet N Engl J Med 344 2001 3 10 Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001;344:3-10.
32 G.B. Lim Hypertension: low sodium and DASH diet to lower blood pressure Nat Rev Cardiol 15 2018 68 Lim GB. Hypertension: low sodium and DASH diet to lower blood pressure. Nat Rev Cardiol 2018;15:68.
33 M. Siervo J. Lara S. Chowdhury A. Ashor C. Oggioni J.C. Mathers Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis Br J Nutr 113 2015 1 15 Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr 2015;113:1-15.
34 A. Salehi-Abargouei Z. Maghsoudi F. Shirani L. Azadbakht Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases incidence: a systematic review and meta-analysis on observational prospective studies Nutrition 29 2013 611 618 Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition 2013;29:611-618.
35 S.C. Larsson A. Wallin A. Wolk Dietary Approaches to Stop Hypertension Diet and incidence of stroke: results from 2 prospective cohorts Stroke 47 2016 986 990 Larsson SC, Wallin A, Wolk A. Dietary Approaches to Stop Hypertension Diet and incidence of stroke: results from 2 prospective cohorts. Stroke 2016;47:986-990.
36 L.M. León-Muñoz P. Guallar-Castillón A. Graciani Dietary habits of the hypertensive population of Spain: accordance with the DASH diet and the Mediterranean diet J Hypertens 30 2012 1373 1382 Leon-Munoz LM, Guallar-Castillon P, Graciani A, et al. Dietary habits of the hypertensive population of Spain: accordance with the DASH diet and the Mediterranean diet. J Hypertens 2012;30:1373-1382.
37 S.E. Nissen E.M. Tuzcu P. Schoenhagen Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial JAMA 291 2004 1071 1080 Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004;291:1071-1080.
38 S.L. Papadopoulou L.A. Neefjes H.M. Garcia-Garcia Natural history of coronary atherosclerosis by multislice computed tomography J Am Coll Cardiol Img 5 2012 S28 S37 Papadopoulou SL, Neefjes LA, Garcia-Garcia HM, et al. Natural history of coronary atherosclerosis by multislice computed tomography. J Am Coll Cardiol Img 2012;5:S28-37.
39 F. Gragano P. Calabro Role of dual lipid-lowering therapy in coronary atherosclerosis regression: evidence from recent studies Atherosclerosis 269 2018 219 228 Gragano F, Calabro P. Role of dual lipid-lowering therapy in coronary atherosclerosis regression: evidence from recent studies. Atherosclerosis 2018;269:219-228.
40 S. Auscher L. Heinsen K. Nieman Effects of intensive lipid-lowering therapy on coronary plaques composition in patients with acute myocardial infarction: assessment with serial coronary CT angiography Atherosclerosis 241 2015 579 587 Auscher S, Heinsen L, Nieman K. Effects of intensive lipid-lowering therapy on coronary plaques composition in patients with acute myocardial infarction: assessment with serial coronary CT angiography. Atherosclerosis 2015;241:579-587.
41 M. Naghavi P. Libby E. Falk From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I Circulation 108 2003 1664 1672 Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I. Circulation 2003;108:1664-1672.
42 S.B. Puchner T. Liu T. Mayhorfer High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of stenosis in acute chest pain: results from the ROMICAT-II trial J Am Coll Cardiol 64 2014 684 692 Puchner SB, Liu T, Mayhorfer T, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014;64:684-692.
43 S. Motoyama T. Kondo M. Sarai Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes J Am Coll Cardiol 50 2007 319 326 Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007;50:319-326.
44 S. Motoyama M. Sarai H. Harigaya Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome J Am Coll Cardiol 54 2009 49 57 Motoyama S, Sarai M, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 2009;54:49-57.
45 S. Motoyama H. Ito M. Sarai Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up J Am Coll Cardiol 66 2015 337 346 Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 2015;66:337-346.
46 S. Soltani M.J. Chitsazi A. Salehi-Abargouei The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: a systematic review and meta-analysis of randomized trials Clin Nutr 37 2018 542 550 Soltani S, Chitsazi MJ, Salehi-Abargouei A. The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: a systematic review and meta-analysis of randomized trials. Clin Nutr 2018;37:542-550.
47 R. Sakhaei S. Shahvazi H. Mozaffari-Khosravi The dietary approaches to stop hypertension (DASH)-Style diet and an alternative Mediterranean diet are differently associated with serum inflammatory markers in female adults Food Nutr Bull 39 2018 361 376 Sakhaei R, Shahvazi S, Mozaffari-Khosravi H, et al. The dietary approaches to stop hypertension (DASH)-Style diet and an alternative Mediterranean diet are differently associated with serum inflammatory markers in female adults. Food Nutr Bull 2018;39:361-376.
48 M. Makarewicz-Wujec J. Henzel M. Kruk DASH diet decreases CXCL4 plasma concentration in patients diagnosed with coronary atherosclerotic lesions Nutr Metab Cardiovasc Dis 30 2020 56 59 Makarewicz-Wujec M, Henzel J, Kruk M, et al. DASH diet decreases CXCL4 plasma concentration in patients diagnosed with coronary atherosclerotic lesions. Nutr Metab Cardiovasc Dis 2020;30:56-59.
49 Tanaka A. Kashiwagi H. Kitabata Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography J Am Coll Cardiol Img 12 2009 1412 1419 Kashiwagi, Tanaka A, Kitabata H, et al. Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. J Am Coll Cardiol Img 2009;12:1412-1419.
50 S.L. Papadopoulou L.A. Neefjes M. Schaap Detection and quantification of coronary atherosclerotic plaque by 64-slice multidetector CT: a systematic head-to-head comparison with intravascular ultrasound Atherosclerosis 219 2011 163 170 Papadopoulou SL, Neefjes LA, Schaap M, et al. Detection and quantification of coronary atherosclerotic plaque by 64-slice multidetector CT: a systematic head-to-head comparison with intravascular ultrasound. Atherosclerosis 2011;219:163-170.
51 A. Nair M.P. Margolis B.D. Kuban D.G. Vince Automated coronary plaque characterization with intravascular ultrasound backscatter: ex vivo validation Eurointervention 3 2007 113 120 Nair A, Margolis MP, Kuban BD, Vince DG. Automated coronary plaque characterization with intravascular ultrasound backscatter: ex vivo validation. Eurointervention 2007;3:113-120.
52 A. Nair B.D. Kuban E.M. Tuzcu P. Schoenhagen S.E. Nissen D.G. Vince Coronary plaque classification with intravascular ultrasound radiofrequency data analysis Circulation 106 2002 2200 2206 Nair A, Kuban BD, Tuzcu EM, Schoenhagen P, Nissen SE, Vince DG. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002;106:2200-2206.
53 E. Archer C.J. Lavie Is the PURE study pure fiction? Eur Heart J 40 2019 394 Archer E, Lavie CJ. Is the PURE study pure fiction? Eur Heart J 2019;40:394.