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Ikeuchi Y, Shimasaki T, Tachizawa N, Yamamoto Y, Ishii T. Successful intravascular ultrasonography-assisted carotid artery stenting for iatrogenic carotid artery dissection: Illustrative case. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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2
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Zhang J, Han R, Shao G, Lv B, Sun K. Artificial Intelligence in Cardiovascular Atherosclerosis Imaging. J Pers Med 2022; 12:jpm12030420. [PMID: 35330420 PMCID: PMC8952318 DOI: 10.3390/jpm12030420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
At present, artificial intelligence (AI) has already been applied in cardiovascular imaging (e.g., image segmentation, automated measurements, and eventually, automated diagnosis) and it has been propelled to the forefront of cardiovascular medical imaging research. In this review, we presented the current status of artificial intelligence applied to image analysis of coronary atherosclerotic plaques, covering multiple areas from plaque component analysis (e.g., identification of plaque properties, identification of vulnerable plaque, detection of myocardial function, and risk prediction) to risk prediction. Additionally, we discuss the current evidence, strengths, limitations, and future directions for AI in cardiac imaging of atherosclerotic plaques, as well as lessons that can be learned from other areas. The continuous development of computer science and technology may further promote the development of this field.
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Affiliation(s)
- Jia Zhang
- Hohhot Health Committee, Hohhot 010000, China;
| | - Ruijuan Han
- The People’s Hospital of Longgang District, Shenzhen 518172, China;
| | - Guo Shao
- The Third People’s Hospital of Longgang District, Shenzhen 518100, China;
| | - Bin Lv
- Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing 100037, China;
| | - Kai Sun
- The Third People’s Hospital of Longgang District, Shenzhen 518100, China;
- Correspondence:
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3
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Xu M, Hu X, Wang L, Zhang W, Wu L, Li J, Chen Y, Zhang P, Su H, Han Y, Zhang C, Zhang M, Zhang Y. Plasma biomarkers and plaque strain predict long-term cardiovascular events in patients with acute coronary syndrome. SCIENCE CHINA-LIFE SCIENCES 2019; 63:269-278. [PMID: 31278618 DOI: 10.1007/s11427-019-9557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
To test whether circulating and intracoronary biomarkers and coronary plaque strain have additive values to Global Registry of Acute Coronary Events (GRACE) score for predicting long-term cardiovascular events in ACS patients. One hundred ACS patients were enrolled and the GRACE score and plasma levels and intracoronary gradients of a number of biomarkers were measured. Coronary plaque burden and morphology in non-critical stenotic plaques were determined by intravascular ultrasound (IVUS) technique, and the maximal shear strain (SSmax) and maximal area strain (ASmax) were determined by intravascular ultrasound elastography (IVUSE) technique. Patients were followed for cardiovascular events and the predictive values of clinical characteristics, plasma biomarkers and plaque parameters were compared with GRACE score, and the incremental values of these measurements to the GRACE score were assessed. GRACE score, plasma biomarkers and plaque strain were independent predictors of cardiovascular events. Combination of GRACE score, plasma biomarkers and plaque strains significantly improved the predictive value of the GRACE score alone with the receiver-operating characteristic area increased from 0.457 to 0.667 (P=0.014). The combination of circulating and intracoronary biomarkers, plaque strain and GRACE score provides a better predictive tool than GRACE score alone in patients with ACS.
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Affiliation(s)
- Mingjun Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xiaobo Hu
- Department of Intensive Care Unit, Shandong Provincial Hospital affiliated to Shandong University, Jinan, 250012, China
| | - Lin Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Wei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Lindi Wu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Jifu Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yuguo Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Haijun Su
- School of Mathematics, Shandong University, Jinan, 250012, China
| | - Yaling Han
- Department of Cardiology, Shenyang Military Region General Hospital, Shenyang, 110016, China
| | - Cheng Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Yun Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
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Chiocchi M, Chiaravalloti A, Morosetti D, Loreni G, Gandini R, Mancino S, Fabiano S, Simonetti G. Virtual histology-intravascular ultrasound as a diagnostic alternative for morphological characterization of carotid plaque. J Cardiovasc Med (Hagerstown) 2019; 20:335-342. [DOI: 10.2459/jcm.0b013e328356a5d2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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5
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Analysis of Cardiovascular Tissue Components for the Diagnosis of Coronary Vulnerable Plaque from Intravascular Ultrasound Images. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9837280. [PMID: 29065676 PMCID: PMC5320383 DOI: 10.1155/2017/9837280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/03/2017] [Accepted: 01/15/2017] [Indexed: 12/05/2022]
Abstract
The purpose of this study was to characterize cardiovascular tissue components and analyze the different tissue properties for predicting coronary vulnerable plaque from intravascular ultrasound (IVUS) images. For this purpose, sequential IVUS image frames were obtained from human coronary arteries using 20 MHz catheters. The plaque regions between the intima and media-adventitial borders were manually segmented in all IVUS images. Tissue components of the plaque regions were classified into having fibrous tissue (FT), fibrofatty tissue (FFT), necrotic core (NC), or dense calcium (DC). The media area and lumen diameter were also estimated simultaneously. In addition, the external elastic membrane (EEM) was computed to predict the vulnerable plaque after the tissue characterization. The reliability of manual segmentation was validated in terms of inter- and intraobserver agreements. The quantitative results found that the FT and the media as well as the NC would be good indicators for predicting vulnerable plaques in IVUS images. In addition, the lumen was not suitable for early diagnosis of vulnerable plaque because of the low significance compared to the other vessel parameters. To predict vulnerable plaque rupture, future study should have additional experiments using various tissue components, such as the EEM, FT, NC, and media.
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Ong P, Aziz A, Hansen HS, Prescott E, Athanasiadis A, Sechtem U. Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris. Circ J 2015; 79:1431-1438. [DOI: 10.1253/circj.cj-15-0520] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert Bosch Krankenhaus
| | - Ahmed Aziz
- Department of Cardiology, Odense University Hospital
- Department of Cardiology, Robert Bosch Krankenhaus
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen
| | | | - Udo Sechtem
- Department of Cardiology, Robert Bosch Krankenhaus
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7
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Yamanaga K, Tsujita K, Shimomura H, Nakamura Y, Ogura Y, Onoue Y, Chazono N, Nagata T, Morisaki S, Kudo T, Yamada Y, Komura N, Miyazaki T, Akasaka T, Horio E, Sato K, Arima Y, Kojima S, Kaikita K, Tayama S, Hokimoto S, Ogawa H. Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement. J Cardiol 2014; 64:279-84. [DOI: 10.1016/j.jjcc.2014.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 01/04/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
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Giannoglou VG, Theocharis JB. Decision Fusion of Multiple Classifiers for Coronary Plaque Characterization from IVUS Images. INT J ARTIF INTELL T 2014. [DOI: 10.1142/s0218213014600057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular tissue characterization is of great importance concerning the possibility of an Acute Cardiac Syndrome (ACS). Gray-scale intravascular ultrasound (IVUS) is a powerful tomographic modality providing a thorough visualization of coronary arteries. Among the existing methods, virtual histology (VH) is the most popular and clinically available technique for plaque component analysis, it suffers however from a poor longitudinal resolution. In order to surmount this demerit, a new image-based methodology for plaque assessment is suggested here that differentiates tissue components into four classes: calcium, necrotic core, fibrous and fibro-lipid. A rich set of five textural feature families are extracted from IVUS images, computed at different scales. The main contribution of this paper is that tissue classification is accomplished using the principles of multiple classifiers combination approach. At the first stage, an ensemble of base SVM classifiers is constructed from each feature family, separately. The fuzzy outputs of the individual classifiers are then aggregated to provide the final fused results. We investigate four efficient decision fusion schemes of the literature and the SVM fuser. Extensive experimentation is carried out to highlight the merits of the suggested schemes against single SVM classifiers that use reduced feature subsets obtained after feature selection or the entire feature space. The analysis demonstrates that the decision fusion techniques offer improved classification accuracies, compared to single SVM classifiers and existing methods in IVUS imaging. In addition, the method provides accurate assessments of plaque composition in IVUS images.
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Affiliation(s)
- V. G. Giannoglou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - J. B. Theocharis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
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9
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Quantification of coronary artery plaque using 64-slice dual-source CT: comparison of semi-automatic and automatic computer-aided analysis based on intravascular ultrasonography as the gold standard. Int J Cardiovasc Imaging 2013; 29 Suppl 2:93-100. [PMID: 24293043 DOI: 10.1007/s10554-013-0333-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/18/2013] [Indexed: 12/19/2022]
Abstract
We evaluated the feasibility of automatic computer-aided analysis (CAA) compared with semi-automatic CAA for differentiating lipid-rich from fibrous plaques based on coronary CT angiography (CCTA) imaging. Seventy-four coronary plaques in 57 patients were evaluated by CCTA using 64-slice dual-source CT. Quantitative analysis of coronary artery plaques was performed by measuring the relative volumes (low, medium, and calcified) of plaque components using automatic CAA and by measuring mean CT density using semi-automatic CAA. We compared the two plaque measurement methods for lipid-rich and fibrous plaques using Pearson's correlation. Intravascular ultrasonography was used as the goal standard for assessment of plaques. Mean CT density of plaques tended to increase in the order of lipid [36 ± 19 Hounsfield unit (HU)], fibrous (106 ± 34 HU), and then calcified plaques (882 ± 296 HU). The mean relative volumes of 'low' components measured by automatic CAA were 13.8 ± 4.6, 7.9 ± 6.7, and 3.5 ± 3.0 % for lipid, fibrous, and calcified plaques, respectively (r = -0.348, P = 0.022). The mean relative volumes of 'medium' components on automatic CAA were 12.9 ± 4.1, 15.7 ± 9.6, and 5.6 ± 4.8 % for lipid, fibrous, and calcified plaques, respectively (r = -0.385, P = 0.011). The mean relative volumes of low and medium components within plaques significantly correlated with the types of plaques. Plaque analysis using automatic CAA has the potential to differentiate lipid from fibrous plaques based on measurement of the relative volume percentages of the low and medium components.
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10
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Obaid DR, Calvert PA, Gopalan D, Parker RA, Hoole SP, West NEJ, Goddard M, Rudd JHF, Bennett MR. Atherosclerotic plaque composition and classification identified by coronary computed tomography: assessment of computed tomography-generated plaque maps compared with virtual histology intravascular ultrasound and histology. Circ Cardiovasc Imaging 2013; 6:655-64. [PMID: 23960215 DOI: 10.1161/circimaging.112.000250] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomography (CT) is used routinely for coronary angiography, and higher-risk features of plaques can also be identified. However, the ability of CT to discriminate individual plaque components and classify plaques according to accepted histological definitions is unknown. METHODS AND RESULTS We first determined CT attenuation ranges for individual plaque components using combined in vivo CT coregistered with virtual histology intravascular ultrasound (VH-IVUS) in 108 plaques from 57 patients. Comparison with contrast attenuation created plaque/contrast attenuation ratios that were significantly different for each component. In a separate validation cohort of 47 patients, these Plaque Maps correlated significantly with VH-IVUS-determined plaque component volumes (necrotic core: r=0.41, P=0.002; fibrous plaque: r=0.54, P<0.001; calcified plaque: r=0.59, P<0.001; total plaque: r=0.62, P<0.001). We also assessed VH-IVUS and CT Plaque Maps against coregistered histology in 72 (VH-IVUS) and 87 (CT) segments from 8 postmortem coronary arteries. The diagnostic accuracy of CT to detect calcified plaque (83% versus 92%), necrotic core (80% versus 65%), and fibroatheroma (80% versus 79%) was comparable with VH-IVUS. However, although VH-IVUS could identify thin-cap fibroatheromas (TCFA) with a diagnostic accuracy of between 74% and 82% (depending on the TCFA definition used), the spatial resolution of CT prevented direct identification of TCFA. CONCLUSIONS CT-derived Plaque Maps based on contrast-adjusted attenuation ranges can define individual plaque components with a similar accuracy to VH-IVUS ex vivo. However, coronary CT Plaque Maps could not reliably classify plaques and identify TCFA, such that high-risk plaques may be misclassified or overlooked.
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Affiliation(s)
- Daniel R Obaid
- Division of Cardiovascular Medicine, and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, United Kingdom; and Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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11
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Verjans JW, Jaffer FA. Biological imaging of atherosclerosis: moving beyond anatomy. J Cardiovasc Transl Res 2013; 6:681-94. [PMID: 23733542 DOI: 10.1007/s12265-013-9474-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/09/2013] [Indexed: 12/27/2022]
Abstract
Biological or molecular imaging is now providing exciting new strategies to study atherosclerosis in both animals and humans. These technologies hold the promise to provide disease-specific, molecular information within the context of a systemic or organ-specific disease beyond traditional anatomical-based imaging. By integration of biological, chemical, and anatomical imaging knowledge into diagnostic strategies, a more comprehensive and predictive picture of atherosclerosis is likely to emerge. As such, biological imaging is well positioned to study different stages of atherosclerosis and its treatment, including the sequence of atheroma initiation, progression, and plaque rupture. In this review, we describe the evolving concepts in atherosclerosis imaging with a focus on coronary artery disease, and we provide an overview of recent exciting translational developments in biological imaging. The illuminated examples and discussions will highlight how biological imaging is providing new clinical approaches to identify high-risk plaques, and to streamline the development process of new atherosclerosis therapies.
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Affiliation(s)
- Johan W Verjans
- Massachusetts General Hospital, Cardiovascular Research Center, Harvard Medical School, 185 Cambridge Street, Simches Building, Room 3206, Boston, MA, 02114, USA
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Takahashi K, Kakuta T, Yonetsu T, Lee T, Koura K, Hishikari K, Murai T, Iesaka Y, Isobe M. In vivo detection of lipid-rich plaque by using a 40-MHz intravascular ultrasound: a comparison with optical coherence tomography findings. Cardiovasc Interv Ther 2013; 28:333-43. [DOI: 10.1007/s12928-013-0177-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 03/31/2013] [Indexed: 11/28/2022]
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13
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Tsujita K, Takaoka N, Kaikita K, Hokimoto S, Horio E, Sato K, Mizobe M, Nakayama N, Kojima S, Tayama S, Sugiyama S, Nakamura S, Ogawa H. Neointimal tissue component assessed by tissue characterization with 40 MHz intravascular ultrasound imaging: comparison of drug-eluting stents and bare-metal stents. Catheter Cardiovasc Interv 2013; 82:1068-74. [PMID: 23460385 DOI: 10.1002/ccd.24907] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The present study used iMap IVUS system to compare neointimal tissue components between DES and bare-metal stents (BMSs). BACKGROUND Drug-eluting stents (DESs) can cause impaired arterial healing, which constitutes the most important pathological substrate underlying late DES thrombosis. Intravascular ultrasound (IVUS)-based tissue characterization allows for the in vivo identification of neointimal tissue components. METHODS AND RESULTS Follow-up IVUS data after coronary stenting (9.8 ± 9.4 months from index procedures) was obtained from consecutive 61 lesions (34 in DES, 27 in BMS). The iMap tissue components (fibrotic, lipidic, necrotic, and calcified) were measured in every recorded frame and expressed as percentages of mean neointimal cross-sectional area for the stented segment. Patients' characteristics were comparable between DES and BMS. When compared with BMSs, smaller (2.9 ± 0.4 mm vs. 3.2 ± 0.4 mm, P = 0.004) and longer (34 ± 18 mm vs. 26 ± 14 mm, P = 0.03) DESs were implanted. When compared with BMS group, minimum lumen area at follow-up was significantly greater in DES group (3.9 ± 1.8 mm(2) vs. 3.1 ± 1.5 mm(2) , P < 0.04), mainly attributable to suppression of neointimal hyperplasia (1.7 ± 0.8 mm(2) vs. 3.1 ± 1.5 mm(2) , P < 0.0001). The iMap analyses showed that neointima after DES placement was composed of smaller fibrotic component (67 ± 8% vs. 78 ± 7%, P < 0.0001), larger necrotic (14 ± 4% vs. 9 ± 3%, P < 0.0001) and calcified (15 ± 6% vs. 7 ± 4%, P < 0.0001) components compared with BMS. Logistic regression analysis showed that only intra-DES neointima was a significant predictor of necrotic neointima at follow-up. CONCLUSIONS DES implantation would be associated with iMap-derived necrotic and less-fibrotic neointimal formation. In vivo iMap evaluation of neointimal tissue may provide useful information in detecting impaired healing after stenting.
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Affiliation(s)
- Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Tsujita K, Sakamoto K, Kojima S, Kojima S, Takaoka N, Nagayoshi Y, Sakamoto T, Tayama S, Kaikita K, Hokimoto S, Sumida H, Sugiyama S, Nakamura S, Ogawa H. Coronary plaque component in patients with vasospastic angina: a virtual histology intravascular ultrasound study. Int J Cardiol 2013; 168:2411-5. [PMID: 23453453 DOI: 10.1016/j.ijcard.2013.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 11/01/2012] [Accepted: 02/05/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Coronary spasm plays an important role in the pathogenesis of ischemic heart disease. However, tissue components of coronary plaque in patients with vasospastic angina (VSA) have been unknown. This study used virtual histology (VH)-intravascular ultrasound (IVUS) to elucidate the tissue component of spastic coronary arteries and its gender differences in patients with VSA. METHODS According to acetylcholine provocation tests, the study subjects (42 patients [19 men, 23 women, 61 ± 13 years]) were divided into 2 groups: the VSA group of 26 patients and the non-VSA group of 16 patients. After nitrate injection, IVUS volumetric analysis was done, and the parameters were compared between the groups. RESULTS Although clinical demographics were almost identical between the groups, VSA group had lower plasma adiponectin level (5.9 ± 3.3 μg/ml vs. 11.2 ± 7.6 μg/ml, p=0.007) and tended to have higher high-sensitivity C-reactive protein (0.15 ± 0.24 mg/dl vs. 0.06 ± 0.04 mg/dl, p=0.1) than non-VSA group. VSA group had diffusely thickened intima (% plaque volume, 34 ± 11% vs. 27 ± 7%, p=0.01) compared with non-VSA group. However, plaque components of patients with VSA were similar with that of non-VSA patients (dense calcium, 4 ± 6% vs. 3 ± 4%; necrotic core, 10 ± 9% vs. 8 ± 6%; fibrofatty, 19 ± 16% vs. 22 ± 11%; and fibrous, 67 ± 16% vs. 67 ± 9%). Although male patients with VSA had atherogenic lipid and metabolic profiles than female VSA patients, there were no significant gender differences in the volumetric IVUS parameters and plaque components. CONCLUSIONS Compared with non-VSA patients, VSA patients had diffusely thickened fibrous-dominant coronary plaque without gender difference, and that might suggest the role of vasospasm in the development of atherosclerosis.
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Affiliation(s)
- Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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Inoue F, Ueshima K, Fujimoto T, An K, Uemura S, Saito Y. Coronary plaque characteristics that indicate distal embolization during percutaneous coronary intervention in patients with stable angina-virtual histology intravascular ultrasound study. Cardiovasc Interv Ther 2013; 28:227-34. [PMID: 23381575 DOI: 10.1007/s12928-013-0157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
Distal embolization (DE) is a serious complication of percutaneous coronary intervention (PCI) in patients with stable angina. The purpose of this study was to evaluate the coronary plaque characteristics that indicate DE during PCI in patients with stable angina using virtual histology intravascular ultrasound (VH-IVUS). Three hundred and sixty-four consecutive stable angina patients who underwent PCI were enrolled in this study. The patients were divided into two groups as follows: patients exhibiting DE (DE group, n = 10) and patients without DE (non-DE group, n = 354). Coronary plaque compositions were assessed by VH-IVUS. The fibro-fatty (FF) ratio (28 ± 17 vs. 11 ± 9 %, p < 0.0001) was higher in the DE group compared with the non-DE group. The best cut-off value of FF ratio for prediction of DE was 20 %, with a sensitivity of 0.80 and a specificity of 0.81 (odds ratio; 17.1, 95 % confidence interval 3.56-82.5, p = 0.0004). Coronary plaques with a high FF ratio may be the predictor of indicating DE in patients with stable angina during PCI.
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Affiliation(s)
- Fumitaka Inoue
- Department of Cardiology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan.
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Obaid DR, Calvert PA, McNab D, West NEJ, Bennett MR. Identification of coronary plaque sub-types using virtual histology intravascular ultrasound is affected by inter-observer variability and differences in plaque definitions. Circ Cardiovasc Imaging 2012; 5:86-93. [PMID: 22109982 DOI: 10.1161/circimaging.111.965442] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing inter-observer variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined. METHODS AND RESULTS Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappa=0.86), but lower for thin-capped fibroatheromatas (k=0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (k=0.71), particularly for thin-capped fibroatheromatas (k=0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (k=0.14). CONCLUSIONS VH-IVUS plaque classification, and particularly VH-IVUS-defined thin-capped fibroatheromata identification, varies significantly between local observers, and particularly in comparison with core-laboratory analysis. Differences in VH-IVUS plaque definitions introduce further variability between studies. These factors reduce the use of VH-IVUS plaque classification to guide intervention in a "live" clinical setting, and also affect comparison of diagnostic accuracy and natural history of plaques between studies.
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Affiliation(s)
- Daniel R Obaid
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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17
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Abstract
Cardiac allograft vasculopathy (CAV), characterized by diffuse intimal thickening and luminal narrowing in the arteries of the allograft, is the leading cause of morbidity and mortality in cardiac transplant recipients. Many transplant centers perform routine annual surveillance coronary angiography. However, angiography can underdiagnose or miss CAV due to its diffuse nature. Intravascular ultrasound (IVUS) is more sensitive than angiography. IVUS provides not only accurate information on lumen size, but also quantification of intimal thickening, vessel wall morphology, and composition. IVUS has evolved as a valuable adjunct to angiography and the optimal diagnostic tool for early detection. Noninvasive testing such as dobutamine stress echocardiography and nuclear stress test have shown considerable accuracy in diagnosing significant CAV. Computed tomographic imaging and cardiac magnetic resonance imaging are promising new modalities but require further study. This article reviews the diagnostic methods that are currently available.
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Shen X, Aronow WS, Nair CK, Korlakunta H, Holmberg MJ, Wang F, Maciejewski S, Esterbrooks DJ. Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography. Arch Med Sci 2011; 7:61-6. [PMID: 22291734 PMCID: PMC3258703 DOI: 10.5114/aoms.2011.20605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/29/2010] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA). MATERIAL AND METHODS We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70% narrowing). RESULTS HRCA was present in 45 of 187 patients (24%). AA severity was grade I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p< 0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ≤ 2 died (p= 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p= 0.002). CONCLUSIONS AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality.
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Affiliation(s)
- Xuedong Shen
- Cardiac Center of Creighton, University School of Medicine, Omaha, Nebraska, USA
| | - Wilbert S. Aronow
- Cardiology Division, Department of Medicine, New York Medical College, Valhalla, New York, USA
| | - Chandra K. Nair
- Cardiac Center of Creighton, University School of Medicine, Omaha, Nebraska, USA
| | - Hema Korlakunta
- Cardiac Center of Creighton, University School of Medicine, Omaha, Nebraska, USA
| | - Mark J. Holmberg
- Cardiac Center of Creighton, University School of Medicine, Omaha, Nebraska, USA
| | - Fenwei Wang
- Cardiac Center of Creighton, University School of Medicine, Omaha, Nebraska, USA
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Fisher SE, Harris AT, Khanna N, Sule-Suso J. Vibrational Spectroscopy: What Does the Clinician Need? BIOMEDICAL APPLICATIONS OF SYNCHROTRON INFRARED MICROSPECTROSCOPY 2010. [DOI: 10.1039/9781849731997-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Sheila E. Fisher
- Clinical Research Fellow, Section of Experimental Therapeutics, University of Leeds Room 6.01, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7JT, UK and Hon Senior Research Fellow, School of Health Studies, University of Bradford UK
| | - Andrew T Harris
- Cancer-Research UK Research Training Fellow Oral Biology, Leeds Dental Institute, University of Leeds UK
| | - Nitish Khanna
- Specialist Registrar in Medical Microbiology Western Infirmary Glasgow, Scotland UK
| | - Josep Sule-Suso
- Associate Specialist and Senior Lecturer in Oncology Cancer Centre, University Hospital of North Staffordshire and Keele University, Stoke-on-Trent UK
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20
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Abdel-Wahab M, Khattab AA, Toelg R, Geist V, Liska B, Richardt G. Plaque characteristics of nonobstructive coronary lesions in diabetic patients: an intravascular ultrasound virtual histology analysis. J Cardiovasc Med (Hagerstown) 2010; 11:345-51. [DOI: 10.2459/jcm.0b013e328333ebb2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Hong YJ, Jeong MH, Kim SW, Choi YH, Ma EH, Ko JS, Lee MG, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Relation between plaque components and plaque prolapse after drug-eluting stent implantation--virtual histology-intravascular ultrasound. Circ J 2010; 74:1142-51. [PMID: 20453386 DOI: 10.1253/circj.cj-09-0781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is not well known which plaque components are associated with the development of plaque prolapse (PP) and what are the major components in prolapsed plaque. The relationship between pre-stenting plaque components and post-stenting PP was assessed and the plaque components of prolapsed plaque were evaluated in patients who underwent drug-eluting stent (DES) implantation using virtual histology-intravascular ultrasound (VH-IVUS). METHODS AND RESULTS The study group consisted of 132 patients who underwent DES implantation and pre- and post-stenting VH-IVUS. Of these patients, 68 patients had 76 PP lesions and 64 patients had 76 non-PP lesions. Intra-stent PP volume was 3.6+/-1.5 mm(3). Plaque volume was significantly greater and absolute fibrotic (FT) and necrotic core (NC) volumes were significantly greater in PP lesions compared with non-PP lesions. On multivariate analysis, absolute NC (odds ratios [OR]=1.14, P<0.001) and FT volume (OR =1.09, P<0.001) were independently associated with the development of PP. In intra-stent prolapsed plaque the FT component was greatest, but the NC component was also large, and %NC volume correlated positively with Deltacreatine kinase-MB (r=0.489, P<0.001) and Deltatroponin-I (r=0.679, P<0.001), and %FT volume correlated negatively with DeltaCK-MB (r=-0.539, P<0.001) and Deltatroponin-I. CONCLUSIONS NC and FT components were associated with development of PP; and NC and FT components in prolapsed plaque were associated with cardiac enzyme elevation after DES implantation.
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Affiliation(s)
- Young Joon Hong
- Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
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Abstract
This article provides a systematic approach to vulnerable plaques. It is divided into 4 sections. The first section is devoted to definition, incidence, anatomic distribution, and clinical presentation. The second section is devoted to plaque composition, setting up the foundations to understand plaque vulnerability. The third section relates to invasive plaque imaging. The fourth section is devoted to therapy, from conservative pharmacologic options to aggressive percutaneous coronary intervention alternatives.
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Affiliation(s)
- Pedro R Moreno
- Zena and Michael A. Wiener Cardiovascular Institute and The Marie-Josee and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, Box 1030, New York, NY 10029, USA.
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Relation between N-terminal pro-B-type natriuretic peptide and coronary plaque components in patients with acute coronary syndrome: virtual histology-intravascular ultrasound analysis. Coron Artery Dis 2010; 20:518-24. [PMID: 19838110 DOI: 10.1097/mca.0b013e32832a196e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a sensitive indicator of hemodynamic stress and its increased level is associated with higher mortality in acute coronary syndrome (ACS) patients. Virtual histology-intravascular ultrasound (VH-IVUS) can provide quantitative information on plaque components. METHODS We measured preprocedural serum NT-pro-BNP levels in 156 ACS patients with preserved left ventricular systolic function and normal serum creatinine. VH-IVUS classified the color-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (>or=10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden of at least 40%. We divided the patients into two groups according to the NT-pro-BNP levels [group I: >or=200 pg/ml (n = 58) vs. group II: <200 pg/ml (n = 98)]. RESULTS The percent areas of NC at the minimum lumen site (19.8+/-13.1% vs. 15.2+/-11.1%, P = 0.027) and at the largest NC site (24.7+/-10.3% vs. 19.2+/-11.4%, P = 0.015) were significantly greater in group I than in group II. Percent NC volume was significantly greater in group I than in group II (15.8+/-8.1% vs. 10.1+/-9.1%, P = 0.008). The total number of TCFAs was 38 in group I and 56 in group II. The presence of at least one TCFA (58 vs. 38%, P = 0.009) and multiple TCFAs (25 vs. 10%, P = 0.005) within culprit lesions were observed more frequently in group I than in group II. The TCFAs were located more in proximal in group I than in group II [the length from coronary ostium to TCFA: 10.8+/-7.6 mm in group I vs. 25.7+/-16.3 mm in group II (P<0.001)]: 85% of TCFAs was located within 20 mm from coronary ostium in group I; conversely only 36% of TCFAs was located within 20 mm from coronary ostium in group II (P<0.001). CONCLUSION VH-IVUS analysis shows that ACS patients with high NT-pro-BNP levels had more vulnerable plaque component (more NC-containing lesions and higher frequency of culprit lesion TCFAs) and had more proximally located TCFAs.
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Gonzalo N, Serruys PW, Barlis P, Ligthart J, Garcia-Garcia HM, Regar E. Multi-modality intra-coronary plaque characterization: A pilot study. Int J Cardiol 2010; 138:32-9. [DOI: 10.1016/j.ijcard.2008.08.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 06/04/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
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Hetterich H, Redel T, Lauritsch G, Rohkohl C, Rieber J. New X-ray imaging modalities and their integration with intravascular imaging and interventions. Int J Cardiovasc Imaging 2009; 26:797-808. [PMID: 19898992 DOI: 10.1007/s10554-009-9529-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 10/22/2009] [Indexed: 12/17/2022]
Affiliation(s)
- H Hetterich
- Department of Cardiology, Medizinische Poliklinik, University of Munich, Ziemssenstrasse 1, Munich, Germany
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26
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Qian J, Maehara A, Mintz GS, Margolis MP, Biro S, Stone GW, Leon MB. Relation between individual plaque components and overall plaque burden in the prospective, multicenter virtual histology intravascular ultrasound registry. Am J Cardiol 2009; 104:501-6. [PMID: 19660602 DOI: 10.1016/j.amjcard.2009.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/02/2009] [Accepted: 04/02/2009] [Indexed: 10/20/2022]
Abstract
The impact of total plaque burden on absolute and relative amounts of each virtual histologic (VH) intravascular ultrasound (IVUS) plaque component has yet to be studied. We analyzed gray-scale and VH-IVUS findings in the first 990 patients enrolled in the 3,000+ patient global VH-IVUS registry. Whole pullback plaque burden and absolute and relative cross-sectional areas of fibrous tissue, fibrofatty plaque, dense calcium, and necrotic core were analyzed using a linear regression statistical model. Overall, absolute cross-sectional areas of each of the 4 plaque components correlated with total plaque cross-sectional area; however, the correlation between fibrous tissue and total plaque cross-sectional area was stronger than the correlation between fibrofatty plaque, dense calcium, or necrotic core and total plaque cross-sectional area. This was also true overall for each of the subgroups analyzed (gender, age, and presence/absence of acute coronary syndromes). Slope of the regression line relating each plaque component to overall plaque mass showed that 50% of the plaque cross-sectional area increase was because of fibrous tissue with a more gradual increase in fibrofatty plaque, dense calcium, and necrotic core. However, when comparing relative amounts of each plaque component with total plaque cross-sectional area, there was no significant relation between the increase in fibrous tissue, fibrofatty plaque, dense calcium, and necrotic core and the increase in total plaque cross-sectional area. In conclusion, only the absolute area of each plaque component correlated to overall plaque area, not the relative amount of each plaque; therefore, VH-IVUS plaque component increases must be analyzed by controlling for increases in plaque mass.
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Plaque components at coronary sites with focal spasm in patients with variant angina: virtual histology-intravascular ultrasound analysis. Int J Cardiol 2009; 144:367-72. [PMID: 19450889 DOI: 10.1016/j.ijcard.2009.04.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 03/15/2009] [Accepted: 04/23/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND We compared the plaque components at coronary sites with focal spasm after ergonovine provocation test in 30 variant angina (VA) patients with those at culprit coronary sites in 32 unstable angina (UA) patients using virtual histology-intravascular ultrasound (VH-IVUS). METHODS VH-IVUS classified and color-coded tissue into four major components: fibrotic; fibro-fatty; dense calcium (DC); and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as a NC≥10% of plaque area in at least 3 consecutive frames without overlying fibrous tissue in the presence of ≥40% plaque burden. RESULTS The lesion site plaque burden was significantly smaller (44.5±10.8% vs. 70.5±13.1%, p<0.001), the plaque volume was significantly smaller (135±118 mm³ vs. 223±160 mm³, p=0.020), the remodeling index was significantly lower (0.90±0.14 vs. 0.97±0.23, p=0.023), and more plaque was hypoechoic with less calcium (87% vs. 56% and 0% vs. 19%, respectively, p=0.033) in VA patients compared with UA patients. The % NC and DC areas were significantly smaller at the minimum lumen site within spasm/culprit lesion (12.9±12.9% vs. 22.3±11.7%, p=0.004, and 6.5±8.0% vs. 12.8±10.8%, p=0.011, respectively), and the % NC and DC volumes were significantly smaller in VA patients compared with UA patients (12.2±10.3% vs. 17.7±8.1%, p=0.025, and 6.4±6.0% vs. 11.8±8.5%, p=0.007, respectively). The TCFA within lesion segments was less frequently observed in VA patients compared with UA patients (13% vs. 53%, p=0.001). CONCLUSIONS VA patients have less plaque, more negative remodeling behavior, more hypoechoic plaque with less calcification, and less NC- and DC-containing lesions and less TCFA lesions compared with UA patients.
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Qian J, Maehara A, Mintz GS, Margolis MP, Lerman A, Rogers J, Banai S, Kazziha S, Castellanos C, Dani L, Fahy M, Stone GW, Leon MB. Impact of gender and age on in vivo virtual histology-intravascular ultrasound imaging plaque characterization (from the global Virtual Histology Intravascular Ultrasound [VH-IVUS] registry). Am J Cardiol 2009; 103:1210-4. [PMID: 19406261 DOI: 10.1016/j.amjcard.2009.01.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 01/13/2009] [Accepted: 01/13/2009] [Indexed: 01/08/2023]
Abstract
Virtual histology intravascular ultrasound (VH-IVUS) analyses were performed in the first 990 patients enrolled in the 3,000+ patient global VH-IVUS Registry to assess the impact of gender and age on in vivo VH-IVUS plaque characterization. The 990 patients were divided into 3 age group terciles (<58, 58 to 68, and >68 years) and again divided according to gender. In conclusion, (1) both women and men had an increase in plaque with increasing age; (2) at any age, men had more plaque than women; (3) percentages of dense calcium and necrotic core increased with increasing patient age in both men and women; and (4) gender differences were lowest in the oldest tercile (>68 years).
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29
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Hong YJ, Mintz GS, Kim SW, Lee SY, Okabe T, Pichard AD, Satler LF, Waksman R, Kent KM, Suddath WO, Weissman NJ. Impact of Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention. JACC Cardiovasc Imaging 2009; 2:458-68. [DOI: 10.1016/j.jcmg.2008.12.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 12/02/2008] [Accepted: 12/19/2008] [Indexed: 11/30/2022]
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30
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Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, Yoon NS, Youn HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis. Eur Heart J 2009; 32:2059-66. [PMID: 19228713 PMCID: PMC3155758 DOI: 10.1093/eurheartj/ehp034] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aims We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients. Methods and results A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6 ± 1.2 vs. 0.9 ± 0.8 mm2, P < 0.001, and 24.5 ± 14.3 vs. 16.1 ± 10.6%, P = 0.001, respectively) and the absolute and %NC volumes (30 ± 24 vs. 16 ± 17 mm3, P = 0.001, and 22 ± 11 vs. 14 ± 8%, P < 0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P = 0.001, and 38 vs. 15%, P = 0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio = 1.126; 95% CI 1.045–1.214, P = 0.002). Conclusion In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, 671 Jaebongro, Dong-gu, Gwangju 501-757, Republic of Korea
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Rodriguez Granillo GA. Non-invasive assessment of vulnerable plaque. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:53-66. [PMID: 23495963 DOI: 10.1517/17530050802607357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sudden cardiac death or unheralded acute coronary syndromes are common initial manifestations of coronary atherosclerosis and most such events occur at sites of non-flow limiting coronary atherosclerosis. OBJECTIVE Non-invasive detection of high-risk plaques might provide a means to improve risk stratification in primary and secondary prevention settings. METHODS This review is focused on the potential of multidetector computed tomography coronary angiography (MDCT-CA) to provide the opportunity to identify different aspects of plaque vulnerability throughout the coronary tree in an accurate, fast, safe and non-invasive manner. CONCLUSION Coronary artery calcium scoring, on top of established risk stratification, could potentially be a cost-effective strategy for primary prevention. MDCT-CA allows a non-invasive evaluation of several features commonly seen in vulnerable plaques and has demonstrated an independent prognostic value on a patient basis. The value of the technique itself might result, potentially, in a better estimation of the relative risk of an invidual plaque to rupture.
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Affiliation(s)
- Gastón A Rodriguez Granillo
- Otamendi Hospital, Clínica La Sagrada Familia, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Department of Cardiovascular Imaging, Azcuenaga 870, Buenos Aires, Argentina +54 11 49648740 ; +54 11 49648740 ;
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32
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Multicenter assessment of coronary allograft vasculopathy by intravascular ultrasound-derived analysis of plaque composition. ACTA ACUST UNITED AC 2008; 6:61-9. [DOI: 10.1038/ncpcardio1410] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 09/30/2008] [Indexed: 11/08/2022]
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Tanimoto S, Bruining N, van Domburg RT, Rotger D, Radeva P, Ligthart JM, Serruys PW. Late Stent Recoil of the Bioabsorbable Everolimus-Eluting Coronary Stent and its Relationship With Plaque Morphology. J Am Coll Cardiol 2008; 52:1616-20. [DOI: 10.1016/j.jacc.2008.08.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/08/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
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Missel E, Mintz GS, Carlier SG, Qian J, Shan S, Castellanos C, Kaple R, Biro S, Fahy M, Moses JW, Stone GW, Leon MB. In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry. Eur Heart J 2008; 29:2141-7. [PMID: 18596073 DOI: 10.1093/eurheartj/ehn293] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and risk factors histopathologically associated with sudden coronary death (SCD) in men: cigarette smoking and an increased total cholesterol-to-high-density lipoprotein cholesterol (HDL-C) ratio (TC/HDL > 5). METHODS AND RESULTS We assessed volumetric VH-IVUS parameters in a consecutive series of 473 male patients: fibrous, fibro-fatty, dense calcium (DC), necrotic core (NC), and a calculated NC/DC ratio. Patients' age was 61 ± 11 years, with 27% smokers and 69% having a lipid disorder. The NC/DC ratio was the only VH-IVUS parameter related to both TC/HDL ratio (r = 0.18, P= 0.0008) and low-density lipoprotein cholesterol levels (r = 0.17, P= 0.002); had a negative correlation with HDL-C levels (r = -0.11, P= 0.03); and was higher for smokers [median 1.98 (1.35-3.18)] vs. non-smokers [median 1.70 (1.23-2.53), P= 0.006]. An NC/DC value >3 was the threshold that best identified smokers and/or patients presenting TC/HDL >5 (odds ratio 3.0, 95% CI 1.7-4.9, P= 0.0001), and receiver-operator curves showed the superiority of the NC/DC ratio [area under curve (AUC) 0.64, P < 0.0001] over %DC (AUC 0.58, P= 0.006) or %NC (AUC 0.51, P= 0.43) to identify these patients. CONCLUSION The ratio of NC to calcification detected by VH-IVUS in diseased coronary segments is related to known risk factors for SCD and, thus, may be associated with a worse prognosis.
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Affiliation(s)
- Eduardo Missel
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA
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Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK. In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 2008; 29:1721-8. [PMID: 18577556 DOI: 10.1093/eurheartj/ehn286] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Positive coronary arterial remodelling has been shown to be associated with unstable coronary syndromes and ex vivo histological characteristics of plaque vulnerability such as a large lipid core and high macrophage content. The aim of this study is to evaluate the in vivo association between coronary artery remodelling and underlying plaque characteristics identified by optical coherence tomography (OCT). OCT is a unique imaging modality capable of characterizing these important morphological features of vulnerable plaque. METHODS AND RESULTS OCT and intravascular ultrasound imaging was performed at corresponding sites in patients undergoing catheterization. OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (two or more quadrants) with fibrous cap thickness <65 microm. Remodelling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area. A total of 54 lesions from 48 patients were imaged. Positive remodelling compared with absent or negative remodelling was more commonly associated with lipid-rich plaque (100 vs. 60 vs. 47.4%, P = 0.01), a thin fibrous cap (median 40.2 vs. 51.6 vs. 87 microm, P = 0.003) and the presence of TCFA (80 vs. 38.5 vs. 5.6%, P < 0.001). Fibrous cap macrophage density was also higher in plaques with positive remodelling showing a positive linear correlation with the RI (r = 0.60, P < 0.001). CONCLUSION Coronary plaques with positive remodelling exhibit characteristic features of vulnerable plaque. This may explain the link between positive remodelling and unstable clinical presentations.
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Affiliation(s)
- Owen Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
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Coronary plaque composition as assessed by greyscale intravascular ultrasound and radiofrequency spectral data analysis. Int J Cardiovasc Imaging 2008; 24:811-8. [DOI: 10.1007/s10554-008-9324-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 05/26/2008] [Indexed: 11/26/2022]
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Missel E, Mintz GS, Carlier SG, Sano K, Qian J, Kaple RK, Castellanos C, Dangas G, Mehran R, Moses JW, Stone GW, Leon MB. Necrotic core and its ratio to dense calcium are predictors of high-risk non-ST-elevation acute coronary syndrome. Am J Cardiol 2008; 101:573-8. [PMID: 18308001 DOI: 10.1016/j.amjcard.2007.10.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 10/02/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
Abstract
Increased creatine kinase-MB levels and ST-segment depression are well-known prognostic factors in the setting of non-ST-elevation acute coronary syndrome (ACS). We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these prognostic factors. We performed "whole vessel" VH-IVUS analysis in culprit arteries of 225 patients with ACS and measured the 4 basic VH-IVUS coronary plaque components--fibrous, fibrofatty, dense calcium (DC), and necrotic core (NC)--and calculated a NC/DC ratio. Patients' age was 62 +/- 11 years; 72% were men and 23% had diabetes. Only the NC/DC ratio had a positive association with creatine kinase-MB levels (r = 0.21, p = 0.03), and it was significantly higher for patients with ST-depression compared with those with non-ST-depression ACS (1.97 +/- 1.46 vs 1.58 +/- 1.10, p = 0.02). Sensitivity and specificity curves determined that a NC/DC value > or =2 (odds ratio 3.8, p = 0.01) and percentage of NC > or =6 (odds ratio 3.1, p = 0.04) were thresholds that best separated patients with high-risk non-ST-elevation ACS from those without abnormal creatine kinase-MB or ST depression. Patients with both predictors had significantly higher total cholesterol (204.7 +/- 60.5 vs 173.6 +/- 44.3 mg/dl, p = 0.01), higher low-density liprotein cholesterol (132.5 +/- 49.8 vs 101.3 +/- 33.2 mg/dl, p = 0.02), and more myocardial injury (creatine kinase-MB value of 42 +/- 38 vs 12 +/- 21, p = 0.01) than patients with no predictors. In conclusion, VH-IVUS analysis showed that the percentage of NC and its ratio to DC in diseased coronary segments are positively associated with a high-risk ACS presentation.
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38
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Comparison of coronary plaque composition among patients with acute coronary syndrome and stable coronary artery disease. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200803020-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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39
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Kips JG, Segers P, Van Bortel LM. Identifying the vulnerable plaque: A review of invasive and non-invasive imaging modalities. Artery Res 2008. [DOI: 10.1016/j.artres.2007.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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40
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Abdel-Wahab M, Khattab A, Liska B, Toelg R, El-Hammady W, Farag N, Geist V, Ramzy A, Richardt G. Relationship between cardiovascular risk as predicted by established risk scores and coronary artery plaque composition as detected by virtual histology intravascular ultrasound analysis: the PREDICT pilot study. EUROINTERVENTION 2008; 3:482-9. [DOI: 10.4244/eijv3i4a86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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41
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Takayama K, Taoka T, Nakagawa H, Myouchin K, Wada T, Sakamoto M, Fukusumi A, Iwasaki S, Kurokawa S, Kichikawa K. Successful percutaneous transluminal angioplasty and stenting for symptomatic intracranial vertebral artery stenosis using intravascular ultrasound virtual histology. ACTA ACUST UNITED AC 2007; 25:243-6. [PMID: 17581715 DOI: 10.1007/s11604-007-0127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
This is the first report of percutaneous transluminal angioplasty (PTA) of an intracranial artery applying intravascular ultrasound virtual histology (IVUS-VH), which has been recently developed for tissue characterization of coronary artery plaque. We report a case of successful PTA and stenting for symptomatic intracranial vertebral artery stenosis using IVUS-VH.
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Affiliation(s)
- Katsutoshi Takayama
- Department of Interventional Neuroradiology, Ishinkai Yao General Hospital, 1-41 Numa, Yao, 581-0036, Japan.
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Kuo WC, Chou NK, Chou C, Lai CM, Huang HJ, Wang SS, Shyu JJ. Polarization-sensitive optical coherence tomography for imaging human atherosclerosis. APPLIED OPTICS 2007; 46:2520-7. [PMID: 17429466 DOI: 10.1364/ao.46.002520] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Polarization-sensitive optical coherence tomography (PS-OCT) combines the advantages of OCT with image contrast enhancement, which is based on its ability to detect phase retardation and the fast-axis angle. Both PS-OCT images and histopathology have demonstrated similar features that allowed differentiation of atherosclerotic structures (i.e., plaques) from normal tissue. Moreover, the picrosirius polarization method was used to confirm PS-OCT assessment of collagen in the fibrous cap of atherosclerotic plaques, and high-frequency (40 MHz) ultrasound images were used to identify calcium in the vessel wall. Our preliminary ex vivo investigation of human aortic specimens indicated that PS-OCT might help to identify atherosclerotic lesions.
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Affiliation(s)
- Wen-Chuan Kuo
- Institute of Electro-Optical Science and Technology, National Taiwan Normal University, Taipei 116, Taiwan
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43
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Bruining N, Verheye S, Knaapen M, Somers P, Roelandt JR, Regar E, Heller I, de Winter S, Ligthart J, Van Langenhove G, de Feijter PJ, Serruys PW, Hamers R. Three-dimensional and quantitative analysis of atherosclerotic plaque composition by automated differential echogenicity. Catheter Cardiovasc Interv 2007; 70:968-78. [DOI: 10.1002/ccd.21310] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Coronary events often result from thrombi that form because of physical disruption of the atherosclerotic plaque. The dynamic nature of the plaque offers the opportunity to intervene to modify plaque biology with lifestyle changes and, if needed, pharmacologic measures. Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (statins) reduce levels of serum cholesterol and decrease the incidence of coronary events, but some of the benefits of statins may not depend on their effects on circulating lipids. Indeed, increasing evidence suggests that statins may also enhance plaque stability. Such evidence includes results of preclinical studies with experimental atherosclerosis as well as imaging data and analyses of proinflammatory and prothrombotic mediators in clinical trials. Currently, however, no studies have demonstrated conclusively the mechanisms underlying the unexpected magnitude and rapidity of statin benefits. This article reviews the evolution of the concept of plaque stabilization and reexamines the evidence for the role of statins in that process.
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Affiliation(s)
- Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02135, USA.
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45
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Rieber J, Meissner O, Babaryka G, Reim S, Oswald M, Koenig A, Schiele TM, Shapiro M, Theisen K, Reiser MF, Klauss V, Hoffmann U. Diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of atherosclerotic plaque composition in ex-vivo coronary specimens: a comparison with histology. Coron Artery Dis 2006; 17:425-30. [PMID: 16845250 DOI: 10.1097/00019501-200608000-00005] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both intravascular ultrasound and optical coherence tomography have been purported to accurately detect and characterize coronary atherosclerotic plaque composition. The aim of our study was to directly compare the reproducibility and diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of coronary plaque composition ex vivo as compared with histology. METHODS AND RESULTS Intravascular ultrasound (20 MHz) and optical coherence tomography imaging was performed in eight heart specimens using motorized pullback. Standard histology using hematoxylin-eosin and van Gieson staining was performed on 4 mum thick slices. Each slice was divided into quadrants and accurately matched cross-sections were analyzed for the presence of fibrous, lipid-rich, and calcified coronary plaque using standard definitions for both intravascular ultrasound and optical coherence tomography and correlated with histology. After exclusion of 145/468 quadrants, we analyzed the remaining 323 quadrants with excellent image quality in each procedure. Optical coherence tomography demonstrated a sensitivity and specificity of 91/88% for normal wall, 64/88% for fibrous plaque, 77/94% for lipid-rich plaque, and 67/97% for calcified plaque as compared with histology. Intravascular ultrasound demonstrated a sensitivity and specificity of 55/79% for normal wall, 63/59% for fibrous plaque, 10/96% for lipid-rich plaque, and 76/98% for calcified plaque. Both intravascular ultrasound and optical coherence tomography demonstrated excellent intraobserver and interobserver agreement (optical coherence tomography: kappa=0.90, kappa=0.82; intravascular ultrasound: kappa=0.87, kappa=0.86). CONCLUSION Optical coherence tomography is superior to intravascular ultrasound for the detection and characterization of coronary atherosclerotic plaque composition, specifically for the differentiation of noncalcified, lipid-rich, or fibrous plaque.
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Affiliation(s)
- Johannes Rieber
- Department of Cardiology, Division of Internal Medicine, Institute for Clinical Radiology, University of Munich, Germany, and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Rodriguez-Granillo GA, García-García HM, Valgimigli M, Vaina S, van Mieghem C, van Geuns RJ, van der Ent M, Regar E, de Jaegere P, van der Giessen W, de Feyter P, Serruys PW. Global characterization of coronary plaque rupture phenotype using three-vessel intravascular ultrasound radiofrequency data analysis. Eur Heart J 2006; 27:1921-7. [PMID: 16840496 DOI: 10.1093/eurheartj/ehl104] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To compare the global characteristics of patients with and without evidence of plaque rupture (PR) in their coronary tree and to evaluate the phenotype of ruptured plaques using intravascular ultrasound (IVUS) radiofrequency data analysis (IVUS-VH). METHODS AND RESULTS Forty patients underwent three-vessel IVUS-VH interrogation. Twenty-eight PRs were diagnosed in 26 vessels (25.7% of the vessels studied) of 20 patients (50% of the population). Ruptures located in the left anterior descending were clustered in the proximal part of the vessel, whereas ruptures located in the right coronary artery were more distally located (P=0.02). Patients with at least one PR presented larger body mass index (BMI) (28.4+/-3.7 vs. 25.8+/-2.6 kg/m(2), P=0.01) and plaque burden (40.7+/-7.6 vs. 33.7+/-8.4%, P=0.01) than patients without rupture, despite showing similar lumen cross-sectional area (9.6+/-3.3 vs. 9.2+/-2.3 mm(2), P=0.60). Among current smokers, 66.7% presented a PR in their coronary tree. Finally, PR sites showed a higher content of necrotic core compared with minimum lumen area sites (17.48+/-10.8 vs. 13.10+/-6.5%, P=0.03) and a trend towards higher calcified component. CONCLUSION Patients with at least one PR in their coronary tree presented larger BMI and worse IVUS-derived characteristics compared with patients without PR.
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Affiliation(s)
- Gastón A Rodriguez-Granillo
- Department of Cardiology, Thoraxcenter, Erasmus MC, Bd-406, Dr Molewaterplein 40, PO Box 1738, 3015-GD Rotterdam, The Netherlands
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Kawasaki M, Bouma BE, Bressner J, Houser SL, Nadkarni SK, MacNeill BD, Jang IK, Fujiwara H, Tearney GJ. Diagnostic Accuracy of Optical Coherence Tomography and Integrated Backscatter Intravascular Ultrasound Images for Tissue Characterization of Human Coronary Plaques. J Am Coll Cardiol 2006; 48:81-8. [PMID: 16814652 DOI: 10.1016/j.jacc.2006.02.062] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 02/21/2006] [Accepted: 02/27/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of the present study was to validate the diagnostic accuracy of optical coherence tomography (OCT), integrated backscatter intravascular ultrasound (IB-IVUS), and conventional intravascular ultrasound (C-IVUS) for tissue characterization of coronary plaques and to evaluate the advantages and limitations of each of these modalities. BACKGROUND The diagnostic accuracy of OCT for characterizing tissue types is well established. However, comparisons among OCT, C-IVUS, and IB-IVUS have not been done. METHODS We examined 128 coronary arterial sites (42 coronary arteries) from 17 cadavers; IVUS and OCT images were acquired on the same slice as histology. Ultrasound signals were obtained using an IVUS system with a 40-MHz catheter and digitized at 1 GHz with 8-bit resolution. The IB values of the ultrasound signals were calculated with a fast Fourier transform. RESULTS Using histological images as a gold standard, the sensitivity of OCT for characterizing calcification, fibrosis, and lipid pool was 100%, 98%, and 95%, respectively. The specificity of OCT was 100%, 94%, and 98%, respectively (Cohen's kappa = 0.92). The sensitivity of IB-IVUS was 100%, 94%, and 84%, respectively. The specificity of IB-IVUS was 99%, 84%, and 97%, respectively (Cohen's kappa = 0.80). The sensitivity of C-IVUS was 100%, 93%, and 67%, respectively. The specificity of C-IVUS was 99%, 61%, and 95%, respectively (Cohen's kappa = 0.59). CONCLUSIONS Within the penetration depth of OCT, OCT has a best potential for tissue characterization of coronary plaques. Integrated backscatter IVUS has a better potential for characterizing fibrous lesions and lipid pools than C-IVUS.
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Affiliation(s)
- Masanori Kawasaki
- Wellman Laboratories of Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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48
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Rodriguez-Granillo GA, Vaina S, García-García HM, Valgimigli M, Duckers E, van Geuns RJ, Regar E, van der Giessen WJ, Bressers M, Goedhart D, Morel MA, de Feyter PJ, Serruys PW. Reproducibility of intravascular ultrasound radiofrequency data analysis: implications for the design of longitudinal studies. Int J Cardiovasc Imaging 2006; 22:621-31. [PMID: 16575482 DOI: 10.1007/s10554-006-9080-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 01/19/2006] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The purpose of this study was to assess in vivo the reproducibility of tissue characterization using spectral analysis of intravascular ultrasound (IVUS) radiofrequency data (IVUS-VH). BACKGROUND Despite the need for reproducibility data to design longitudinal studies, such information remains unexplored. METHODS AND RESULTS IVUS-VH (Volcano Corp., Rancho Cordova, USA) was performed in patients referred for elective percutaneous intervention and in whom a non-intervened vessel was judged suitable for a safe IVUS interrogation. The IVUS catheters used were commercially available catheters (20 MHz, Volcano Corp., Rancho Cordova, USA). Following IVUS-VH acquisition, and after the disengagement and re-engagement of the guiding catheter, an additional acquisition was performed using a new IVUS catheter. Fifteen patients with 16 non-significant lesions were assessed by 2 independent observers. The relative inter-catheter differences regarding geometrical measurements were negligible for both observers. The inter-catheter relative difference in plaque cross-sectional area (CSA) was 3.2% for observer 1 and 0.5% for observer 2. The limits of agreement for (observer 1 measurements) lumen, vessel, plaque and plaque burden measurements were 0.82, -1.10 mm(2); 0.80, -0.66 mm(2); 1.08, -0.66 mm(2); and 5.83, -3.89%; respectively. Limits of agreement for calcium, fibrous, fibrolipidic and necrotic core CSA measurements were 0.22, -0.25 mm(2); 1.02, -0.71 mm(2); 0.61, -0.65 mm(2); and 0.43, -0.38 mm(2) respectively. Regarding the inter-observer agreement, the limits of agreement for lumen, vessel, plaque and plaque burden measurements were 2.61, -2.09 mm(2); 2.20-3.03 mm(2); 1.70, -3.04 mm(2); and 9.16, -16.41%; respectively, and for calcium, fibrous, fibrolipidic and necrotic core measurements of 0.08, -0.09 mm(2); 0.89, -1.28 mm(2); 0.74, -1.06 mm(2); and 0.16, -0.20 mm(2); respectively. CONCLUSIONS The present study demonstrates that the geometrical and compositional output of IVUS-VH is acceptably reproducible.
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Pershad A, Buchbinder M. Management of calcified lesions in 2004. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2005; 7:199-204. [PMID: 16373267 DOI: 10.1080/14628840500339512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Calcified lesions are encountered with increasing frequency in the catheterization laboratory. Percutaneous coronary interventions of calcified lesions are associated with a higher complication rate than percutaneous intervention on non-calcified lesions. The review focuses on current management strategies in the drug eluting stent era of this complex lesion subset. Evidence based approaches to treat calcified coronary lesions with balloon based and atherectomy devices as adjunctive modalities in the drug eluting stent era are discussed in this article.
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Affiliation(s)
- Ashish Pershad
- Heart and Vascular Center of Arizona, Phoenix, AZ 85006, USA
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Fujii K, Carlier SG, Mintz GS, Wijns W, Colombo A, Böse D, Erbel R, de Ribamar Costa J, Kimura M, Sano K, Costa RA, Lui J, Stone GW, Moses JW, Leon MB. Association of plaque characterization by intravascular ultrasound virtual histology and arterial remodeling. Am J Cardiol 2005; 96:1476-83. [PMID: 16310425 DOI: 10.1016/j.amjcard.2005.07.054] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 07/07/2005] [Accepted: 07/07/2005] [Indexed: 11/22/2022]
Abstract
Positive remodeling is more often observed in lesions of patients who have acute coronary syndromes or vulnerable (rupture-prone) plaques. However, there are few data that correlate plaque morphology, composition, and arterial remodeling in vivo. We evaluated coronary plaque characterization of lesions with positive remodeling using intravascular ultrasound (IVUS) radiofrequency data analysis. Seventy-seven nonbifurcation native coronary lesions (in 50 patients) were imaged in vivo using 30-MHz IVUS transducers. Lesions were classified into 4 plaque types, fibrous, fibrofatty, dense calcium, and necrotic core, by using processing of the radiofrequency signal validated in vitro. The remodeling index was calculated as the lesion external elastic membrane area divided by the proximal reference external elastic membrane area. Lesions were divided into 2 groups: positive remodeling (remodeling index>1.0, 26 lesions) and intermediate/negative remodeling (remodeling index<or=1.0, 51 lesions). Total plaque volume and the volume of each plaque type were averaged over the length of the lesion. Reference segment plaque compositions were similar. Mean lesion fibrofatty plaque area was significantly larger in lesions with positive remodeling than in lesions with intermediate/negative remodeling (1.2+/-0.7 vs 0.8+/-0.4 mm2, p=0.001; 26.3+/-6.6% vs 19.8+/-5.7%, p<0.001, of total plaque volume). The same results were obtained at the minimum lumen site and in the subgroup of patients who had acute coronary syndromes. Further, there was a linear relation between remodeling index and fibrofatty plaque area (r=0.26, p=0.02). In conclusion, in vivo IVUS radiofrequency data analysis demonstrates that positive remodeling occurs in lesions with more fibrofatty plaque.
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Affiliation(s)
- Kenichi Fujii
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA
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