Coronary plaque composition of culprit/target lesions according to the clinical presentation: a virtual histology intravascular ultrasound analysis

Surmely, Jean‐François; Nasu, Kenya; Fujita, Hiroshi; Terashima, Mitsuyasu; Matsubara, Takehiro; Tsuchikane, Etsuo; Ehara, Mariko; Kinoshita, Yoshihisa; Zheng, Quan; Tanaka, Nobuyoshi; Katoh, Osamu; Suzuki, Takahiko

doi:10.1093/eurheartj/ehl285

Cited by 57 publications

(30 citation statements)

References 35 publications

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“…43 On the other hand, controversial results also exist on the relationship between the virtual histology findings and clinical presentations (less necrotic core and more fibrous tissue in acute coronary syndromes). 44 Current technical limitations include limited spatial resolution (100 to 250 m), no classifications for thrombus, blood, or intimal hyperplasia, and potential errors due to poor ultrasound penetration through extensive calcification. Among several multicenter studies initiated worldwide, PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) is one of the largest natural history trials; it used 3-vessel imaging with Virtual Histology and IVUS palpography (see below) in 700 acute coronary syndrome patients.…”

Section: Ultrasound-based Approachesmentioning

confidence: 99%

Frontiers in Intravascular Imaging Technologies

Honda

Fitzgerald

2008

Circulation

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I n 1971, Bom et al 1 developed one of the first catheterbased real-time imaging techniques for use in the cardiac system. In placing a set of phased-array ultrasound transducers within the cardiac chambers, Bom and colleagues showed that higher frequencies than those used in transthoracic ultrasound imaging could be used to produce high-resolution images of cardiac structures. By the late 1980s, Yock et al 2 had successfully miniaturized a single-transducer system to enable transducer placement within coronary arteries. Since then, intravascular ultrasound (IVUS) has become a pivotal catheter-based imaging technology, having provided practical guidance for percutaneous interventions and scientific insights into vascular biology in clinical settings. Technical developments currently being explored consist of further device improvements, a variety of advanced image analyses, and the extension of this ultrasound-based approach to diverse intravascular imaging techniques with other energy sources. Principles and Device DevelopmentsUltrasound-Based Approaches IVUS systems produce tomographic images by performing a series of pulse/echo sequences, or vectors, in which an acoustic pulse is emitted and the subsequent reflections from the tissue are detected. Each vector is acquired by directing the ultrasound beam from the catheter in a slightly different direction from the previous vector by mechanical or electrical means. A gray-scale IVUS image is made with all the vectors (commonly 256 vectors), with each vector acquired at a different angle of rotation.Several clinically relevant properties of the ultrasound image, such as the resolution, depth of penetration and attenuation of the acoustic pulse by tissue, are dependent on the geometric and frequency properties of the transducer. A crystal transducer emits a signal that spans a range of frequencies. The higher the center frequency, the better the radial resolution (Figure 1) but the lower the depth of penetration. Conventional IVUS catheters used in the coronary arteries have center frequencies that range from 20 MHz to 40 MHz, thus providing theoretical lower limits of resolution (calculated as half the wavelength) of 39 and 19 m, respectively. In practice, the radial resolution is at least 2 to 5 times poorer, as determined by factors such as the length of the emitted pulse and the position of the imaged structures relative to the transducer.For peripheral and intracardiac echocardiographic (ICE) applications, larger imaging catheters with lower center frequencies (8 to 20 MHz) are produced in both mechanical and electrical configurations. In addition, a phased-array intracardiac echocardiography catheter is available that provides a sector image with color/spectral Doppler and multiple frequency imaging (5.0 to 10 MHz) capabilities. Optical Approaches AngioscopyIntracoronary angioscopy is an endoscopic technology that allows direct visualization of the surface color and superficial morphology of atherosclerotic plaque, thrombus, neointima, or stent struts. The ...

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Section: Ultrasound-based Approachesmentioning

confidence: 99%

Frontiers in Intravascular Imaging Technologies

Honda

Fitzgerald

2008

Circulation

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“…21 According to VH-IVUS, the FF component is associated with development of acute coronary syndrome. 22 As shown in the TRUTH study, statins have the plaque-stabilizing effect of decreasing the FF component. 9 Kovarnik et al also reported the same results using dual lipid-lowering therapy with statin plus ezetimibe.…”

Section: Discussionmentioning

confidence: 90%

Impact of Diabetes Mellitus on Coronary Atherosclerosis and Plaque Composition Under Statin Therapy

Nozue

Yamamoto

Tohyama

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp iabetes mellitus (DM) is a risk factor for the development of coronary artery disease (CAD), 1 and DM patients have a markedly increased incidence of adverse cardiovascular events. 2 The mechanisms underlying this increased incidence, however, have not been well-characterized.Recent clinical trials using gray-scale intravascular ultrasound (IVUS) have shown that intensive lipid-lowering therapy with statins resulted in regression of coronary artery plaques 3 and reduced the risk of coronary events.

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“…1) Pathological data also shows that high-risk plaques such as vulnerable TCFA have more NC volume than stable plaques. 25) Furthermore, a previous report by IVUS also reported that ACS patients showed a significantly higher ratio of NC plaque compared with SAP patients, and VH-IVUS-derived TCFA was more frequently observed in ACS patients compared with SAP patients. 26) In the present study, the ACS group had significantly more %NC and NC volume and less %Fibrous than the SAP group.…”

Section: Difference In Ivus and Vh-ivus Parameters Between Acsmentioning

confidence: 89%

“…However, VH-IVUS data concerning the relationship of NC to clinical presentation are still controversial. 25,27) In VH-IVUS studies, the presence of thrombi in ACS lesions may influence plaque composition because thrombi are not recognized as a different component but assigned to one of the four available components (usually fibrous or fibro-fatty by VH-IVUS).…”

Section: Difference In Ivus and Vh-ivus Parameters Between Acsmentioning

confidence: 99%

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

et al. 2015

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SummaryCoronary intraplaque hemorrhage up-regulates hemoglobin scavenger receptor CD163 expression on macrophages, and has an association with vulnerable plaque development. During percutaneous coronary intervention, mechanical plaque disruption exposes potentially embolic atheromatous contents from culprit plaque.In 37 patients with stable angina pectoris (SAP, n = 20) or acute coronary syndrome (ACS, n = 17), atherothrombotic debris was collected using a filter-based distal embolic protection device. We immunohistochemically determined CD14-positive macrophages and CD163-positive macrophages in filtered debris. We also examined the relation of CD14-and CD163-positive macrophages with culprit plaque volume and components evaluated with ultrasonic tissue characterization (VH-IVUS).The only significant difference in clinical characteristics between the two groups was in hs-CRP. In ACS, the percentage of CD14-and CD163-positive macrophages to the whole cells (%CD14 and %CD163, respectively) was significantly higher than that in SAP (20.1 ± 8.2 versus 8.8 ± 6.8%, P < 0.001 and 32.6 ± 18.9 versus 9.0 ± 3.8%, P < 0.001, respectively). In IVUS indices of culprit plaque, the remodeling index was significantly higher in ACS than in SAP. However, necrotic core component (%NC) in ACS was significantly higher than that in SAP. Furthermore, fibrotic component (%Fibrous) in ACS was significantly lower than that in SAP (56.1 ± 4.7 versus 60.1 ± 3.3%, P = 0.03). %CD14 and %CD163 had a significant positive correlation with %NC (%CD14: r = 0.40, P = 0.01 and %CD163: r = 0.45, P = 0.01), but only %CD163 was negatively correlated with %Fibrous (%CD163: r = −0.48, P = 0.01).These findings suggest that the presence of CD14-and CD163-positive macrophages may reflect plaque inflammation, NC expansion, and plaque vulnerability in patients with coronary heart disease. (Int Heart J 2015; 56: 150-156) Key words: Coronary artery disease, Intraplaque hemorrhage, Catheters B oth macrophage infiltration and hemorrhage into coronary plaque are associated with the development of atherosclerotic lesions and plaque instability. 1) Atherosclerosis largely involves macrophage-mediated inflammation driven by oxidized lipids.2) CD14 on the macrophage surface is bound to lipopolysaccharides, thereby activating macrophages to produce cytokines such as TNF-α, IL-1, and IL-6, which, in turn, serve as endogenous mediators of inflammation.3) In a previous pathological report, CD14-positive macrophages were more prevalent in atherosclerotic lesions compared with normal intimal regions of coronary arteries.3) Thus, CD 14-positive macrophages within the plaque indicates plaque with inflammatory macrophage inflammation.In advanced atherosclerosis, intraplaque hemorrhage (IPH) is an important contributor to lesion development and destabilization by several mechanisms, including the release of hemoglobin (Hb) into plaque. 4) Hb derived from IPH binds tightly to haptoglobin (Hp) to form an Hp-Hb complex. The Hp-Hb complex is exclusively cleared by macrophages ...

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Coronary plaque composition of culprit/target lesions according to the clinical presentation: a virtual histology intravascular ultrasound analysis

Abstract: Plaque composition obtained by VH-IVUS shows less necrotic core and more fibrous tissue in ACS compared to SAP lesions, which is in contradiction with previously published histopathologic data.

Cited by 57 publications

References 35 publications

Frontiers in Intravascular Imaging Technologies

Frontiers in Intravascular Imaging Technologies

Impact of Diabetes Mellitus on Coronary Atherosclerosis and Plaque Composition Under Statin Therapy

Enhanced Expression of Hemoglobin Scavenger Receptor CD163 in Accumulated Macrophages Within Filtered Debris Between Acute Coronary Syndromes and Stable Angina Pectoris

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