The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization

Kubo, Takashi; Maehara, Akiko; Mintz, Gary S.; Doi, Hiroshi; Tsujita, Kenichi; Choi, So Yeon; Katoh, Osamu; Nasu, Kenya; Köenig, Andreas; Pieper, Michael; Rogers, Jason H.; Wijns, William; Böse, Dirk; Margolis, M. Pauliina; Moses, Jeffrey W.; Stone, Gregg W.; Leon, Martin B.

doi:10.1016/j.jacc.2009.07.078

Cited by 319 publications

(182 citation statements)

References 26 publications

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“…The finding may partially support the concept why larger non-calcified plaque volumes were associated with future cardiac events in the aforementioned study [28]. In the intravenous ultrasound (IVUS) study examining the dynamic nature of coronary atherosclerosis, all non-calcified plaque components by IVUS such as pathological intimal thickening (PIT), virtual histology IVUS derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA) and fibrotic plaque could convert to other type of non-calcified components [41]. Also, PIT, VH-TCFA and ThCFA are likely to increase in volume overtime compared to more pathologically stable plaque such as fibrotic and fibro-calcified plaques.…”

Section: Discussionmentioning

confidence: 99%

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

et al. 2016

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Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study Methods: We identified 142 study subjects undergoing serial coronary computed tomography angiography. The resulting propensity score was applied 1:1 to match diabetic patients to non-diabetic patients for clinical risk factors, prior coronary stenting, coronary artery calcium (CAC) score and the serial scan interval, resulting in the 71 diabetes and 71 non-diabetes patients. Coronary plaque (total, calcified, noncalcified including fibrous, fibrous-fatty and low attenuation plaque [LAP]) volume normalized by total coronary artery length was measured using semi-automated plaque software and its change overtime between diabetic and non-diabetic patients was evaluated.Results: The matching was successful without significant differences between the two groups in all matched variables. The baseline volumes in each plaque also did not differ. During a mean scan interval of 3.4 ± 1.8 years, diabetic patients showed a 2-fold greater progression in normalized total plaque volume (TPV) than non-diabetes patients (52.8 mm 3 vs. 118.3 mm 3 , p ¼ 0.005). Multivariable linear regression model revealed that diabetes was associated with normalized TPV progression (b 72.3, 95%CI 24.3e120.3). A similar trend was observed for the non-calcified components, but not calcified plaque (b 3.8, 95%CI À27.0e34.7). Higher baseline CAC score was found to be associated with total, non-calcified and calcified plaque progression. However, baseline non-calcified volume but not CAC score was associated with LAP progression. Conclusions: The current study among matched patients indicates diabetes is associated with a greater plaque progression. Our results show the need for strict adherence of diabetic patients to the current preventive guidelines.

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Section: Discussionmentioning

confidence: 99%

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

et al. 2016

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“…5) Several subsequent studies then evaluated the incidence, distribution, and clinical outcomes of VH-TCFA. [16][17][18] However, only a few studies evaluated the diagnostic accuracy of VH-IVUS to identify TCFA. Sawada, et al assessed 126 coronary lesions (culprit and nonculprit lesions) by VH-IVUS and OCT in 56 patients with angina including acute coronary syndrome and demonstrated that the positive ratio of VH-IVUS for detecting definite TCFA, which was defined as a plaque meeting the TCFA criteria in both methods, was 45.9%.…”

Section: Discussionmentioning

confidence: 99%

Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-Cap Fibroatheroma

et al. 2011

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SummaryVirtual histology intravascular ultrasound (VH-IVUS) allows detailed assessment of plaque composition in the clinical setting. Optical coherence tomography (OCT) has been developed as a high-resolution imaging method, which might be a promising technique to identify thin-cap fibroatheroma (TCFA) in vivo. The purpose of the present study was to evaluate the diagnostic accuracy of VH-IVUS to identify TCFA as determined by OCT.We examined 96 target lesions in patients with stable angina pectoris by using VH-IVUS and OCT. VH-IVUS derived TCFA was defined as a focal necrotic core-rich lesion without evident overlying fibrous tissue. OCT derived TCFA was defined as a plaque with a fibrous cap of < 65 μm. VH-IVUS correctly identified 16 TCFA and 67 non-TCFA but misclassified 2 TCFA and 11 non-TCFA as determined by OCT. The sensitivity, specificity, and positive and negative predictive values of VH-IVUS to identify TCFA as determined by OCT were 89%, 86%, 59%, and 97%, respectively.VH-IVUS showed an acceptable sensitivity and specificity to identify TCFA as determined by OCT. Although the positive predictive value was low reflecting a high number of false positives, the negative predictive value was notably high. Our results suggest a potential role for VH-IVUS to exclude high risk lesions for future coronary events. (Int Heart J 2011; 52: 175-179)

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“…Since then, several other researchers have used combined intravascular imaging to study coronary atheroma and changed our understanding about plaque evolution. Diletti et al used serial combined IVUS-VH-OCT imaging to study plaque characteristics in bifurcation lesions and found no difference in the fibrous cap thickness and necrotic core component at 6 months followup concluding that plaque evolution is a slow process and contradicted the findings of a previous report that used serial stand-alone IVUS to assess changes in plaque morphology at 1-year follow-up [25,66]. In another report, combined IVUS-OCT imaging was used to assess plaques that ruptured and caused events, plaques that had a silent rupture and nonruptured TCFAs.…”

Section: Multimodality Imagingmentioning

confidence: 89%

“…Preliminary IVUS studies showed that vulnerable plaques have focal manifestations and are mainly located proximally within the coronary arteries and at coronary bifurcations [17][18][19]. IVUS also enabled assessment of the effect of systemic and local factors on the progression of atherosclerosis [20][21][22][23][24], allowed morphologic comparison of symptomatic versus asymptomatic plaque rupture, serial assessment of plaque evolution [25], and the effect of different treatments on this process [26][27][28].…”

Section: Intravascular Ultrasoundmentioning

confidence: 99%

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

Patel

Tarkin

Serruys

et al. 2017

Expert Review of Cardiovascular Therapy

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Introduction: Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an arsenal of invasive and non-invasive imaging modalities have been developed that are capable of identifying these features allowing in vivo assessment of plaque vulnerability. Areas covered: This review article presents the available and emerging imaging modalities introduced to assess plaque morphology and biology, describes the evidence from the first large scale studies that evaluated the efficacy of invasive and non-invasive imaging in detecting lesions that are likely to progress and cause cardiovascular events and discusses the potential implications of the in vivo assessment of coronary artery pathology in the clinical setting. Expert commentary: Invasive imaging, with its high resolution, and in particular hybrid intravascular imaging appears as the ideal approach to study the mechanisms regulating atherosclerotic disease progression; whereas non-invasive imaging is expected to enable complete assessment of coronary tree pathology, detection of high-risk lesions, more accurate risk stratification and thus to allow a personalized treatment of vulnerable patients. ARTICLE HISTORY

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The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization

Abstract: Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.

Cited by 319 publications

References 26 publications

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-Cap Fibroatheroma

Invasive or non-invasive imaging for detecting high-risk coronary lesions?

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