CLINICAL RESEARCH: ATHEROSCLEROSIS EVALUATION BY ULTRASOUND
In Vivo Intravascular Ultrasound-Derived Thin-Cap Fibroatheroma Detection Using Ultrasound Radiofrequency Data Analysis
Gastón A. Rodriguez-Granillo, MD,
Héctor M. García-García, MD,
Eugène P. Mc Fadden, MD, FRCPI,
Marco Valgimigli, MD,
Jiro Aoki, MD,
Pim de Feyter, MD, PhD and
Patrick W. Serruys, MD, PhD*
Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
Manuscript received May 25, 2005;
revised manuscript received June 24, 2005,
accepted July 25, 2005.
* Reprint requests and correspondence: Dr. Patrick W. Serruys, Thoraxcenter, Bd406, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands (Email: p.w.j.c.serruys{at}erasmusmc.nl).
OBJECTIVES: The purpose of this study was to assess the prevalence of intravascular ultrasound (IVUS)-derived thin-cap fibroatheroma (IDTCFA) and its relationship with the clinical presentation using spectral analysis of IVUS radiofrequency data (IVUS-Virtual Histology [IVUS-VH]).
BACKGROUND: Thin-cap fibroatheroma lesions are the most prevalent substrate of plaque rupture.
METHODS: In 55 patients, a non-culprit, non-obstructive (<50%) lesion was investigated with IVUS-VH. We classified IDTCFA lesions as focal, necrotic core-rich ( 10% of the cross-sectional area) plaques being in contact with the lumen; IDTCFA definition required a percent atheroma volume (PAV) 40%.
RESULTS: Acute coronary syndrome (ACS) (n = 23) patients presented a significantly higher prevalence of IDTCFA than stable (n = 32) patients (3.0 [interquartile range (IQR) 0.0 to 5.0] vs. 1.0 [IQR 0.0 to 2.8], p = 0.018). No relation was found between patient’s characteristics such as gender (p = 0.917), diabetes (p = 0.217), smoking (p = 0.904), hypercholesterolemia (p = 0.663), hypertension (p = 0.251), or family history of coronary heart disease (p = 0.136) and the presence of IDTCFA. A clear clustering pattern was seen along the coronaries, with 35 (35.4%), 31 (31.3%), 19 (19.2%), and 14 (14.1%) IDTCFAs in the first 10 mm, 11 to 20 mm, 21 to 30 mm, and 31 mm segments, respectively, p = 0.008. Finally, we compared the severity (mean PAV 56.9 ± 7.4 vs. 54.8 ± 6.0, p = 0.343) and the composition (mean percent necrotic core 19.7 ± 4.1 vs. 18.1 ± 3.0, p = 0.205) of IDTCFAs between stable and ACS patients, and no significant differences were found.
CONCLUSIONS: In this in vivo study, IVUS-VH identified IDTCFA as a more prevalent finding in ACS than in stable angina patients.
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | IDTCFA = intravascular ultrasound-derived thin-cap fibroatheroma | | IQR = interquartile range | | IVUS = intravascular ultrasound | | IVUS-VH = Intravascular Ultrasound-Virtual Histology | | LAD = left anterior descending coronary artery | | LCX = left circumflex artery | | PAV = percent atheroma | | RCA = right coronary artery | | ROI = region of interest | | TCFA = thin-cap fibroatheroma |
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