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CLINICAL RESEARCH: STUDY WITH INTRAVASCULAR ULTRASOUND

Accuracy of In Vivo Coronary Plaque Morphology Assessment

A Validation Study of In Vivo Virtual Histology Compared With In Vitro Histopathology

Kenya Nasu, MD^_*,_*, Etsuo Tsuchikane, MD, PhD^_*, Osamu Katoh, MD^_*, D. Geoffrey Vince, PhD, Renu Virmani, MD, Jean-François Surmely, MD^_*, Akira Murata, MD^_*, Yoshihiro Takeda, MD^_*, Tatsuya Ito, MD^_*, Mariko Ehara, MD^_*, Tetsuo Matsubara, MD^_*, Mitsuyasu Terashima, MD^_* and Takahiko Suzuki, MD, PhD^_*

^_* Department of Cardiology, Toyohashi Heart Center, Toyohashi-city, Aichi, Japan
Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, Ohio
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC.

Manuscript received October 10, 2005; revised manuscript received January 27, 2006, accepted February 7, 2006.

^_* Reprint requests and correspondence: Dr. Kenya Nasu, The Department of Cardiology, Toyohashi Heart Center, 21-1 Azagobutori, Ohyama-cho, Toyohashi-city, Aichi, 441-8530 Japan. (Email: yuya0728{at}m3.kcn.ne.jp).

OBJECTIVES: The goal of the present study was to compare the accuracy of in vivo tissue characterization obtained by intravascular ultrasound (IVUS) radiofrequency (RF) data analysis, known as Virtual Histology (VH), to the in vitro histopathology of coronary atherosclerotic plaques obtained by directional coronary atherectomy.

BACKGROUND: Vulnerable plaque leading to acute coronary syndrome (ACS) has been associated with specific plaque composition, and its characterization is an important clinical focus.

METHODS: Virtual histology IVUS images were performed before and after a single debulking cut using directional coronary atherectomy. Debulking region of in vivo histology image was predicted by comparing pre- and post-debulking VH images. Analysis of VH images with the corresponding tissue cross section was performed.

RESULTS: Fifteen stable angina pectoris (AP) and 15 ACS patients were enrolled. The results of IVUS RF data analysis correlated well with histopathologic examination (predictive accuracy from all patients data: 87.1% for fibrous, 87.1% for fibro-fatty, 88.3% for necrotic core, and 96.5% for dense calcium regions, respectively). In addition, the frequency of necrotic core was significantly higher in the ACS group than in the stable AP group (in vitro histopathology: 22.6% vs. 12.6%, p = 0.02; in vivo virtual histology: 24.5% vs. 10.4%, p = 0.002).

CONCLUSIONS: Correlation of in vivo IVUS RF data analysis with histopathology shows a high accuracy. In vivo IVUS RF data analysis is a useful modality for the classification of different types of coronary components, and may play an important role in the detection of vulnerable plaque.

Abbreviations and Acronyms   ACS = acute coronary syndrome   AP = angina pectoris   DCA = directional coronary atherectomy   IVUS = intravascular ultrasound   RF = radiofrequency   VH = Virtual Histology

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