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Noninvasive Detection of Subclinical Coronary Atherosclerosis Coupled With Assessment of Changes in Plaque Characteristics Using Novel Invasive Imaging Modalities

The Integrated Biomarker and Imaging Study (IBIS)

Carlos A.G. Van Mieghem, MD^_*, Eugène P. McFadden, MBChB, MD, FRCPI, FACC^_*, Pim J. de Feyter, MD, PhD, FACC^_*, Nico Bruining, PhD^_*, Johannes A. Schaar, MD^_*, Nico R. Mollet, MD^_*, Filippo Cademartiri, MD^_*, Dick Goedhart, MSc, Sebastiaan de Winter, BSc^_*, Gaston Rodriguez Granillo, MD^_*, Marco Valgimigli, MD^_*, Frits Mastik^_*, Anton F. van der Steen, PhD^_*, Willem J. van der Giessen, MD, PhD^_*, Georgios Sianos, MD, PhD^_*, Bianca Backx, PhD, Marie-Angèle M. Morel, BSc, Gerrit-Anne van Es, PhD, Andrew Zalewski, MD, PhD^, and Patrick W. Serruys, MD, PhD, FACC^_*,_*

^_* Erasmus Medical Center, Rotterdam, the Netherlands
Cardialysis, Rottterdam, the Netherlands
GlaxoSmithKline, Philadelphia, Pennsylvania
Thomas Jefferson University, Philadelphia, Pennsylvania.

View larger version (22K): [in a new window]   Figure 1 Flow chart detailing number of patients at baseline and follow-up. Values in parentheses reflect number of vessels examined with different imaging modalities. IVUS = intravascular ultrasound; QCA = quantitative coronary angiography.

View larger version (28K): [in a new window]   Figure 2 Bland-Altman plot of the intravascular ultrasound data on plaque volume. The green (top) and blue (bottom) lines indicate the borders of 2 x SD.

View larger version (84K): [in a new window]   Figure 3 Example of multimodality coronary imaging of the proximal left anterior descending coronary artery. (A, B) Region of interest (ROI) is defined by the ostium of the left anterior descending and a large septal branch, as marked by white lines on the conventional angiogram (A) and arrowheads on multislice computed tomography maximum intensity projection reconstruction (B). (C) Gated longitudinal intravascular ultrasound (IVUS) reconstruction. The vertical lines mark the boundaries of the ROI. The red line indicates the lumen-intima interface and the green line the external border of the plaque plus echolucent media. (D, E) Representative color-coded cross-sectional palpograms that are superimposed on the IVUS image. Strain values are color-coded from 0% (blue) to 2% (yellow), as shown on the vertical scale. (D) Shows non-deformable eccentric plaque with calcification and acoustic shadowing. The blue line around the lumen indicates a non-deformable plaque with 0% strain. In the regions without plaque, the gray color indicates that no strain value can be measured. (E) Shows eccentric partly calcified plaque with a high strain (yellow) spot on one shoulder of the plaque (nine o’clock). On the other shoulder (four o’clock) the blue color (0% strain) indicates that the plaque is not deformable in this region. (F, G) Representative color-coded echogenicity cross sections. Hypoechogenic tissue is represented in red and hyperechogenic tissue in green. (F) Shows a cross section with a relatively large hyperechogenic area. The white spots visible most likely represent thick fibrous tissue and not calcification, because there was no acoustic shadowing on the corresponding IVUS images (not shown). (G) Shows a cross section, which predominantly contains hypoechogenic tissue. (H) Multislice computed tomography reconstruction and (inset) a cross section in an area with calcified plaque (arrows).