Evaluation of Variable Thin-Cap Fibroatheroma Definitions and Association of Virtual Histology-Intravascular Ultrasound Findings with Cavity Rupture Size

• Published in: The American journal of cardiology Vol. 118; no. 2; pp. 162 - 169
• Main Authors: Hirai, Taishi, MD, Chen, Zhi, PhD, Zhang, Ling, PhD, Baaj, Shamsa, BS, Kovarnik, Tomas, MD, Porcaro, Katie, MD, Kaminski, John, MD, Hawn, Stephen, BS, Agrawal, Anoop, MD, Makki, Nader, MD, Downe, Richard, PhD, Wahle, Andreas, PhD, Sonka, Milan, PhD, Lopez, John J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2016; Elsevier Limited
• Subjects: Aged; Angina pectoris; Angina, Stable - diagnostic imaging; Angina, Stable - surgery; Angina, Unstable - diagnostic imaging; Angina, Unstable - surgery; Automation; Calcinosis - diagnostic imaging; Calcinosis - pathology; Cardiovascular; Cardiovascular disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary vessels; Diabetes; Dimensional analysis; Female; Fibrosis; Heart attacks; Histology; Humans; Hypertension; Male; Medical imaging; Middle Aged; Morphology; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - surgery; Necrosis; Nuclear polyhedrosis virus; Patients; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - pathology; Retrospective Studies; Rupture, Spontaneous - diagnostic imaging; Software; Ultrasonic imaging; Ultrasonography, Interventional; plaque rupture; thin-cap fibrous atheroma; intravascular ultrasound
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.04.050

Abstract The accepted definition of virtual histology intravascular ultrasound (IVUS-VH) thin-cap fibroatheroma (TCFA) is only a modest predictor of plaque rupture. We sought to determine the relationship between IVUS-VH findings and culprit lesions with plaque rupture using computational analysis. A total of 80 culprit lesions from 80 patients with stable angina (n = 37), unstable angina (n = 20), and myocardial infarction (n = 23) were divided into those with (n=15) and without plaque rupture (n=65). By use of automated computational analysis, the standard IVUS-VH TCFA criterion as well as 124 additional criterion were compared. The standard TCFA definition demonstrated modest ability to discriminate lesions with and without plaque rupture (Sens 87%, Spec 37%, PPV 0.24 NPV 0.92). Of 124 additional IVUS-VH TCFA definitions, only two improved the discriminative ability even modestly. However, a positive correlation was demonstrated between cavity size and necrotic core percentage (r = 0.78, p <0.01) and a negative correlation with percentage of fibrous tissue (r = -0.81, p < 0.01). In conclusion, IVUS-VH criteria were only modestly associated with plaque rupture, without significant improvement by varying IVUS-VH TCFA features, but IVUS-VH features of ruptured plaques were strongly correlated with cavity size.