Author + information
- Received May 7, 2014
- Revision received September 5, 2014
- Accepted September 8, 2014
- Published online February 1, 2015.
- Soo-Jin Kang, MD, PhD∗,†,
- Gary S. Mintz, MD†,
- Jun Pu, MD∗,†,
- Stephen T. Sum, PhD‡,
- Sean P. Madden, PhD‡,
- Allen P. Burke, MD§,‖,
- Ke Xu, PhD†,
- James A. Goldstein, MD#,
- Gregg W. Stone, MD∗,†,
- James E. Muller, MD‡,
- Renu Virmani, MD‖ and
- Akiko Maehara, MD∗,†∗ ()
- ∗Columbia University Medical Center, New York, New York
- †Cardiovascular Research Foundation, New York, New York
- ‡InfraReDx, Inc., Burlington, Massachusetts
- §University of Maryland Medical Center, Baltimore, Maryland
- ‖CVPath Institute, Gaithersburg, Maryland
- #Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Columbia University Medical Center, New York-Presbyterian Hospital, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022.
Objectives This study assessed grayscale intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) detection of a histological fibroatheroma (FA).
Background NIRS-detected, lipid-rich plaques (LRPs) and IVUS-detected attenuated plaques are considered to be vulnerable.
Methods IVUS-attenuated plaque and NIRS-LRP (yellow or tan block chemogram) were compared with histopathology in 1,943 sections of 103 coronary arteries from 56 autopsied hearts.
Results IVUS-superficial attenuation and NIRS-LRP showed a similar high specificity of approximately 95%, whereas IVUS-superficial attenuation alone had a poor sensitivity (vs. NIRS-LRP) in detecting FAs (36% vs. 47%; p = 0.001). Compared with FA sections with superficial attenuation, FA sections without superficial attenuation had a smaller plaque burden (57.1% vs. 67.7%), a larger arc of calcium (79.7° vs. 16.8°), and a lower prevalence of a ≥20% histological necrotic core (28% vs. 50%) or late FA (14% vs. 37%; all p < 0.05). Compared with FA sections with NIRS-LRP, FA sections without NIRS-LRP showed a smaller plaque burden (58.0% vs. 63.3%) and a lower prevalence of a ≥20% necrotic core (27% vs. 46%). Conversely, non-FAs with NIRS-LRP (vs. non-FAs without LRP) showed a larger plaque burden (55.1% vs. 46.3%), a greater prevalence of a ≥20% histological lipid pool (34% vs. 5%), and mostly pathological intimal thickening (50%) or fibrocalcific plaque (33%). When sections showed either IVUS attenuation or NIRS-LRP, the sensitivity for predicting a FA was significantly higher compared with IVUS attenuation alone (63% vs. 36%; p < 0.001) or NIRS-LRP alone (63% vs. 47%; p < 0.001). When sections showed both IVUS attenuation and NIRS-LRP, the positive predictive value improved compared with IVUS attenuation alone (84% vs. 66%; p < 0.001) or NIRS-LRP alone (84% vs. 65%; p < 0.001).
Conclusions NIRS-LRP was more accurate than IVUS for predicting plaque containing a necrotic core or a large lipid pool, and the combination was more accurate than either alone.
Dr. Mintz has received consulting fees from Boston Scientific, InfraReDx, Acist, and Volcano Corporation; and research grant support from Volcano Corporation. Dr. Pu has received research grants from Boston Scientific China. Drs. Sum, Madden, and Muller are current employees of InfraReDx. Dr. Burke was a consultant to InfraReDx for histological studies. Dr. Goldstein is an InfraReDx consultant and equity owner. Dr. Stone is a consultant to Boston Scientific, Volcano Corporation, and InfraReDx. Dr. Virmani has been a consultant to Abbott Vascular, Atrium, Biosensors International, Biotronick, Boston Scientific, Celonova, Cordis J&J, GlaxoSmithKline, Kona Medical, Lutonix, Medtronic, Merck Speakers Bureau, MicroPort Medical, Mitralign, OrbusNeich Medical, ReCor Medical, SINO Medical, Terumo, 480 Biomedical, and WL Gore. Dr. Maehara is a consultant to Boston Scientific and Acist; and has received research/grant support from Boston Scientific and speaker fees from St. Jude Medical and Volcano Corporation. All other authors have no relationships relevant to the contents of this paper to disclose.
Morton Kern, MD, served as Guest Editor for this paper.
- Received May 7, 2014.
- Revision received September 5, 2014.
- Accepted September 8, 2014.
- American College of Cardiology Foundation