Author + information
- Received November 26, 2018
- Revision received January 18, 2019
- Accepted February 26, 2019
- Published online September 18, 2019.
- Christos V. Bourantas, MD, PhDa,b,c,∗,
- Lorenz Räber, MD, PhDd,∗∗ (, )
- Antonis Sakellarios, BSce,
- Yashusi Ueki, MDd,
- Thomas Zanchin, MDd,
- Konstantinos C. Koskinas, MD, MScd,
- Kyohei Yamaji, MD, PhDd,
- Masanori Taniwaki, MDd,
- Dik Heg, PhDf,g,
- Maria D. Radu, MDh,
- Michail I. Papafaklis, MD, PhDi,
- Fanis Kalatzis, PhDe,
- Katerina K. Naka, MD, PhDi,
- Dimitrios I. Fotiadis, PhDe,
- Anthony Mathur, MD, PhDa,c,
- Patrick W. Serruys, MD, PhDj,
- Lampros K. Michalis, MDi,
- Hector M. Garcia-Garcia, MD, PhDk,
- Alexios Karagiannis, PhDf and
- Stephan Windecker, MDd
- aDepartment of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- bInstitute of Cardiovascular Sciences, University College London, London, United Kingdom
- cBarts and the London School of Medicine, Queen Mary University London, London, United Kingdom
- dDepartment of Interventional Cardiology, Bern University Hospital, Bern, Switzerland
- eDepartment of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- fCTU Bern, University of Bern, Bern, Switzerland
- gInstitute of Social and Preventive Medicine, Bern University, Bern, Switzerland
- hThe Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- iDepartment of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
- jInternational Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
- kSection of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
- ↵∗Address for correspondence:
Dr. Lorenz Räber, Department of Cardiology, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland.
Objectives This study sought to examine the utility of multimodality intravascular imaging and of the endothelial shear stress (ESS) distribution to predict atherosclerotic evolution.
Background There is robust evidence that intravascular ultrasound (IVUS)-derived plaque characteristics and ESS distribution can predict, with however limited accuracy, atherosclerotic evolution; nevertheless, it is yet unclear whether multimodality imaging and ESS mapping enable more accurate prediction of coronary plaque progression.
Methods A total of 44 patients admitted with a myocardial infarction that had successful revascularization and 3-vessel IVUS and optical coherence tomography (OCT) imaging at baseline and 13-month follow-up were included in the study. The IVUS data acquired at baseline in the nonculprit vessels were fused with x-ray angiography to reconstruct coronary anatomy and in the obtained models blood flow simulation was performed and the ESS was estimated. The baseline plaque characteristics and ESS distribution were used to identify predictors of disease progression: defined as a lumen reduction and an increase in plaque burden at follow-up.
Results Seventy-three vessels were included in the final analysis. Baseline ESS and the IVUS-derived but not the OCT-derived plaque characteristics were independently associated with a decrease in lumen area and an increase in plaque burden. Low ESS (odds ratio: 0.45; 95% confidence interval: 0.28 to 0.71; p < 0.001) and plaque burden (odds ratio: 0.73; 95% confidence interval: 0.54 to 0.97; p = 0.030) were the only independent predictors of disease progression at follow-up. The accuracy of the IVUS-derived plaque characteristics in predicting disease progression did not improve when ESS (AUC: 0.824 vs. 0.847; p = 0.127) or when OCT variables and ESS (AUC: 0.842; p = 0.611) were added into the model.
Conclusions ESS and OCT-derived variables did not improve the efficacy of IVUS in predicting disease progression. Further research is required to investigate whether multimodality imaging combined with ESS mapping will allow more reliable vulnerable plaque detection. (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction [STEMI] [COMFORTABLE]; NCT00962416)
↵∗ Drs. Bourantas and Räber contributed equally to this work.
The IBIS-4 trial was supported by the Swiss National Science Foundation, St. Jude Medical, and Volcano Cooperation. Dr. Räber has received research grants from Abbott Vascular, Sanofi, and Regeneron; and speaker fees from Abbott Vascular, AstraZeneca, CSL Behring, Biotronik, Sanofi, and Regeneron. Dr. Radu is a lecturer with St. Jude/Abbott Vascular. Dr. Naka has received lecture fees from Novartis and Servier, outside the submitted work; and is an investigator in randomized clinical trials sponsored by Novartis, Merck, Amgen, Bristol-Myers Squibb, Actelion, and Boehringer Ingelheim, outside the submitted work. Dr. Fotiadis is a founder of PD Neurotechnology Ltd. Dr. Windecker has received research grants to the institution from Amgen, Abbott, Boston Scientific, Biotronik, Medtronic, Edwards Lifesciences, Bayer, St. Jude, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2018.
- Revision received January 18, 2019.
- Accepted February 26, 2019.
- 2019 American College of Cardiology Foundation
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