Accuracy of in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology.
OBJECTIVE
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.
Nasu
Kenya
K
Department of Cardiology, Toyohashi Heart Center, Toyohashi-city, Aichi, Japan. yuya0728@m3.kcn.ne.jp
Tsuchikane
Etsuo
E
Katoh
Osamu
O
Vince
D Geoffrey
DG
Virmani
Renu
R
Surmely
Jean-François
JF
Murata
Akira
A
Takeda
Yoshihiro
Y
Ito
Tatsuya
T
Ehara
Mariko
M
Matsubara
Tetsuo
T
Terashima
Mitsuyasu
M
Suzuki
Takahiko
T
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional