Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system.
OBJECTIVE
This study sought to assess agreement between an intravascular near-infrared spectroscopy (NIRS) system and histology in coronary autopsy specimens.


BACKGROUND
Lipid core plaques cannot be detected by conventional tests, yet are suspected to be the cause of most acute coronary syndromes. Near-infrared spectroscopy is widely used to determine the chemical content of substances. A NIRS system has been developed and used successfully in 99 patients.


METHODS
Scanning NIRS was performed through blood in 212 coronary segments from 84 autopsy hearts. One histologic section was analyzed for every 2 mm of artery. Lipid core plaque of interest (LCP) was defined as a lipid core >60 degrees in circumferential extent, >200-microm thick, with a mean fibrous cap thickness <450 microm. The first 33 hearts were used to develop the algorithm; the subsequent 51 validation hearts were used in a prospective, double-blind manner to evaluate the accuracy of NIRS in detecting LCP. A NIRS-derived lipid core burden index for an entire artery was also validated by comparison to histologic findings.


RESULTS
The LCPs were present in 115 of 2,649 (4.3%) sections from the 51 validation hearts. The algorithm prospectively identified LCP with a receiver-operator characteristic area of 0.80 (95% confidence interval [CI]: 0.76 to 0.85). The lipid core burden index detected the presence or absence of any fibroatheroma with an area under the curve of 0.86 (95% CI: 0.81 to 0.91). A retrospective analysis of lipid core burden index conducted in extreme artery segments with either no or extensive fibroatheroma yielded an area under the curve of 0.96 (95% CI: 0.92 to 1.00), confirming the accuracy of spectroscopy in identifying plaques with markedly different lipid content under ideal circumstances.


CONCLUSIONS
This novel catheter-based NIRS system accurately identified lipid core plaques through blood in a prospective study in coronary autopsy specimens. It is expected that this novel capability will be of assistance in the management of patients with coronary artery disease.
Gardner
Craig M
CM
InfraReDx, Inc., Burlington, Massachusetts 01803, USA. cgardner@infraredx.com
Tan
Huwei
H
Hull
Edward L
EL
Lisauskas
Jennifer B
JB
Sum
Stephen T
ST
Meese
Thomas M
TM
Jiang
Chunsheng
C
Madden
Sean P
SP
Caplan
Jay D
JD
Burke
Allen P
AP
Virmani
Renu
R
Goldstein
James
J
Muller
James E
JE
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001344:Autopsy; D002404:Catheterization / Q000295:instrumentation*; D023921:Coronary Stenosis / Q000378:metabolism* / Q000473:pathology; D003331:Coronary Vessels / Q000737:chemistry* / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation*
D008055:Lipids