The dynamic nature of coronary artery lesion morphology assessed by serial virtual histology intravascular ultrasound tissue characterization.
OBJECTIVE
We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology.


BACKGROUND
Plaque stability is related to its histological composition.


METHODS
We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden >or=40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque.


RESULTS
At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs "healed," 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm(2) [8.2 to 10.7 mm(2)] vs. 6.9 mm(2) [6.0 to 8.2 mm(2)], p = 0.021), vessel (18.7 mm(2) [17.3 to 28.6 mm(2)] vs. 15.5 mm(2) [13.3 to 16.6 mm(2)]; p = 0.010), and plaque (9.7 mm(2) [9.6 to 15.7 mm(2)] vs. 8.4 mm(2) [7 to 9.7 mm(2)], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm(2) [6.2 to 10.0 mm(2)] to 9.0 mm(2) [6.5 to 12.0 mm(2)], p < 0.001), VH-TCFAs (8.6 mm(2) [7.3 to 9.9 mm(2)] to 9.5 mm(2) [7.8 to 10.8 mm(2)], p = 0.024), and ThCFAs (8.6 mm(2) [6.8 to 10.2 mm(2)] to 8.8 mm(2) [7.1 to 11.4 mm(2)], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque.


CONCLUSIONS
Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.
Kubo
Takashi
T
Cardiovascular Research Foundation, New York, New York 10022, USA.
Maehara
Akiko
A
Mintz
Gary S
GS
Doi
Hiroshi
H
Tsujita
Kenichi
K
Choi
So-Yeon
SY
Katoh
Osamu
O
Nasu
Kenya
K
Koenig
Andreas
A
Pieper
Michael
M
Rogers
Jason H
JH
Wijns
William
W
Böse
Dirk
D
Margolis
M Pauliina
MP
Moses
Jeffrey W
JW
Stone
Gregg W
GW
Leon
Martin B
MB
D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006652:Histological Techniques / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*; D014584:User-Computer Interface