Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT.
OBJECTIVE
The presence of thin-cap fibroatheromas (TCFA) is associated with high risk of acute coronary syndrome, hence their early detection may identify high-risk patients. In the present study we investigated the ability of a combined imaging catheter with near-infrared spectroscopy (NIRS) plus intravascular ultrasound (IVUS) to detect TCFA in patients with stable coronary artery disease.


RESULTS
Optical coherence tomography (OCT) and combined NIRS-IVUS assessment were performed on identical coronary segments. IVUS analysis provided per-segment minimal cross-sectional area (CSA), plaque length (PL), plaque burden (PB), plaque volume (PV), and remodelling index (RI). OCT was used as the gold-standard reference to define TCFA (fibrous cap thickness <65 μm). Plaque lipid content was estimated by NIRS (lipid core burden index [LCBI]). OCT-defined TCFA was present in 18 of 76 segments. IVUS revealed that OCT-defined TCFA were positively remodelled lesions with greater PB and PV, smaller CSA, and longer PL, while NIRS revealed greater LCBI per 2 mm segment (LCBI2mm) (all p<0.001). Greatest accuracy for OCT-defined TCFA detection was achieved using LCBI2mm >315 with RI >1.046 as a combined criterion value.


CONCLUSIONS
OCT-defined TCFA are characterised by positive vessel remodelling, high plaque burden and greater lipid core burden as assessed by dual NIRS-IVUS imaging.
Mount Sinai Medical Center and Mount Sinai School of Medicine, New York, NY, USA.
Tomasz
T
Roleder
Jason C
JC
Kovacic
Ziad
Z
Ali
Raman
R
Sharma
Ecatarina
E
Cristea
Pedro
P
Moreno
Samin K
SK
Sharma
Jagat
J
Narula
Annapoorna S
AS
Kini
D000368:Aged; D015415:Biomarkers / Q000032:analysis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation*; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional / Q000295:instrumentation*
D015415:Biomarkers; D008055:Lipids