title: Multimodality imaging of attenuated plaque using grayscale and virtual histology intravascular ultrasound and optical coherent tomography.
abstract: BACKGROUND
  Although attenuated plaque is a marker for plaque vulnerability, the quantification and its implication have not been known.
  
  
  METHODS
  Multimodality pre-procedural imaging using grayscale intravascular ultrasound (IVUS), virtual histology-IVUS (VH-IVUS), and optical coherence tomography (OCT) were performed in 115 coronary lesions with diameter stenosis (DS) >30% and plaque burden ≥50% and compared the diagnostic accuracies for detecting thin-cap fibroatheromas (TCFA).
  
  
  RESULTS
  A maximal arc of attenuation (40 MHz IVUS) ≥29.0° was the cutoff for predicting VH-TCFA (sensitivity 74%, specificity 66%); and OCT-TCFA (sensitivity 89%, specificity 64%), while a maximal arc attenuation ≥29.0° (20MHz IVUS) showed a poor sensitivity for predicting TCFA. Compared to the lesions with an arc of attenuation <30° as a rough cutoff value, the lesions with a maximum arc of attenuation ≥30° (40 MHz) were associated with more severe (smaller angiographic minimum lumen diameter and greater DS, smaller IVUS-MLA and a larger plaque burden) and had more unstable lesion characteristics: (1) larger remodeling index and more plaque ruptures (grayscale IVUS); (2) greater %necrotic core and more VH-TCFAs (VH-IVUS); and (3) more lipid, macrophages, cholesterol crystals, and microchannels; thinner fibrous caps; and more OCT-TCFAs, OCT-detected plaque ruptures, and red and white thrombi (OCT). Among 58 patients treated with stent implantation, postintervention peak CK-MB was higher in patients with the maximal attenuation ≥30° compared to those without (median 2.7 ng/ml [IQR 0.9-18.7 ng/ml] vs. median 0.9 ng/ml [IQR 0.7-2.1 ng/ml], P = 0.012).
  
  
  CONCLUSIONS
  Attenuated plaque with a maximal attenuation ≥30° vs. <30° (40 MHz, but not 20 MHz IVUS) were more likely to be associated with unstable lesion morphology that may contribute to the immediate poststenting CK-MB elevation. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Department of Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004867:Equipment Design; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D015607:Stents; D041623:Tomography, Optical Coherence; D014159:Transducers; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: attenuated plaque; optical coherent tomography; virtual histology; vulnerable plaque