title: Ex vivo comparison of angioscopy and histopathology for the evaluation of coronary plaque characteristics.
abstract: The yellow plaque has been considered to be a vulnerable and high risk for acute coronary syndrome events but not fully evaluated. The aim of this study was to evaluate the relationship between angioscopic color grade and histological features in coronary autopsy specimens. We longitudinally sectioned 110 coronary arteries from 40 autopsy hearts with non-cardiovascular death. Harvested arteries were imaged with intravascular ultrasound to identify the focal plaque (plaque burden >50 %). An angioscopic examination of each focal plaque evaluated its color intensity as follows: 0 (white), 1 (light yellow), 2 (yellow), or 3 (dark yellow). The corresponding histological assessment was classified according to a modified version of the American Heart Association classification of atherosclerosis. Two hundred six plaques were matched to the histological analysis. Of these, 82 (40 %) were categorized as yellow (≥grade 1). Although, yellow plaque often includes thin-cap fibroatheroma (TCFA), the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for histological TCFA were 83, 91, 22, 99 and 91 %, respectively. The false-positive coronary angioscopic diagnoses for TCFA that contributed to the low positive predictive value consisted of the following plaques: thick FA (>65 μm), accumulations of large quantities of foam cells on the luminal surface, or dense calcified plates at the surface of the intima. Vulnerable coronary plaques were detected with high sensitivity and low positive predictive value from their yellow color on angioscopy. Not only fibroatheroma but also various types of plaques and their components, such as immature lipidic components and superficial calcium plates, appeared yellow on coronary angioscopy.
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibuya
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan. kfujii350@hotmail.com.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hao
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Imanaka
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukunaga
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Miki
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tamaru
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakata
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sawada
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Naito
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirota
authors.affiliation: Cardiovascular Division/Division of Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
mesh_terms: D017546:Angioscopy; D001344:Autopsy; D001706:Biopsy; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D005189:False Positive Reactions; D005355:Fibrosis; D006801:Humans; D008055:Lipids / Q000032:analysis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional
chemical_list: D008055:Lipids
keywords: Coronary angioscopy; Histopathology; Vulnerable plaque; Yellow plaque