Evaluation of Variable Thin-Cap Fibroatheroma Definitions and Association of Virtual Histology-Intravascular Ultrasound Findings With Cavity Rupture Size.
The accepted definition of virtual histology intravascular ultrasound (IVUS-VH) thin-cap fibroatheroma (TCFA) is only a modest predictor of plaque rupture (PR). We sought to determine the relation between IVUS-VH findings and culprit lesions with PR using computational analysis. A total of 80 culprit lesions from 80 patients with stable angina (n = 37), unstable angina (n = 20), and myocardial infarction (n = 23) were divided into those with (n = 15) and without PR (n = 65). By use of automated computational analysis, the standard IVUS-VH TCFA criterion and 124 additional criteria were compared. The standard TCFA definition demonstrated modest ability to discriminate lesions with and without PR (sensitivity 87%, specificity 37%, PPV 0.24, and NPV 0.92). Of 124 additional IVUS-VH TCFA definitions, only 2 improved the discriminative ability even modestly. However, a positive correlation was demonstrated between cavity size and necrotic core percentage (r = 0.78, p <0.01) and a negative correlation with percentage of fibrous tissue (r = -0.81, p <0.01). In conclusion, IVUS-VH criteria were only modestly associated with PR, without significant improvement by varying IVUS-VH TCFA features, but IVUS-VH features of ruptured plaques were strongly correlated with cavity size.
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Taishi
T
Hirai
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
Zhi
Z
Chen
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
Ling
L
Zhang
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Shamsa
S
Baaj
Department of Medicine, Charles University Hospital, Prague, Czech Republic.
Tomas
T
Kovarnik
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Katie
K
Porcaro
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
John
J
Kaminski
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Stephen
S
Hawn
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Anoop
A
Agrawal
Division of Cardiology, Department of Medicine, Ohio State University, Columbus, Ohio.
Nader
N
Makki
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
Richard
R
Downe
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
Andreas
A
Wahle
Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
Milan
M
Sonka
Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois. Electronic address: jlopez7@lumc.edu.
John J
JJ
Lopez
D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000601:surgery; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000601:surgery; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional