In vivo coronary lesion differentiation with computed tomography angiography and intravascular ultrasound as compared to optical coherence tomography.
BACKGROUND
In vitro studies have shown the feasibility of coronary lesion grading with computed tomography angiography (CTA), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) as compared to histology, whereas OCT had the highest discriminatory capacity.


OBJECTIVE
We investigated the ability of CTA and IVUS to differentiate between early and advanced coronary lesions in vivo, OCT serving as standard of reference.


METHODS
Multimodality imaging was prospectively performed in 30 NSTEMI patients. Plaque characteristics were assessed in 1083 cross-sections of 30 culprit lesions, co-registered among modalities. Absence of plaque, fibrous and fibrocalcific plaque on OCT were defined as early plaque, whereas lipid rich-plaque on OCT was defined as advanced plaque. Odds ratios adjusted for clustering were calculated to assess associations between plaque types on CTA and IVUS with early or advanced plaque.


RESULTS
Normal findings on CTA as well as on IVUS were associated with early plaque. Non-calcified, calcified plaques and the napkin ring sign on CTA were associated with advanced plaque. On IVUS, fatty and calcified plaques were associated with advanced plaque.


CONCLUSIONS
In vivo coronary plaque characteristics on CTA and IVUS are associated with plaque characteristics on OCT. Of note, normal findings on CTA and IVUS relate to early lesions on OCT. Nevertheless, multiple plaque features on CTA and IVUS are related to advanced plaques on OCT, which may make it difficult to use qualitative plaque assessment in clinical practice.
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Wouter G
WG
Wieringa
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Chris P H
CP
Lexis
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Erik
E
Lipsic
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Hindrik W
HW
van der Werf
University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
Johannes G M
JG
Burgerhof
Ommelander Hospitals Group, Department of Cardiology, The Netherlands.
Vincent E
VE
Hagens
Martini Hospital, Department of Cardiology, Groningen, The Netherlands.
G Louis
GL
Bartels
University of Leiden, Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden, The Netherlands.
Alexander
A
Broersen
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Remco A
RA
Schurer
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Eng-Shiong
ES
Tan
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Pim
P
van der Harst
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands.
Ad F M
AF
van den Heuvel
University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands.
Tineke P
TP
Willems
University of Groningen, University Medical Center Groningen, Thorax Center, Department of Cardiology, Groningen, The Netherlands. Electronic address: g.pundziute@umcg.nl.
Gabija
G
Pundziute
D000368:Aged; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging / Q000379:methods*; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging*; D015588:Observer Variation; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
Computed tomography; Coronary atherosclerosis; Intravascular ultrasound; Optical coherence tomography