Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma.
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Authors
Brown, Adam
Obaid, Daniel R
Costopoulos, Charis
Parker, Richard A
Calvert, Patrick A
Hoole, Stephen P
West, Nick EJ
Goddard, Martin
Publication Date
2015-10Alternative Title
VH-IVUS and OCT identification of TCFA
Journal Title
Circ Cardiovasc Imaging
ISSN
1941-9651
Publisher
Ovid Technologies (Wolters Kluwer Health)
Volume
8
Number
e003487
Language
English
Type
Article
Metadata
Show full item recordCitation
Brown, A., Obaid, D. R., Costopoulos, C., Parker, R. A., Calvert, P. A., Teng, Z., Hoole, S. P., et al. (2015). Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma.. Circ Cardiovasc Imaging, 8 (e003487) https://doi.org/10.1161/CIRCIMAGING.115.003487
Abstract
BACKGROUND: Although rupture of thin-cap fibroatheroma (TCFA) underlies most myocardial infarctions, reliable TCFA identification remains challenging. Virtual-histology intravascular ultrasound (VH-IVUS) and optical coherence tomography (OCT) can assess tissue composition and classify plaques. However, direct comparisons between VH-IVUS and OCT are lacking and it remains unknown whether combining these modalities improves TCFA identification. METHODS AND RESULTS: Two hundred fifty-eight regions-of-interest were obtained from autopsied human hearts, with plaque composition and classification assessed by histology and compared with coregistered ex vivo VH-IVUS and OCT. Sixty-seven regions-of-interest were classified as fibroatheroma on histology, with 22 meeting criteria for TCFA. On VH-IVUS, plaque (10.91±4.82 versus 8.42±4.57 mm(2); P=0.01) and necrotic core areas (1.59±0.99 versus 1.03±0.85 mm(2); P=0.02) were increased in TCFA versus other fibroatheroma. On OCT, although minimal fibrous cap thickness was similar (71.8±44.1 μm versus 72.6±32.4; P=0.30), the number of continuous frames with fibrous cap thickness ≤85 μm was higher in TCFA (6.5 [1.75-11.0] versus 2.0 [0.0-7.0]; P=0.03). Maximum lipid arc on OCT was an excellent discriminator of fibroatheroma (area under the curve, 0.92; 95% confidence interval, 0.87-0.97) and TCFA (area under the curve, 0.86; 95% confidence interval, 0.81-0.92), with lipid arc ≥80° the optimal cut-off value. Using existing criteria, the sensitivity, specificity, and diagnostic accuracy for TCFA identification was 63.6%, 78.1%, and 76.5% for VH-IVUS and 72.7%, 79.8%, and 79.0% for OCT. Combining VH-defined fibroatheroma and fibrous cap thickness ≤85 μm over 3 continuous frames improved TCFA identification, with diagnostic accuracy of 89.0%. CONCLUSIONS: Both VH-IVUS and OCT can reliably identify TCFA, although OCT accuracy may be improved using lipid arc ≥80° and fibrous cap thickness ≤85 μm over 3 continuous frames. Combined VH-IVUS/OCT imaging markedly improved TCFA identification.
Keywords
Atherosclerosis, Intravascular ultrasound, Coronary artery disease
Sponsorship
This study was funded by grants from the British Heart Foundation (FS/13/33/30168), Heart Research UK (RG2638/14/16), the Cambridge NIHR Biomedical Research Centre, and the BHF Cambridge Centre for Research Excellence.
Funder references
British Heart Foundation (None)
British Heart Foundation (FS/15/26/31441)
Identifiers
External DOI: https://doi.org/10.1161/CIRCIMAGING.115.003487
This record's URL: https://www.repository.cam.ac.uk/handle/1818/250368
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