Show simple item record

dc.contributor.authorBrown, Adam J
dc.contributor.authorObaid, Daniel R
dc.contributor.authorCostopoulos, Charis
dc.contributor.authorParker, Richard A
dc.contributor.authorCalvert, Patrick A
dc.contributor.authorTeng, Zhongzhao
dc.contributor.authorHoole, Stephen P
dc.contributor.authorWest, Nick EJ
dc.contributor.authorGoddard, Martin
dc.contributor.authorBennett, Martin R
dc.identifier.citationCirculation: Cardiovascular Imaging 2015, 8(10), e00348. doi: 10.1161/CIRCIMAGING.115.003487
dc.description.abstractBACKGROUND: 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.
dc.description.sponsorshipThis 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.
dc.publisherOvid Technologies (Wolters Kluwer Health)
dc.rightsCreative Commons Attribution 4.0
dc.subjectIntravascular ultrasound
dc.subjectCoronary artery disease
dc.titleDirect Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma.
dc.title.alternativeVH-IVUS and OCT identification of TCFA
dc.description.versionThis is the final version of the article. It first appeared from American Heart Association via
prism.publicationNameCirc Cardiovasc Imaging
dc.contributor.orcidTeng, Zhongzhao [0000-0003-3973-6157]
dc.contributor.orcidBennett, Martin [0000-0002-2565-1825]
rioxxterms.typeJournal Article/Review
pubs.funder-project-idBritish Heart Foundation (None)
pubs.funder-project-idBritish Heart Foundation (FS/15/26/31441)

Files in this item


This item appears in the following Collection(s)

Show simple item record

Creative Commons Attribution 4.0
Except where otherwise noted, this item's licence is described as Creative Commons Attribution 4.0