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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.date.accessioned2015-08-27T10:45:25Z
dc.date.available2015-08-27T10:45:25Z
dc.date.issued2015-10
dc.identifier.citationCirculation: Cardiovascular Imaging 2015, 8(10), e00348. doi: 10.1161/CIRCIMAGING.115.003487
dc.identifier.issn1941-9651
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1818/250368
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.languageEnglish
dc.language.isoen
dc.publisherOvid Technologies (Wolters Kluwer Health)
dc.rightsCreative Commons Attribution 4.0
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAtherosclerosis
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.typeArticle
dc.description.versionThis is the final version of the article. It first appeared from American Heart Association via http://dx.doi.org/10.1161/CIRCIMAGING.115.003487
prism.numbere003487
prism.publicationDate2015
prism.publicationNameCirc Cardiovasc Imaging
prism.volume8
dc.rioxxterms.funderBHF
dc.rioxxterms.funderNIHR
dc.rioxxterms.projectidFS/13/33/30168
rioxxterms.versionofrecord10.1161/CIRCIMAGING.115.003487
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2015-08-01
dc.contributor.orcidTeng, Zhongzhao [0000-0003-3973-6157]
dc.contributor.orcidBennett, Martin [0000-0002-2565-1825]
dc.identifier.eissn1942-0080
rioxxterms.typeJournal Article/Review
pubs.funder-project-idBritish Heart Foundation (None)
pubs.funder-project-idBritish Heart Foundation (FS/15/26/31441)
cam.issuedOnline2015-10-20


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