TY - JOUR
T1 - The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization
AU - Kubo, Takashi
AU - Maehara, Akiko
AU - Mintz, Gary S.
AU - Doi, Hiroshi
AU - Tsujita, Kenichi
AU - Choi, So Yeon
AU - Katoh, Osamu
AU - Nasu, Kenya
AU - Koenig, Andreas
AU - Pieper, Michael
AU - Rogers, Jason H.
AU - Wijns, William
AU - Böse, Dirk
AU - Margolis, M. Pauliina
AU - Moses, Jeffrey W.
AU - Stone, Gregg W.
AU - Leon, Martin B.
N1 - Funding Information:
Volcano Corporation (Rancho Cordova, California) has sponsored this registry. Dr. Kubo has received research grant support from Volcano Corporation . Dr. Mintz is a member of the Speakers' Bureau, serves as a consultant, has received research/grant support, and is a stockholder with Volcano Corporation. Dr. Rogers is a consultant for Volcano Corporation. Dr. Margolis is an employee and stockholder with Volcano Corporation. Drs. Stone and Leon serve as consultants for Volcano Corporation.
PY - 2010/4/13
Y1 - 2010/4/13
N2 - Objectives: We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology. Background: Plaque stability is related to its histological composition. Methods: We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden ≥40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque. Results: At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs "healed," 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm2 [8.2 to 10.7 mm2] vs. 6.9 mm2 [6.0 to 8.2 mm2], p = 0.021), vessel (18.7 mm2 [17.3 to 28.6 mm2] vs. 15.5 mm2 [13.3 to 16.6 mm2]; p = 0.010), and plaque (9.7 mm2 [9.6 to 15.7 mm2] vs. 8.4 mm2 [7 to 9.7 mm2], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm2 [6.2 to 10.0 mm2] to 9.0 mm2 [6.5 to 12.0 mm2], p < 0.001), VH-TCFAs (8.6 mm2 [7.3 to 9.9 mm2] to 9.5 mm2 [7.8 to 10.8 mm2], p = 0.024), and ThCFAs (8.6 mm2 [6.8 to 10.2 mm2] to 8.8 mm2 [7.1 to 11.4 mm2], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque. Conclusions: Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.
AB - Objectives: We used virtual histology intravascular ultrasound (VH-IVUS) to investigate the natural history of coronary artery lesion morphology. Background: Plaque stability is related to its histological composition. Methods: We performed serial (baseline and 12-month follow-up) VH-IVUS studies and examined 216 nonculprit lesions (plaque burden ≥40%) in 99 patients. Lesions were classified into pathological intimal thickening (PIT), VH-IVUS-derived thin-capped fibroatheroma (VH-TCFA), thick-capped fibroatheroma (ThCFA), fibrotic plaque, and fibrocalcific plaque. Results: At baseline, 20 lesions were VH-TCFAs; during follow-up, 15 (75%) VH-TCFAs "healed," 13 became ThCFAs, 2 became fibrotic plaque, and 5 (25%) VH-TCFAs remained unchanged. Compared with VH-TCFAs that healed, VH-TCFAs that remained VH-TCFAs located more proximally (values are median [interquartile range]) (16 mm [15 to 18 mm] vs. 31 mm [22 to 47 mm], p = 0.013) and had larger lumen (9.1 mm2 [8.2 to 10.7 mm2] vs. 6.9 mm2 [6.0 to 8.2 mm2], p = 0.021), vessel (18.7 mm2 [17.3 to 28.6 mm2] vs. 15.5 mm2 [13.3 to 16.6 mm2]; p = 0.010), and plaque (9.7 mm2 [9.6 to 15.7 mm2] vs. 8.4 mm2 [7 to 9.7 mm2], p = 0.027) areas; however, baseline VH-IVUS plaque composition did not differ between VH-TCFAs that healed and VH-TCFAs that remained VH-TCFAs. Conversely, 12 new VH-TCFAs developed; 6 late-developing VH-TCFAs were PITs, and 6 were ThCFAs at baseline. In addition, plaque area at minimum lumen sites increased significantly in PITs (7.8 mm2 [6.2 to 10.0 mm2] to 9.0 mm2 [6.5 to 12.0 mm2], p < 0.001), VH-TCFAs (8.6 mm2 [7.3 to 9.9 mm2] to 9.5 mm2 [7.8 to 10.8 mm2], p = 0.024), and ThCFAs (8.6 mm2 [6.8 to 10.2 mm2] to 8.8 mm2 [7.1 to 11.4 mm2], p < 0.001) with a corresponding decrease lumen areas, but not in fibrous or fibrocalcific plaque. Conclusions: Most VH-TCFAs healed during 12-month follow-up, whereas new VH-TCFAs also developed. PITs, VH-TCFAs, and ThCFAs showed significant plaque progression compared with fibrous and fibrocalcific plaque.
KW - atherosclerosis
KW - coronary disease
KW - intravascular ultrasound
KW - virtual histology
UR - http://www.scopus.com/inward/record.url?scp=77950315932&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2009.07.078
DO - 10.1016/j.jacc.2009.07.078
M3 - Article
C2 - 20378076
AN - SCOPUS:77950315932
SN - 0735-1097
VL - 55
SP - 1590
EP - 1597
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -