The correlation of necrotic core percentage in coronary plaques by virtual histology to patients' characteristics and clinical presentation

Abstract OBJECTIVE Virtual histology–intravascular ultrasound (VH-IVUS) has been reported to be useful in detecting the components of coronary plaques in vivo. Recently, the application of VH-IVUS to peripheral interventions has been evaluated. The aim of this study was to examine the extent to which the necrotic core of carotid plaques could be assessed accurately by VH-IVUS compared with histopathology. METHODS A total of 37 carotid plaques underwent ex vivo VH-IVUS within 24 hours after endarterectomy. Ninety-five segments of virtual histological images were matched to histological sections. The area of the necrotic core on histological sections was compared with that on virtual histological images. Intraplaque hemorrhage (IPH) was histopathologically graded by its severity using immunohistochemical staining for glycophorin A as a marker. The relationship of the severity of the IPH to the necrotic core was histopathologically evaluated. The correlation between the necrotic core or IPH with symptomatology was also evaluated. RESULTS The area of the necrotic core on virtual histological images (median, 8.0%; interquartile range, 5.0%–13%) was significantly smaller compared with that of the histological sections (median, 50%; interquartile range, 40%–63%) (P < 0.0001). The Bland-Altman analysis showed poor agreement in the necrotic core measurement between virtual histological images and histological sections (mean difference, 39.8%; 95% confidence interval, 35.8%–43.8%). Severe IPH was significantly associated with a larger necrotic core and symptomatology (P < 0.0001 and P = 0.0039, respectively). The area of necrotic core on the virtual histological analysis did not correlate with symptomatology (P = 0.70), but that on pathological analysis tended to correlate with symptomatology (P = 0.059). CONCLUSION In the present virtual histological algorithm, the underestimation of the necrotic core was revealed. The lack of a hemorrhage component in the virtual histological algorithm is a leading cause of its underestimation.

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Comparison of Intravascular Ultrasound Virtual Histology Parameters in Diabetes versus Non-Diabetes with Acute Coronary Syndrome

Cardiology ◽

10.1159/000508886 ◽

2020 ◽

Vol 145 (9) ◽

pp. 570-577

Author(s):

Sreenivas Reddy ◽

Vikas Kadiyala ◽

Jeet Ram Kashyap ◽

Raghavendra Rao ◽

Hithesh Reddy ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Intravascular Ultrasound ◽

Vascular Complications ◽

Necrotic Core ◽

High Dose ◽

Virtual Histology ◽

Coronary Syndrome ◽

Minimal Lumen Area ◽

Significant Difference

Introduction: The progression and pattern of coronary atherosclerosis in diabetes mellitus (DM) is different from non-DM, leading to a higher rate of vascular complications in DM. Objective: This study aims to assess and compare the high-risk plaque characteristics in the culprit artery of DM and non-DM patients with acute coronary syndrome (ACS) using virtual histology intravascular ultrasound (VH-IVUS). Methods: A total of 158 ACS patients were included, 63 of whom were known to have DM. IVUS analysis was done in the de novo target vessel and culprit lesion for which percutaneous coronary intervention was planned. Culprit lesions with a visual-estimate angiographic stenosis of <70% were excluded. Results: The mean age of patients was 52.4 ± 11.6 years. The study group comprised 82% men, 31% with hypertension, and 39.87% with DM. No significant difference was observed between the DM and non-DM groups in relation to quantitative IVUS parameters like lesion length, minimal lumen area, and plaque area. However, there was a significant difference in VH-IVUS parameters like higher necrotic core and dense calcium in the DM patients than in the non-DM patients (p < 0.01). The occurrence of VH-derived thin-cap fibroatheroma (VH-TCFA) in the culprit vessel was significantly higher in the DM group than in the non-DM group (25.3 vs. 5.2%; p < 0.01). Positive vessel-wall remodeling was noted in both groups without any significant difference (p = 0.74). Conclusion: The DM patients had high-risk plaque composition features like a higher necrotic core, which is a marker of plaque vulnerability. Thus, aggressive medical therapy targeting vascular inflammation using high-dose statins would help in the stabilization of unstable plaque morphology and the reduction of major cardiovascular events.

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What is behind the calcium? The relationship between calcium and necrotic core on virtual histology analyses

European Heart Journal ◽

10.1093/eurheartj/ehn506 ◽

2008 ◽

Vol 30 (1) ◽

pp. 125-125 ◽

Cited By ~ 11

Author(s):

S. W. Murray ◽

N. D. Palmer

Keyword(s):

Necrotic Core ◽

Virtual Histology ◽

The Relationship

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Abstract 1982: In Vivo Virtual Histology Intravascular Ultrasound Correlates of Risk Factors for Sudden Coronary Death in Men: Results from the Prospective, Global, Multi-center VH-IVUS Registry

Circulation ◽

10.1161/circ.116.suppl_16.ii_428 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Eduardo Missel ◽

Gary S Mintz ◽

Stephane G Carlier ◽

Jie Qian ◽

Shoujie Shan ◽

...

Keyword(s):

Risk Factors ◽

Intravascular Ultrasound ◽

Density Lipoprotein ◽

Necrotic Core ◽

Consecutive Series ◽

Virtual Histology ◽

Virtual Histology Intravascular Ultrasound ◽

Coronary Death ◽

Sudden Coronary Death

Background: Histopathological data shows that cigarette smoking and a total-cholesterol-to-high-density-lipoprotein ratio (TC/HDL) >5 are associated to sudden coronary death (SCD) in men. We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these risk factors. Methods and Results: We performed whole pullback VH-IVUS analyses in a consecutive series of 473 male pts and measured the four basic VH-IVUS coronary plaque components - fibrous (FI), fibro-fatty (FF), dense calcium (DC) and necrotic core (NC) - as well as calculated a NC/DC ratio. Pts age was 61±11years, with 27% current smokers and 69% with a lipid disorder. Among VH-IVUS parameters, the NC/DC ratio was the only parameter related both to the TC/HDL ratio (r=0.18, p=0.0008) and LDL-C levels (r=0.17, p=0.002); it had a negative correlation with HDL-C levels (r=0.11, p=0.03), and was significantly higher for smokers [median: 1.98 (1.35, 3.18)] vs. non-smokers [median: 1.70 (1.23, 2.53), p=0.006]. A NC/DC value >3 was the threshold that best identified smokers with a TC/HDL>5 (odds ratio 3.0, p=0.0001). ROC curves showed superiority of the NC/DC ratio (A 2 : 0.64, p<0.0001) over %DC (A 2 : 0.58, p=0.006) or %NC (A 2 : 0.51, p=0.43) as isolate parameters to identify pts with a risk profile for SCD (Figure ). Conclusions: In diseased coronary segments the ratio of necrotic core to calcification detected by VH-IVUS is related to previously-published pathologic risk factors for SCD.

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Coronary plaque composition of culprit/target lesions according to the clinical presentation: a virtual histology intravascular ultrasound analysis

European Heart Journal ◽

10.1093/eurheartj/ehl285 ◽

2006 ◽

Vol 27 (24) ◽

pp. 2939-2944 ◽

Cited By ~ 46

Author(s):

J.-F. Surmely ◽

K. Nasu ◽

H. Fujita ◽

M. Terashima ◽

T. Matsubara ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Clinical Presentation ◽

Coronary Plaque ◽

Plaque Composition ◽

Virtual Histology ◽

Virtual Histology Intravascular Ultrasound

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Matrix Metalloproteinase 9 as a Predictor of Coronary Atherosclerotic Plaque Instability in Stable Coronary Heart Disease Patients with Elevated Lipoprotein(a) Levels

Biomolecules ◽

10.3390/biom9040129 ◽

2019 ◽

Vol 9 (4) ◽

pp. 129 ◽

Cited By ~ 7

Author(s):

Marat Ezhov ◽

Maya Safarova ◽

Olga Afanasieva ◽

Maksim Mitroshkin ◽

Yuri Matchin ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Atherosclerotic Plaque ◽

Necrotic Core ◽

Enzyme Linked Immunosorbent Assay ◽

Virtual Histology ◽

Lipoprotein A ◽

Plaque Instability ◽

Stable Coronary Heart Disease ◽

Coronary Atherosclerotic Plaque

We sought to investigate whether levels of matrix metalloproteinases (MMPs) and their inhibitors predict coronary atherosclerotic plaque instability, as assessed by intravascular ultrasound (IVUS) virtual histology during coronary angiography. Blood samples were collected before angiography in 32 subjects (mean age 56 ± 8 years) with stable coronary heart disease (CHD) and elevated lipoprotein(a) (Lp(a), 94 ± 35 mg/dL). Levels of high-sensitivity C-reactive protein (hsCRP), apolipoprotein B100 (apoB100), MMP-7, MMP-9, tissue inhibitor of metalloproteinases (TIMP)-1, and TIMP-2 were determined using commercially available enzyme-linked immunosorbent assay kits. Results. The morphology of a total of sixty coronary lesions was assessed by virtual histology IVUS imaging. Eleven (18%) plaques in nine (28%) patients were classified as plaques with an unstable phenotype or a thin-cap fibroatheroma. Age, low-density lipoprotein cholesterol, apoB100, MMP-7, and MMP-9 levels were positively associated with necrotic core volume. Conversely, there was a negative relationship between MMP-7 and -9 levels and fibrous and fibro-fatty tissue volume. Multivariate regression analysis revealed that MMP-9 is a strong independent predictor of atherosclerotic plaque instability in stable CHD patients. In stable CHD patients with elevated Lp(a), MMP-9 levels are positively associated with the size of the necrotic core of coronary atherosclerotic plaques.

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