Correction to: Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study

An amendment to this paper has been published and can be accessed via the original article.

Implications of the local haemodynamic forces on the phenotype of coronary plaques

AimTo examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype.MethodsPatients with myocardial infarction that had intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of ≥2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable phenotype. Linear mixed effects models were used to assess the effect of ESS in different phenotypes.ResultsSixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and phenotype (p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (β=0.70, p<0.001) than fibrotic/fibrocalcific (β=0.28, p<0.001) or lipid-rich plaques (β=0.15, p=0.015). Standalone IVUS-VH misclassified plaque morphology in one-third of the cases leading to erroneous estimations about the effect of ESS on plaque evolution in different phenotypes.ConclusionsThe effect of ESS on plaque progression is similar in all phenotypes and cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution.Clinical trial registrationNCT00962416; Post-results.

Imaging in cardiovascular prevention

Imaging tools in preventive cardiology can be divided into imaging modalities to assess pre-clinical and clinical atherosclerosis and functional assessments of vascular function or vascular inflammation. To calculate the likelihood of pre-clinical atherosclerosis intima-media thickness as well as coronary calcium scoring are most frequently used. However, beyond these two there are other parameters derived by ultrasound and multi-detector computed tomography as well as magnetic resonance imaging and nuclear/molecular imaging which are discussed in the chapter. Functional tests include flow-mediated dilatation, pulse wave analysis, and the ankle-brachial index. In clinical research other invasive measurements such as intravascular ultrasound/virtual histology/elastography, optical coherence tomography as well as thermography are being used. However, their value in clinical prevention still needs to be established.