Correlation of intracoronary ultrasound plaque characteristics in atherosclerotic coronary artery disease patients with clinical variables

doi:10.1016/0002-9149(94)90876-1

The American Journal of Cardiology

Volume 73, Issue 11, 15 April 1994, Pages 753-758

https://doi.org/10.1016/0002-9149(94)90876-1 Get rights and content

Abstract

It was examined whether intracoronary ultrasound-defined plaque morphology of symptom-producing, severely stenosed, atherosclerotic coronary artery lesions is related to patient-related clinical variables. Data regarding anginal pattern (stable vs unstable), age, sex, history of smoking, diabetes, hypertension, hypercholesterolemia and lesion location were recorded in 146 hemodynamically stable patients referred for clinically indicated balloon angioplasty or directional atherectomy. Intracoronary ultrasound images of the lesions were obtained before and after the intervention. Lesions were classified as soft (homogeneous echoes less dense than adventitia) or hard (bright echoes with or without acoustic shadowing). Eighty-three lesions (57%) were classified as soft and 63 (43%) as hard. Univariate analysis showed anginal pattern, age, vessel location and history of smoking to be significantly related to plaque morphology. Multivariate analysis revealed only anginal pattern, age and vessel location to be independent predictors plaque morphology. The frequency of echogenic hard plaque was significantly higher in patients aged >60 years (56 vs 30%; p = 0.001), those with stable angina (69 vs 35%; p = 0.002), and lesions located in the distal arterial segments (68 vs 31%; p < 0.001) than in younger ones, those with unstable angina, and lesions in proximal segments, respectively. Based on previous studies, echogenic hard plaques are likely to be predominantly fibrous or calcific, or both, whereas low-echogenicity soft plaques are likely to be fibrocellular, lipid rich or thrombotic, or a combination. This difference in plaque morphology is probably due to differences in the predominant mechanism of plaque formation (i.e., slow growth vs rupture/thrombosis). These findings may have implications for interventional or medical treatment, because soft and hard plaques may be expected to respond differently to therapy.

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2018, Computer Methods and Programs in Biomedicine
The purpose of this study was to propose a hybrid ensemble classifier to characterize coronary plaque regions in intravascular ultrasound (IVUS) images.
Pixels were allocated to one of four tissues (fibrous tissue (FT), fibro-fatty tissue (FFT), necrotic core (NC), and dense calcium (DC)) through processes of border segmentation, feature extraction, feature selection, and classification. Grayscale IVUS images and their corresponding virtual histology images were acquired from 11 patients with known or suspected coronary artery disease using 20 MHz catheter. A total of 102 hybrid textural features including first order statistics (FOS), gray level co-occurrence matrix (GLCM), extended gray level run-length matrix (GLRLM), Laws, local binary pattern (LBP), intensity, and discrete wavelet features (DWF) were extracted from IVUS images. To select optimal feature sets, genetic algorithm was implemented. A hybrid ensemble classifier based on histogram and texture information was then used for plaque characterization in this study. The optimal feature set was used as input of this ensemble classifier. After tissue characterization, parameters including sensitivity, specificity, and accuracy were calculated to validate the proposed approach. A ten-fold cross validation approach was used to determine the statistical significance of the proposed method.
Our experimental results showed that the proposed method had reliable performance for tissue characterization in IVUS images. The hybrid ensemble classification method outperformed other existing methods by achieving characterization accuracy of 81% for FFT and 75% for NC. In addition, this study showed that Laws features (SSV and SAV) were key indicators for coronary tissue characterization.
The proposed method had high clinical applicability for image-based tissue characterization.
Age-related effects of smoking on coronary artery disease assessed by gray scale and virtual histology intravascular ultrasound
2015, American Journal of Cardiology
Although smoking is a risk factor for coronary atherosclerosis, the age-related impact on lesion morphology has not been studied. The aim of this study was to assess the age-related impact of smoking on the extent of atherosclerosis and arterial remodeling. In Providing Regional Observations to Study Predictors of Events in the Coronary Tree, 687 patients with acute coronary syndrome underwent 3-vessel gray scale and virtual histology intravascular ultrasound imaging of 3,185 nonculprit lesions. In 207 patients ≤65 years, current (smoking within 1 month) and former (no smoking for >1 month) smokers showed significantly smaller normalized volumes of external elastic membrane (EEM), lumen, and P + M (plaque + media) compared with nonsmokers. At the minimal lumen area site, current and former smokers had significantly smaller EEM, lumen, and P + M areas than nonsmokers. Conversely, in 480 patients >65 years, current smokers had greater normalized P + M volumes than nonsmokers with no difference in normalized EEM or lumen volumes. Finally, in patients >65 years (but not in patients ≤65 years), current smokers showed more plaque ruptures (4.7% vs 1.8%, p = 0.05) and echolucent plaques (8.3% vs 3.9%, p = 0.05) compared with nonsmokers. On multivariable analysis, a history of smoking (combining current and former smoking) predicted smaller normalized EEM volumes compared with nonsmokers ≤65 years. In conclusion, in patients ≤65 years, but not in patients >65 years, smoking had a vascular constrictive effect that contributed to severe luminal stenosis. Conversely, smokers >65 years had more plaque with greater plaque instability.
Is there a role for coronary angiography in the early detection of the vulnerable plaque?
2013, International Journal of Cardiology
Citation Excerpt :
Coronary angiography provides us with a radiographic image of the arterial lumen and surface. Some of the angiographic features that have been investigated for risk of plaque rupture include the degree of luminal stenosis [3–10], presence of plaque calcification [11–17], complex lesions with plaque disruption and thrombosis [18,19], and more recently, coronary artery movement (CAM) patterns [4,20,21]. However, coronary artery disease is also a disease of the vessel wall, and coronary angiography fails to image this (apart from possibly plaque calcification) or provide information about the morphology or composition of the atherosclerotic plaque such as a large lipid-rich core or other histopathological features such as plaque erosion, plaque volume, thin fibrous cap, inflammation and neoangiogenesis [1,22].
The identification of the coronary “vulnerable plaque” that is prone to disruption and thrombosis remains a “holy grail” in the treatment of coronary artery disease. The widespread use of coronary angiography for the identification of coronary atherosclerotic disease has led to numerous earlier studies exploring the role of angiography in the early detection of the vulnerable plaque. Some of the angiographic features explored for risk of plaque rupture include the degree of luminal stenosis, presence of plaque calcification, complex lesions with plaque disruption and thrombosis, and coronary artery movement patterns. However, a major limiting factor with coronary angiography is that it is a “luminogram”, and provides little characterization of plaque morphology or vessel wall, both of which play an important role in the development of plaque vulnerability. Newer intravascular imaging techniques have been developed to permit more detailed interrogation of plaque morphology and vessel wall, potentially allowing for more accurate detection of plaque vulnerability. Whilst coronary angiography may be increasingly superseded by these advances in imaging technologies, it is likely that it will continue to play an important complementary role in the quest for the early detection of the vulnerable plaque. The prospective identification of the vulnerable plaque currently remains elusive, as definitive tools for its detection do not exist. Hence, further prospective studies on the natural history of the atherosclerotic plaque, as well as validation of imaging modalities in clinical studies are needed before the notion of early detection of the vulnerable plaque becomes a clinical reality.
Risk Modelling in Quality Clinical Registries: Monitoring Lesion Treatment Failure Rate in Percutaneous Coronary Interventions
2013, Heart Lung and Circulation
This paper describes the development of a risk adjustment (RA) model predictive of individual lesion treatment failure in percutaneous coronary interventions (PCI) for use in a quality monitoring and improvement program.
Prospectively collected data for 3972 consecutive revascularisation procedures (5601 lesions) performed between January 2003 and September 2011 were studied. Data on procedures to September 2009 (n = 3100) were used to identify factors predictive of lesion treatment failure. Factors identified included lesion risk class (p < 0.001), occlusion type (p < 0.001), patient age (p = 0.001), vessel system (p < 0.04), vessel diameter (p < 0.001), unstable angina (p = 0.003) and presence of major cardiac risk factors (p = 0.01). A Bayesian RA model was built using these factors with predictive performance of the model tested on the remaining procedures (area under the receiver operating curve: 0.765, Hosmer–Lemeshow p value: 0.11). Cumulative sum, exponentially weighted moving average and funnel plots were constructed using the RA model and subjectively evaluated.
A RA model was developed and applied to SPC monitoring for lesion failure in a PCI database. If linked to appropriate quality improvement governance response protocols, SPC using this RA tool might improve quality control and risk management by identifying variation in performance based on a comparison of observed and expected outcomes.
Intravascular ultrasound analysis of plaque characteristics and postpercutaneous coronary intervention catheterization outcomes according to the remodeling pattern in narrowed saphenous vein grafts
2012, American Journal of Cardiology
Citation Excerpt :
Finally, PR was the independent predictor of post-PCI no-reflow and tissue prolapse. Several studies using intravascular ultrasonography before PCI in native coronary arteries have described various characteristics of coronary remodeling and plaque morphology in the culprit lesion of coronary artery disease.10,13–15 However, few data are available about the effect of the remodeling pattern on intravascular ultrasound plaque characteristics in SVG lesions.
We assessed the plaque characteristics and postpercutaneous coronary intervention (PCI) outcome according to the remodeling pattern (positive remodeling [PR], n = 113; and intermediate/negative remodeling [IR/NR], n = 198) in 311 saphenous vein graft lesions using intravascular ultrasound. The remodeling index was the ratio of the lesion site saphenous vein graft area to the mean of the proximal and distal references (PR/remodeling index >1.05, IR 0.95 to 1.05, and NR <0.95). Tissue prolapse was defined as tissue extrusion through the stent strut after PCI, and the tissue prolapse volume was calculated by subtracting the lumen volume from the stent volume. The presence of hypoechoic plaque (59% vs 36%, p = 0.001), plaque rupture (26% vs 16%, p = 0.042), multiple plaque rupture (12% vs 5%, p = 0.020), and an intraluminal mass (59% vs 41%, p = 0.002) were more common in the PR lesions than in the IR/NR lesions. The plaque cavity area was significantly greater in the PR lesions than in the IR/NR lesions (0.83 ± 1.43 mm² vs 0.42 ± 1.07 mm², p = 0.009). Post-PCI no-reflow (19% vs 9%, p = 0.019) and post-PCI tissue prolapse (53% vs 27%, p <0.001) were observed more frequently, and the tissue prolapse volume was significantly greater after PCI for PR lesions than for IR/NR lesions (0.86 ± 1.30 mm³ vs 0.34 ± 0.74 mm³, p <0.001). PR was the independent predictor of post-PCI no-reflow (odds ratio 2.58, 95% confidence interval 1.25 to 5.64, p = 0.040) and post-PCI tissue prolapse (odds ratio 2.45, 95% confidence interval 1.46 to 5.41, p = 0.045). In conclusion, saphenous vein graft lesions with PR have vulnerable plaque and are associated with no-reflow and tissue prolapse after PCI.
Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: Analysis by intravascular ultrasound
2012, Annales de Cardiologie et d'Angeiologie
To evaluate by intravascular ultrasound (IVUS) the characteristics of the culprit lesion with plaque rupture without significant angiographic stenosis after acute coronary syndromes (ACS).
After ACS, IVUS was performed in 68 patients (46.8 years ± 11.9) without significant angiographic stenosis (31 ± 15%). Plaque rupture was defined as a cavity within the plaque, communicating with the arterial lumen and having an overlying residual fibrous cap fragment. Qualitative analysis defined the type of plaque, and quantitative analysis evaluated plaque plus media area, plaque volume, plaque burden, and arterial remodeling index. Patients were divided into two groups: Group I with plaque rupture (25 patients) and Group II without plaque rupture (43 patients).
All patients with rupture showed soft or mixed plaque but no calcified plaque. In Group I, plaque rupture was associated with a larger plaque burden (49.8 ± 12.3% vs. 39.8 ± 12.1%, P < .0005), a more significant plaque plus media area (7.44 ± 2.9 vs. 5.24 ± 2.4 mm², P < .001), a greater plaque volume (151.9 ± 103.4 vs. 99.2 ± 81.6 mm³, P < .007), and a higher ratio of plaque volume over length (8.0 ± 3.8 vs. 5.6 ± 3.7 mm³/mm, P < .003). In Group I, positive remodeling was more frequent than intermediate remodeling (P < .03) or negative remodeling (P < .005). In Group II, there was no significant difference between the three types of remodeling.
The plaque ruptures responsible for ACS frequently appear on voluminous plaques with a large plaque burden and positive arterial remodeling.
Étudier par l’échographie endocoronaire les caractéristiques morphologiques de la lésion rompue au décours d’un syndrome coronarien aigu sans lésion angiographique significative.
Une échographie endocoronaire a été réalisée chez 68 patients (46.8 ± 11,9 ans) après un SCA (21 IDM et 47 angor instable) sans sténose angiographique significative (31% ± 15). La rupture était authentifiée par la présence d’une cavité au sein de la plaque, communiquant avec la lumière artérielle et recouverte d’un fragment de chape fibreuse. L’analyse qualitative de la plaque a permis de préciser son type échographique, l’analyse quantitative a évalué la surface plaque + média, le volume de plaque, le comblement athéromateux et l’index de remodelage artériel au niveau de la lésion responsable du SCA. Les patients ont été divisés en deux groupes : Groupe I avec rupture (25 patients), Groupe II sans rupture (43 patients).
Les patients avec rupture présentaient tous une plaque molle ou mixte, non calcifiée. La rupture de plaque était associée à un comblement athéromateux plus important dans le groupe I (49,8 ± 12,3% vs 39,8 ± 12,1%, p < 0,0005). Il en était de même pour la surface plaque + media (7,4 ± 2,9 mm² vs 5,2 ± 2,4 mm², p < 0,001), pour le volume de plaque (151,9 ± 103,4 mm³ vs 99,2 ± 81,6 mm³, p < 0,007) et pour le rapport volume de plaque sur longueur plus élevé (8,0 ± 4,1 mm³/mm vs 5,9 ± 3,7 mm³/mm, p < 0,003). Dans le groupe I, le remodelage positif était plus fréquemment retrouvé que le remodelage intermédiaire (p < 0,03) ou que le remodelage négatif (p < 0,005). Dans le groupe II, il n’existait pas de différence significative entre les trois types de remodelage.
Les ruptures, responsables d’un SCA, surviennent essentiellement sur des plaques volumineuses, avec important comblement athéromateux et remodelage artériel positif.

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Correlation of intracoronary ultrasound plaque characteristics in atherosclerotic coronary artery disease patients with clinical variables

Abstract

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Prog Cardiovasc Dis

Am J Cardiol

Am Heart J

A macro and micro view of coronary vascular insult in ischemic heart disease

Circulation

Composition of atherosclerotic plaques in the four major epicardial coronary arteries in patients ≥90 years of age

Am J Cardiol

Morphological characteristics of clinically significant coronary artery stenosis in stable angina

Br Heart J

Coronary artery occlusions and their myocardial consequences in arteriosclerotic heart disease (study of 212 cases)

Arch Mal Coeur Vaiss

Percutaneous intracoronary ultrasound imaging: initial applications in patients

Echocardiography

Intravascular ultrasound imaging of human coronary arteries in vivo. Analysis of tissue characteristics with comparison to in vitro histological specimens

Circulation

Percutaneous intravascular ultrasound imaging: validation of a real time synthetic aperture array catheter

Am J Card Imag