Association of Plaque Characterization by Intravascular Ultrasound Virtual Histology and Arterial Remodeling

doi:10.1016/j.amjcard.2005.07.054

The American Journal of Cardiology

Volume 96, Issue 11, 1 December 2005, Pages 1476-1483

https://doi.org/10.1016/j.amjcard.2005.07.054 Get rights and content

Positive remodeling is more often observed in lesions of patients who have acute coronary syndromes or vulnerable (rupture-prone) plaques. However, there are few data that correlate plaque morphology, composition, and arterial remodeling in vivo. We evaluated coronary plaque characterization of lesions with positive remodeling using intravascular ultrasound (IVUS) radiofrequency data analysis. Seventy-seven nonbifurcation native coronary lesions (in 50 patients) were imaged in vivo using 30-MHz IVUS transducers. Lesions were classified into 4 plaque types, fibrous, fibrofatty, dense calcium, and necrotic core, by using processing of the radiofrequency signal validated in vitro. The remodeling index was calculated as the lesion external elastic membrane area divided by the proximal reference external elastic membrane area. Lesions were divided into 2 groups: positive remodeling (remodeling index >1.0, 26 lesions) and intermediate/negative remodeling (remodeling index ≤1.0, 51 lesions). Total plaque volume and the volume of each plaque type were averaged over the length of the lesion. Reference segment plaque compositions were similar. Mean lesion fibrofatty plaque area was significantly larger in lesions with positive remodeling than in lesions with intermediate/negative remodeling (1.2 ± 0.7 vs 0.8 ± 0.4 mm², p = 0.001; 26.3 ± 6.6% vs 19.8 ± 5.7%, p <0.001, of total plaque volume). The same results were obtained at the minimum lumen site and in the subgroup of patients who had acute coronary syndromes. Further, there was a linear relation between remodeling index and fibrofatty plaque area (r = 0.26, p = 0.02). In conclusion, in vivo IVUS radiofrequency data analysis demonstrates that positive remodeling occurs in lesions with more fibrofatty plaque.

Section snippets

Definitions and patient populations

Between June 2003 and May 2004, preintervention IVUS was performed prospectively in 118 lesions with moderate or severe coronary stenosis in 87 patients who were at 4 medical centers. Seventy-seven lesions (in 50 patients), 63 severe target lesions (82%) and 14 (18%) moderate nontarget lesions, met the following criteria: (1) high-quality, automated pullback IVUS images of the entire lesion, including the proximal segment; (2) de novo lesion; and (3) nonostial and bifurcation lesion location.

Baseline patient and lesion characteristics

Positive remodeling was present in 26 lesions, whereas intermediate/negative remodeling was observed in 51 lesions. Baseline patient characteristics are listed in Table 1. No significant difference existed in patient characteristics between groups, although a statistically nonsignificant trend for more acute coronary syndrome was noted for lesions with positive remodeling.

Conventional IVUS data of lesions with positive versus intermediate/negative remodeling

As presented in Table 2, reference measurements were similar between groups. At the minimum lumen site, however, lesions

Discussion

The present study demonstrated a clear relation between extent of arterial remodeling and plaque morphology. There was a direct relation between positive remodeling and more fibrofatty plaque.

Conventional IVUS interpretation is limited to an evaluation of gray-scale images that are generated by ultrasound reflections at tissue interfaces that differ in acoustic impedance.¹⁴ Although gray-scale images indicate the overall composition of large homogeneous regions, such as predominantly calcified

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Coronary artery diseaseAssociation of Plaque Characterization by Intravascular Ultrasound Virtual Histology and Arterial Remodeling

Section snippets

Definitions and patient populations

Baseline patient and lesion characteristics

Conventional IVUS data of lesions with positive versus intermediate/negative remodeling

Discussion

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

Am J Cardiol

Atherosclerosis

Compensatory enlargement of human atherosclerotic coronary arteries

N Engl J Med

Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses

Circulation

Extent and direction of arterial remodeling in stable versus unstable coronary syndromes. An intravascular ultrasound study

Circulation

Coronary artery disease
Association of Plaque Characterization by Intravascular Ultrasound Virtual Histology and Arterial Remodeling