Optical Coherence Tomography and Virtual-Histology Intravascular Ultrasound
2015; Lippincott Williams & Wilkins; Volume: 8; Issue: 10 Linguagem: Inglês
10.1161/circimaging.115.004045
ISSN1942-0080
Autores Tópico(s)Peripheral Artery Disease Management
ResumoHomeCirculation: Cardiovascular ImagingVol. 8, No. 10Optical Coherence Tomography and Virtual-Histology Intravascular Ultrasound Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBOptical Coherence Tomography and Virtual-Histology Intravascular UltrasoundStrange Bedfellows? … or Not? Gary S. Mintz, MD Gary S. MintzGary S. Mintz From the Cardiovascular Research Foundation, New York, NY. Originally published1 Oct 2015https://doi.org/10.1161/CIRCIMAGING.115.004045Circulation: Cardiovascular Imaging. 2015;8The ultimate goal of studies such as the one by Brown et al1 in this issue of Circulation: Cardiovascular Imaging is to provide the clinician with a diagnostic tool that identifies high-risk plaques prospectively to treat and prevent acute events. This tool must have a high positive predictive value and negative predictive value in the clinical setting and not require specific expertise or core-laboratory analysis to determine whether a plaque is vulnerable and should be treated pre-emptively—a yes/no, treat/don't treat tool. Optical coherence tomography (OCT) has been proposed as that tool. OCT criteria for a thin-cap fibroatheroma (TCFA) include the presence and amount of lipid plaque and a thin fibrous cap with macrophage infiltration. However, in a core-laboratory study by Kim et al in which the intraobserver reproducibility was high, the interobserver intraclass correlation coefficient among 4 highly trained individuals (a better, but still idealized representation of what would happen clinically) was only 0.49 (95% confidence interval: 0.26–0.69) for fibrous cap thickness and 0.77 (95% confidence interval: 0.53–0.97) and 0.71 (95% confidence interval: 0.55–0.86) for maximum and average lipid arc, respectively.2 Quantification of lipid by OCT is problematic and is restricted to the arc of lipidic plaque because penetration through lipid or necrotic core (as well as assessment of plaque burden in high-risk plaques3) is one of the limitations of OCT. Furthermore, limitations to the accurate OCT assessment of lipidic plaque include artifacts caused by shallow or tangential beam angulation and drop-put and confounders, such as the presence of macrophages, foam cells, microcalcifications, or hemosiderin, in the fibrous cap—all of which can produce the appearance of lipid, whether or not lipid is actually present.See Article by Brown et alAlthough the study by Brown et al1 is titled "Direct comparison of virtual-histology intravascular ultrasound and optical coherence tomography imaging for identification of thin-cap fibroatheroma," in reality it is less of a direct comparison of 2 techniques than one of an increasing number of, albeit, small studies questioning the accuracy of OCT,2,4–6 as well as a rehabilitation of virtual histology (VH)–intravascular ultrasound (IVUS), suggesting that a combination of the 2 techniques is better than either alone.VH-IVUS was developed to improve on the limited tissue characterization of grayscale IVUS. Proposed criteria for a VH–fibroatheroma included >10% confluent necrotic core for 3 consecutive frames and confluent necrotic core >10% in contact with the lumen for 3 consecutive frames for VH-TCFA. Although used to good advantage in 3 important prospective studies—Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT),7 VH-IVUS in Vulnerable Athersclerosis (VIVA),8 and European Collaborative Project on Inflammation and Vascular Wall Remodeling in Atherosclerosis - Intravascular Ultrasound (ATHEROREMO-IVUS)9—VH-IVUS has fallen into disfavor (especially in the clinical setting) because of the relatively low resolution of VH-IVUS making it impossible to measure fibrous cap thinness consistent with TCFA; reproducibility issues, diagnostic reliability, and artifacts; and studies such as the animal study by Thim et al who found no correlation between the size of the necrotic core determined by VH-IVUS versus histopathology, as well as VH-IVUS necrotic cores in lesions lacking necrotic cores by histopathology.10In Brown et al's histopathologic study, the positive predictive value and negative predictive value were 26.4% and 94.6%, respectively, for a VH-TCFA and 30.8% and 95.9%, respectively, for OCT-TCFAs.1 Thus, by themselves, both techniques were fundamentally flawed. Conversely, the highest diagnostic accuracy (89.0%) in predicting a histopathologic TCFA was seen when VH-IVUS necrotic core detection was combined with OCT fibrous cap thickness measurements. This approach used the strengths of each technology to compensate for the weaknesses of the other—quantification of necrotic core by VH-IVUS (that cannot identify a thin fibrous cap) and measurement of fibrous cap thickness by OCT (that cannot quantify lipid or necrotic core content).Using 2 catheters and 2 machines is clinically cumbersome, unrealistic, and expensive, and it requires some method to coregister the 2 techniques. Although once a fantasy, combined imaging devices are now a reality. However, the 3 currently available radiofrequency IVUS technologies—VH-IVUS, integrated backscatter-IVUS, and iMAP—use different algorithms, are not interchangeable, and each, alone or in combination with OCT, requires validation. Conversely, the 2 frequency-domain OCT imaging devices—marketed as frequency-domain OCT and optical frequency–domain imaging—merely represent different implementations of the same fundamental technology. However, issues of intellectual property may limit the commercialization of certain combinations. For example, VH-IVUS used in the study by Brown et al is owned by a company that was blocked from bringing frequency-domain OCT to market.1 Furthermore, combination devices must not sacrifice quality of each component technology for the sake of convenience and expediency.But Does This Make Clinical Sense?In PROSPECT, events attributable to each identified high-risk plaque were uncommon, suggesting that VH-IVUS in PROSPECT may have overestimated TCFA prevalence—this despite the fact that prespecified 3-vessel VH-IVUS imaged only half of the lesions that caused events. According to the study by Brown et al, 3 quarters of the 600 VH-TCFAs identified in PROSPECT were likely to have been false positives; adding OCT to VH-IVUS would have halved the false-positive rate.1 Even so and especially in a setting of more complete 3-vessel imaging, the combination of OCT and VH-IVUS would still have identified mostly TCFAs that were either stable, developed thick fibrous caps when patients were treated with modern medical therapy, and ruptured silently and asymptomatically. Serial OCT studies have documented an increase in fibrous cap thickness, especially with lipid lowering agents.11–15 Studies by Mann and Davies16 and of Burke et al17 showed that plaque rupture and healing were common and more often led to lesion progression than to acute events.Second, in vivo OCT studies have indicated that ruptured plaques with thrombus formation may underlie only ≈50% of acute coronary syndromes.18–22 Thus, although the absence of a confluent necrotic core >10% (by VH-IVUS) or of a fibrous cap thickness <85 μm (by OCT) likely exclude a TCFA,1 they do not exclude other vulnerable plaque morphologies, such as precursors of erosions, spontaneous dissections, and calcified nodules.Third, these issues become even more problematic in the context of asymptomatic individuals considering the large population at risk with an even lower rate of adverse events, complications associated with 3-vessel invasive imaging, however, low, and higher costs associated with combination versus single imaging technology devices. Although histopathologic correlations are important, imaging findings that reliably predict (or exclude) events are even more important than studies showing that one or another technology (or any combination of technologies) correlate better with histopathology. This is true even if the imaging technology is flawed when compared with histopathology; clinical data trumps histopathologic correlations, but it takes more time and resources.Finally, and most importantly, vulnerable plaque imaging research must move beyond assessment of diagnostic accuracy in vitro and prediction of events in vivo and be linked to therapies that reduce events.DisclosuresDr Mintz is a consultant for and receives honoraria from BostonScientific, Volcano, Infraredx, ACIST, and St Jude. The Cardiovascular Research Foundation receives fellowship or research support from BostonScientific, Volcano, Infraredx, and St Jude.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to Gary S. Mintz, MD, Cardiovascular Research Foundation, 111 E 59th St, New York, NY 10022. E-mail [email protected]References1. Brown AJ, Obaid DR, Costopoulos C, Parker RA, Calvert PA, Teng Z, Hoole SP, West NEJ, Goddard M, Bennett MR.Direct comparison of virtual-histology intravascular ultrasound and optical coherence tomography imaging for identification of thin-cap fibroatheroma.Circ Cardiovasc Imaging. 2015; 8:e003487. doi: 10.1161/CIRCIMAGING.115.003487.LinkGoogle Scholar2. Kim SJ, Lee H, Kato K, Yonetsu T, Xing L, Zhang S, Jang IK.Reproducibility of in vivo measurements for fibrous cap thickness and lipid arc by OCT.JACC Cardiovasc Imaging. 2012; 5:1072–1074. doi: 10.1016/j.jcmg.2012.04.011.CrossrefMedlineGoogle Scholar3. Tian J, Ren X, Vergallo R, Xing L, Yu H, Jia H, Soeda T, McNulty I, Hu S, Lee H, Yu B, Jang IK.Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin-cap fibroatheroma: a combined optical coherence tomography and intravascular ultrasound study.J Am Coll Cardiol. 2014; 63:2209–2216. doi: 10.1016/j.jacc.2014.01.061.CrossrefMedlineGoogle Scholar4. Fujii K, Hao H, Shibuya M, Imanaka T, Fukunaga M, Miki K, Tamaru H, Sawada H, Naito Y, Ohyanagi M, Hirota S, Masuyama T.Accuracy of OCT, grayscale IVUS, and their combination for the diagnosis of coronary TCFA: an ex vivo validation study.JACC Cardiovasc Imaging. 2015; 8:451–460. doi: 10.1016/j.jcmg.2014.10.015.CrossrefMedlineGoogle Scholar5. Nakano M, Yahagi K, Yamamoto H, Taniwake M, Otsuka F, Ladich ER, Joner M, Virmani R.Additive value of integrated backscatter intravascular ultrasound for the detection of vulnerable plaque by optical frequency domain imaging: An ex vivo autopsy study of human coronary arteries.JACC Cardiovasc Imaging. In press.Google Scholar6. Phipps JE, Vela D, Hoyt T, Halaney DL, Mancuso JJ, Buja LM, Asmis R, Milner TE, Feldman MD.Macrophages and intravascular OCT bright spots: a quantitative study.JACC Cardiovasc Imaging. 2015; 8:63–72. doi: 10.1016/j.jcmg.2014.07.027.CrossrefMedlineGoogle Scholar7. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, Parise H, Templin B, White R, Zhang Z, Serruys PW; PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis.N Engl J Med. 2011; 364:226–235. doi: 10.1056/NEJMoa1002358.CrossrefMedlineGoogle Scholar8. Calvert PA, Obaid DR, O'Sullivan M, Shapiro LM, McNab D, Densem CG, Schofield PM, Braganza D, Clarke SC, Ray KK, West NE, Bennett MR.Association between IVUS findings and adverse outcomes in patients with coronary artery disease: the VIVA (VH-IVUS in Vulnerable Atherosclerosis) Study.JACC Cardiovasc Imaging. 2011; 4:894–901. doi: 10.1016/j.jcmg.2011.05.005.CrossrefMedlineGoogle Scholar9. Cheng JM, Garcia-Garcia HM, de Boer SP, Kardys I, Heo JH, Akkerhuis KM, Oemrawsingh RM, van Domburg RT, Ligthart J, Witberg KT, Regar E, Serruys PW, van Geuns RJ, Boersma E.In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study.Eur Heart J. 2014; 35:639–647. doi: 10.1093/eurheartj/eht484.CrossrefMedlineGoogle Scholar10. Thim T, Hagensen MK, Wallace-Bradley D, Granada JF, Kaluza GL, Drouet L, Paaske WP, Bøtker HE, Falk E.Unreliable assessment of necrotic core by virtual histology intravascular ultrasound in porcine coronary artery disease.Circ Cardiovasc Imaging. 2010; 3:384–391. doi: 10.1161/CIRCIMAGING.109.919357.LinkGoogle Scholar11. Takarada S, Imanishi T, Kubo T, Tanimoto T, Kitabata H, Nakamura N, Tanaka A, Mizukoshi M, Akasaka T.Effect of statin therapy on coronary fibrous-cap thickness in patients with acute coronary syndrome: assessment by optical coherence tomography study.Atherosclerosis. 2009; 202:491–497. doi: 10.1016/j.atherosclerosis.2008.05.014.CrossrefMedlineGoogle Scholar12. Habara M, Nasu K, Terashima M, Ko E, Yokota D, Ito T, Kurita T, Teramoto T, Kimura M, Kinoshita Y, Tsuchikane E, Asakura Y, Matsubara T, Suzuki T.Impact on optical coherence tomographic coronary findings of fluvastatin alone versus fluvastatin + ezetimibe.Am J Cardiol. 2014; 113:580–587. doi: 10.1016/j.amjcard.2013.10.038.CrossrefMedlineGoogle Scholar13. Nishio R, Shinke T, Otake H, Nakagawa M, Nagoshi R, Inoue T, Kozuki A, Hariki H, Osue T, Taniguchi Y, Iwasaki M, Hiranuma N, Konishi A, Kinutani H, Shite J, Hirata K.Stabilizing effect of combined eicosapentaenoic acid and statin therapy on coronary thin-cap fibroatheroma.Atherosclerosis. 2014; 234:114–119. doi: 10.1016/j.atherosclerosis.2014.02.025.CrossrefMedlineGoogle Scholar14. Yamano T, Kubo T, Shiono Y, Shimamura K, Orii M, Tanimoto T, Matsuo Y, Ino Y, Kitabata H, Yamaguchi T, Hirata K, Tanaka A, Imanishi T, Akasaka T.Impact of eicosapentaenoic acid treatment on the fibrous cap thickness in patients with coronary atherosclerotic plaque: an optical coherence tomography study.J Atheroscler Thromb. 2015; 22:52–61. doi: 10.5551/jat.25593.CrossrefMedlineGoogle Scholar15. Komukai K, Kubo T, Kitabata H, Matsuo Y, Ozaki Y, Takarada S, Okumoto Y, Shiono Y, Orii M, Shimamura K, Ueno S, Yamano T, Tanimoto T, Ino Y, Yamaguchi T, Kumiko H, Tanaka A, Imanishi T, Akagi H, Akasaka T.Effect of atorvastatin therapy on fibrous cap thickness in coronary atherosclerotic plaque as assessed by optical coherence tomography: the EASY-FIT study.J Am Coll Cardiol. 2014; 64:2207–2217. doi: 10.1016/j.jacc.2014.08.045.CrossrefMedlineGoogle Scholar16. Mann J, Davies MJ.Mechanisms of progression in native coronary artery disease: role of healed plaque disruption.Heart. 1999; 82:265–268.CrossrefMedlineGoogle Scholar17. Burke AP, Kolodgie FD, Farb A, Weber DK, Malcom GT, Smialek J, Virmani R.Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression.Circulation. 2001; 103:934–940.LinkGoogle Scholar18. Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, Kato K, Yonetsu T, Vergallo R, Hu S, Tian J, Lee H, Park SJ, Jang YS, Raffel OC, Mizuno K, Uemura S, Itoh T, Kakuta T, Choi SY, Dauerman HL, Prasad A, Toma C, McNulty I, Zhang S, Yu B, Fuster V, Narula J, Virmani R, Jang IK.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.J Am Coll Cardiol. 2013; 62:1748–1758. doi: 10.1016/j.jacc.2013.05.071.CrossrefMedlineGoogle Scholar19. Saia F, Komukai K, Capodanno D, Sirbu V, Musumeci G, Boccuzzi G, Tarantini G, Fineschi M, Tumminello G, Bernelli C, Niccoli G, Coccato M, Bordoni B, Bezerra H, Biondi-Zoccai G, Virmani R, Guagliumi G; OCTAVIA Investigators. Eroded versus ruptured plaques at the culprit site of STEMI: in vivo pathophysiological features and response to primary PCI.JACC Cardiovasc Imaging. 2015; 8:566–575. doi: 10.1016/j.jcmg.2015.01.018.CrossrefMedlineGoogle Scholar20. Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, Iwaguro T, Ueno S, Okumoto Y, Akasaka T.Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome [published online ahead of print September 11, 2013].Eur Heart J Acute Cardiovasc Care. doi: 10.1177/2048872613504310.Google Scholar21. Wang L, Parodi G, Maehara A, Valenti R, Migliorini A, Vergara R, Carrabba N, Mintz GS, Antoniucci D.Variable underlying morphology of culprit plaques associated with ST-elevation myocardial infarction: an optical coherence tomography analysis from the SMART trial.Eur Heart J Cardiovasc Imaging. doi: http://dx.doi.org/10.1093/ehjci/jev105 First published online: 24 April 2015.Google Scholar22. Higuma T, Soeda T, Abe N, Yamada M, Yokoyama H, Shibutani S, Vergallo R, Minami Y, Ong DS, Lee H, Okumura K, Jang IK.A Combined optical coherence tomography and intravascular ultrasound study on plaque rupture, plaque erosion, and calcified nodule in patients with ST-segment elevation myocardial infarction: incidence, morphologic characteristics, and outcomes after percutaneous coronary intervention.JACC Cardiovasc Interv. 2015; 8:1166–1176. doi: 10.1016/j.jcin.2015.02.026.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Guo X, Tang D, Molony D, Yang C, Samady H, Zheng J, Mintz G, Maehara A, Wang L, Pei X, Li Z, Ma G and Giddens D (2019) A Machine Learning-Based Method for Intracoronary OCT Segmentation and Vulnerable Coronary Plaque Cap Thickness Quantification, International Journal of Computational Methods, 10.1142/S0219876218420082, 16:03, (1842008), Online publication date: 1-May-2019. Gao J, Wang Y and Liu Y (2019) Application of virtual histological intravascular ultrasound in plaque composition assessment of saphenous vein graft diseases, Chinese Medical Journal, 10.1097/CM9.0000000000000183, 132:8, (957-962), Online publication date: 20-Apr-2019. Guo X, Giddens D, Molony D, Yang C, Samady H, Zheng J, Mintz G, Maehara A, Wang L, Pei X, Li Z and Tang D (2018) Combining IVUS and Optical Coherence Tomography for More Accurate Coronary Cap Thickness Quantification and Stress/Strain Calculations: A Patient-Specific Three-Dimensional Fluid-Structure Interaction Modeling Approach, Journal of Biomechanical Engineering, 10.1115/1.4038263, 140:4, Online publication date: 1-Apr-2018. Liu Y, Wang H, Li X, Xiao J, Wang J, Reilly K, Sun B and Gao J (2018) Relationship between plaque composition by virtual histology intravascular ultrasound and clinical outcomes after percutaneous coronary intervention in saphenous vein graft disease patients: study protocol of a prospective cohort study, BMC Cardiovascular Disorders, 10.1186/s12872-018-0975-1, 18:1, Online publication date: 1-Dec-2018. Roth C, Gangl C, Dalos D, Delle-Karth G, Neunteufl T and Berger R (2018) Incidence of late-acquired stent malapposition of drug eluting stents with second generation permanent and biodegradable polymer coatings-A prospective, randomized comparison using optical coherence tomography, Journal of Interventional Cardiology, 10.1111/joic.12572, 31:6, (780-791), Online publication date: 1-Dec-2018. Roth C, Gangl C, Dalos D, Krenn L, Scherzer S, Gerken A, Reinwein M, Zhang C, Hagmann M, Wrba T, Delle-Karth G, Neunteufl T, Maurer G, Vock P, Mayr H, Frey B, Berger R and Lionetti V (2016) Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy, PLOS ONE, 10.1371/journal.pone.0154025, 11:4, (e0154025) October 2015Vol 8, Issue 10 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.115.004045PMID: 26429761 Originally publishedOctober 1, 2015 Keywordsintravascular ultrasoundvulnerable plaqueEditorialsfoam cellsoptical coherence tomographymacrophagePDF download Advertisement SubjectsImagingOptical Coherence Tomography (OCT)Ultrasound
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