NIRS-IVUS for Differentiating Coronary Plaque Rupture, Erosion, and Calcified Nodule in Acute Myocardial Infarction

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Terada, Kosei¹  Kubo, Takashi¹  Kameyama, Takeyoshi¹  Matsuo, Yoshiki¹  Ino, Yasushi¹  Emori, Hiroki¹  Higashioka, Daisuke¹  Katayama, Yosuke¹  Khalifa, Amir Kh M.¹  Takahata, Masahiro¹  Shimamura, Kunihiro¹  Shiono, Yasutsugu¹  Tanaka, Atsushi¹  Hozumi, Takeshi¹  Madder, Ryan D.²  Akasaka, Takashi¹ 

[1] Wakayama Med Univ, Dept Cardiovasc Med, 811-1 Kimiidera, Wakayama 6418509, Japan

[2] Spectrum Hlth, Frederik Meijer Heart & Vasc Inst, Grand Rapids, MI USA

关键词: calcified nodule;    intravascular ultrasound;    near-infrared spectroscopy;    optical coherence tomography;    plaque erosion;    plaque rupture;   

DOI  :  10.1016/j.jcmg.2020.08.030

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to investigate the ability of combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) to differentiate plaque rupture (PR), plaque erosion (PE), or calcified nodule (CN) in acute myocardial infarction (AMI). BACKGROUND Most acute coronary syndromes occur from coronary thrombosis based on PR, PE, or CN. In vivo differentiation among PR, PE, and CN is a major challenge for intravascular imaging. METHODS The study enrolled 244 patients with AMI who had a de novo culprit lesion in a native coronary artery. The culprit lesions were assessed by both NIRS-IVUS and optical coherence tomography (OCT). Maximum lipid core burden index in 4 mm (maxLCBI(4mm)) was measured by MRS. Plaque cavity and convex calcium was detected by IVUS. The OCT diagnosis of PR (n = 175), PE (n = 44), and CN (n = 25) was used as a reference standard. RESULTS In the development cohort, IVUS-detected plaque cavity showed a high specificity (100%) and intermediate sensitivity (62%) for identifying OCT-PR. IVUS-detected convex calcium showed a high sensitivity (93%) and specificity (100%) for identifying OCT-CN. NIRS-measured maxLCBI(4mm) was largest in OCT-PR (705 [interquartile range (IQR): 545 to 854]), followed by OCT-CN (355 [IQR: 303 to 478]) and OCT-PE (300 [IQR: 126 to 357]) (p < 0.001). The optimal cutoff value of maxLCBI(4mm) was 426 for differentiating between OCT-PR and -PE; 328 for differentiating between OCT-PE and -CN; and 579 for differentiating between OCT-PR and -CN. In the validation cohort, the NIRS-IVUS classification algorithm using plaque cavity, convex calcium, and maxLCBI(4mm) showed a sensitivity and specificity of 97% and 96% for identifying OCT-PR, 93% and 99% for OCT-PE, and 100% and 99% for OCT-CN, respectively. CONCLUSIONS By evaluating plaque cavity, convex calcium, and maxLCBI(4mm), NIRS-IVUS can accurately differentiate PR, PE, and CN. (C) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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