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  • Title: Plaque structural stress assessed by virtual histology-intravascular ultrasound predicts dynamic changes in phenotype and composition of untreated coronary artery lesions.
    Author: Kang SJ, Ha H, Lee JG, Han SB, Mintz GS, Kweon J, Chang M, Roh JH, Lee PH, Yoon SH, Ahn JM, Park DW, Lee SW, Lee CW, Park SW, Park SJ, Kim YH.
    Journal: Atherosclerosis; 2016 Nov; 254():85-92. PubMed ID: 27716568.
    Abstract:
    BACKGROUND AND AIMS: We aimed to determine whether finite element analysis (FEA)-derived plaque structural stress (PSS) analysis can predict serial changes in atheroma volume, type, and tissue composition within a fibroatheroma-containing target segment. METHODS: Overall, 210 patients (210 untreated coronary artery lesions) underwent serial (baseline and 12-month follow-up) grayscale- and virtual histology (VH)-intravascular ultrasound (IVUS). Baseline PSS was assessed at the minimal lumen and at the maximum necrotic core (NC) sites. RESULTS: Overall, there was a significant decrease in %NC volume. The highest PSS tertile was associated with a smaller on-statin reduction in %NC volume (-1.55 ± 1.03% in the highest vs. -5.18 ± 1.12% in the lowest tertile, p = 0.025). Of the 115 lesions with baseline VH-thin cap fibroatheroma (TCFA), 36 (31%) showed persistent VH-TCFA at follow-up. Five of the 95 lesions with baseline thick-cap fibroatheroma evolved into VH-TCFA. Independent predictors of VH-TCFA at follow-up (including persistent and new VH-TCFAs) were diabetes mellitus (odds ratio [OR] = 3.87, 95% CI = 1.58-9.47), a large MLA (OR = 1.39, 95% CI = 1.10-1.75), a greater percent atheroma volume (OR = 1.12, 95% CI = 1.05-1.19), VH-TCFA at baseline (OR = 8.01, 95% CI = 2.73-23.50), and a higher superficial PSS at the maximum NC site (OR = 1.02, 95% CI = 1.00-1.03), (all p < 0.05). Independent determinants of the serial change in %NC volume were high-sensitive C-reactive protein (β = -2.79, 95% CI = -5.31 to -0.27), baseline %NC volume (β = -0.70, 95% CI = -0.84 to -0.56), and superficial PSS at the maximum NC site (β = 0.05, 95% CI = 0.01-0.08), (all p < 0.05). CONCLUSIONS: An elevated PSS was more likely associated with an increase in atheroma volume, a smaller on-statin reduction in %NC volumes, and the presence of VH-TCFA at follow-up. Morphologic and hemodynamic assessment by utilizing VH-IVUS may help understand and predict atherosclerotic progression.
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