Abstract
Tissue characterization using imaging is important to understand the pathophysiology of atherosclerosis and subsequent outcomes. In this review, the clinical utility of virtual histology intravascular ultrasound (VH-IVUS), which provides a quantitative and more objective evaluation of tissue characterization compared with grayscale IVUS, will be summarized. Patient clinical characteristics, including coronary risk factors and medications, are associated with lesion morphology, especially plaque vulnerability. Different levels of vulnerability cause different clinical presentations and associated long-term outcomes. For example, in the first natural history study (Providing Regional Observations to Study Predictors of Events in the Coronary Tree [PROSPECT]), we showed that large plaque burden, small lumen area, and presence of thin-cap fibroatheroma were associated with subsequent outcomes at 3-year follow-up. VH-IVUS has contributed significantly to our understanding of atherosclerosis.
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