IVUS-VH: a predictor of plaque morphology?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Abstract

Imaging modalities that identify plaques vulnerable to rupture offer the possibility of preventing the most common substrate of coronary thrombosis. The incidence of progression of thin-cap atheroma, as identified at PCI, is largely unknown. Glaser et al .1 have demonstrated that at 1-year follow-up of a cohort of patients undergoing PCI, at least 6% develop progression of disease requiring additional PCI for another target lesion. The major predictors of plaque progression were multivessel disease, prior PCI, and age less than 65 years. Goldstein et al .2 demonstrated that 17% of acute MI patients with multiple complex angiographic lesions undergo PCI of non-culprit lesions within 1 year. These data underscore the need for identifying those plaques in high-risk patients who will benefit from prophylactic intervention. The hope is that newer imaging modalities, such as IVUS-virtual histology (VH) will precisely identify those lesions. Rodriguez-Granillo et al .3 describe IVUS-VH in a prospective study of 40 patients referred for cardiac catheterization: there were 13 with stable angina, 12 with unstable angina, and 15 with acute myocardial infarction. The risk factor profiles were fairly typical of patients with coronary artery disease (CAD): 10% of patients had diabetes, 73% were male, 38% were smokers, and 50% had elevated cholesterol. Although three-vessel IVUS was the goal in all patients, only two-vessel characterization was possible in nine of the 40 patients. PR was identified in 26 patients and, as expected, was more frequent in patients with acute myocardial infarction and unstable angina. They concluded that patients with plaque ruptures have larger body mass index (BMI) when compared with those without plaque rupture and were more likely smokers and that patients with ruptures had more diffuse calcification and necrotic core area. VH refers to spectral analysis of ultrasound backscatter radiofrequency signals.4 Refinements of IVUS to improve spatial … *Corresponding author. Tel: +1 301 208 2490; fax: +1 301 208 3745. E-mail address : rvirmani{at}cvpath.org