Abstract
Acute coronary syndromes (ACS) secondary to coronary vessel plaques represent a major cause of cardiovascular morbidity and mortality worldwide. Advancements in imaging technology over the last 3 decades have continuously enabled the study of coronary plaques via invasive imaging methods like intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The introduction of near-infrared spectroscopy (NIRS) as a modality that could detect the lipid (cholesterol) content of atherosclerotic plaques in the early nineties, opened the potential of studying “vulnerable” or rupture-prone, lipid-rich coronary plaques in ACS patients. Most recently, the ability of NIRS-IVUS to identify patients at risk of future adverse events was shown in a prospective multicenter trial, the Lipid-Rich-plaque Study. Intracoronary NIRS-IVUS imaging offers a unique method of coronary lipid-plaque characterization and could become a valuable clinical diagnostic and treatment monitoring tool.
Highlights
Coronary artery disease (CAD) has continued to be a major cause of morbidity and mortality worldwide, despite recent advances in medical and interventional therapies [1]
The primary analysis which was done by comparing near-infrared spectroscopy (NIRS) information presented on block chemogram readings vs. the classified histologic findings showed a “receiver operating characteristic (ROC) area under the curve (AUC) of 0.80,” confirming the ability of the NIRS system to accurately identify the lipid core plaques (LCP) [4]
It demonstrated that increasing degree of stenosis seen by angiography was associated with more vulnerable plaque morphology as assessed by NIRS-intravascular ultrasound (IVUS) system
Summary
Coronary artery disease (CAD) has continued to be a major cause of morbidity and mortality worldwide, despite recent advances in medical and interventional therapies [1]. The first study by Gardner et al made use of 84 human heart specimens- 33 hearts were used to develop NIRS algorithms and produce predefined endpoints while the remaining 51 hearts were used for prospective validation of algorithm, in a double-blinded study design, to evaluate the accuracy of NIRS in detecting LCPs. In order to Abbreviations: ACS, Acute Coronary Syndrome; IVUS, Intravascular ultrasound; OCT, Optical Coherence Tomography; NIRS, Near infrared spectroscopy; PB: Plaque Burden CAD, Coronary Artery Disease; PCI, Percutaneous Coronary Intervention; LCP, lipid core plaques; LRP, Lipid rich plaque; FA, Fibroatheroma; ROC, Receiver Operating Characteristic; AUC, Area Under the Curve: TVC, True Vessel Characterization; LCBI, Lipid core burden index; NC-MACE, Non culprit major cardiovascular events; MACE, Major adverse cardiac events; FDA, Food and Drug Administration; TCFA, thin-capped fibroatheromas; PAD, Peripheral arterial disease; MACCE, Major Adverse cardiovascular and cerebrovascular events; FFR, Fractional Flow Reserve; RF-IVUS, Radiofrequency IVUS; BVS, Bioresorbable vascular scaffold. Lower frequency increases depth-of-field while the higher frequency improves clarity
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