Additive Value of Integrated Backscatter IVUS for Detection of Vulnerable Plaque by Optical Frequency Domain Imaging: An Ex  Vivo Autopsy Study of XXXX Coronary Arteries.

@entity1 @entity301 @entity2286 @entity397 @entity1856 @entity715 @entity165
OBJECTIVES: This study sought to evaluate the diagnostic performance of optical frequency domain imaging (OFDI) for recognition of coronary plaque morphologies and to assess additive values of integrated backscatter intravascular ultrasound (IB-IVUS) in detection of vulnerable plaque. BACKGROUND: Precise diagnosis of @entity301 susceptible to @entity397 and @entity715 may serve to stratify the risk of future coronary events and to make decisions for appropriate treatment of choice. METHODS: Twenty-seven coronary arteries from 14 @entity1 autopsy hearts were interrogated ex  vivo by OFDI and IB-IVUS. Imaged segments were sectioned at 3 mm intervals where a total of 360 pairs of cross-sectional images coregistered to histology were investigated. RESULTS: Overall, OFDI could depict various plaque components and structures such as fibrous tissue, sheet and nodular calcification, lipid, @entity165 crystals, and healed @entity397 . OFDI could detect 14 of 18 thin-cap @entity1856 (TCFA), however, the diagnostic accuracy was not high (positive predictive value [ @entity2286 ]  = 60.9%, k  =  0.664; area under the curve [AUC]: 0.88) mainly because of signal interference from macrophages. Further, we defined IB-IVUS-derived TCFA by recursive partitioning analysis as: 1) cross-sectional % lipid area >65.1%; 2) % lipid  area >32.3 but  <65.1% with plaque area >10.5 mm(2), where TCFA detection by IB-IVUS alone was marginal ( @entity2286  =  50.0%, k  = 0.545; AUC: 0.82). However, when IB-IVUS was combined with OFDI, all pseudo OFDI-derived TCFA (non-TCFA on histology) were excluded. Accordingly, @entity2286 of TCFAs diagnosed by both OFDI and IB-IVUS was improved to 100.0% (k  = 0.704; AUC: 0.93). CONCLUSIONS: OFDI could recognize detailed morphologies of @entity1 coronary plaque. However, diagnostic accuracy of both OFDI alone and IB-IVUS alone to identify TCFA is limited. Combination of IB-IVUS with OFDI improved the accuracy for TCFA detection, suggesting hybrid imaging or further development of novel devices will be required to identify @entity301 responsible for future events.
