Fibrous Cap Thickness Predicts Stable Coronary Plaque Progression: Early Clinical Validation of a Semiautomated OCT Technology

Nicholas Kassis; Tomas Kovarnik; Zhi Chen; Joseph R. Weber; Brendan Martin; Amir Darki; Vincent Woo; Andreas Wahle; Milan Sonka; John J. Lopez

doi:10.1016/j.jscai.2022.100400

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Fibrous Cap Thickness Predicts Stable Coronary Plaque Progression: Early Clinical Validation of a Semiautomated OCT Technology

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Fibrous Cap Thickness Predicts Stable Coronary Plaque Progression: Early Clinical Validation of a Semiautomated OCT Technology

Nicholas Kassis, Tomas Kovarnik, Zhi Chen, Joseph R. Weber, Brendan Martin, Amir Darki, Vincent Woo, Andreas Wahle, Milan Sonka and John J. Lopez

Journal of the Society for Cardiovascular Angiography & Interventions, Vol.1(5), 100400

09/01/2022

DOI: 10.1016/j.jscai.2022.100400

PMCID: PMC9668070

PMID: 36397766

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Abstract

Imaging-based characteristics associated with the progression of stable coronary atherosclerotic lesions are poorly defined. Utilizing a combination of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) imaging, we aimed to characterize the lesions prone to progression through clinical validation of a semiautomated OCT computational program. Patients with stable coronary artery disease underwent nonculprit vessel imaging with IVUS and OCT at baseline and IVUS at the 12-month follow-up. After coregistration of baseline and follow-up IVUS images, paired 5-mm segments from each patient were identified, demonstrating the greatest plaque progression and regression as measured by the change in plaque burden. Experienced readers identified plaque features on corresponding baseline OCT segments, and predictors of plaque progression were assessed by multivariable analysis. Each segment then underwent volumetric assessment of the fibrous cap (FC) using proprietary software. Among 23 patients (70% men; median age, 67 years), experienced-reader analysis demonstrated that for every 100 μm increase in mean FC thickness, plaques were 87% less likely to progress (P = .01), which persisted on multivariable analysis controlling for baseline plaque burden (P = .05). Automated FC analysis (n = 17 paired segments) confirmed this finding (P = .01) and found thinner minimal FC thickness (P = .01) and larger FC surface area of <65 μm (P = .02) and <100 μm (P = .04) in progressing segments than in regressing segments. No additional imaging features predicted plaque progression. A semiautomated FC analysis tool confirmed the significant association between thinner FC and stable coronary plaque progression along entire vessel segments, illustrating the diffuse nature of FC thinning and suggesting a future clinical role in predicting the progression of stable coronary artery disease. [Display omitted] •Thinner fibrous cap by optical coherence tomography is associated with stable coronary plaque progression.•We provide early clinical validation of a semiautomated fibrous cap analysis tool.•Fibrous cap thinning is a diffuse process along entire vessel segments.•It is crucial to assess the fibrous cap beyond basic measures of its minimal thickness.

Coronary artery disease

intravascular ultrasound

optical coherence tomography

Details

Title: Subtitle: Fibrous Cap Thickness Predicts Stable Coronary Plaque Progression: Early Clinical Validation of a Semiautomated OCT Technology
Creators: Nicholas Kassis - Loyola University Medical Center
Tomas Kovarnik - General University Hospital in Prague
Zhi Chen - University of Iowa
Joseph R. Weber - Loyola University Medical Center
Brendan Martin - Loyola University Medical Center
Amir Darki - Loyola University Medical Center
Vincent Woo - Loyola University Medical Center
Andreas Wahle - University of Iowa
Milan Sonka - University of Iowa
John J. Lopez - Loyola University Medical Center
Resource Type: Journal article
Publication Details: Journal of the Society for Cardiovascular Angiography & Interventions, Vol.1(5), 100400
DOI: 10.1016/j.jscai.2022.100400
PMID: 36397766
PMCID: PMC9668070
NLM abbreviation: J Soc Cardiovasc Angiogr Interv
ISSN: 2772-9303
eISSN: 2772-9303
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/501100009553, name: Agentura Pro Zdravotnický Výzkum České Republiky, award: AZV 16-28525A; DOI: 10.13039/100000002, name: National Institutes of Health, award: NIH 1T35HL120835, R01 EB004640, R01 HL063373
Language: English
Date published: 09/01/2022
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Electrical and Computer Engineering; Radiation Oncology; The Iowa Institute for Biomedical Imaging; Fraternal Order of Eagles Diabetes Research Center; Injury Prevention Research Center; Ophthalmology and Visual Sciences
Record Identifier: 9984459621402771

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