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European Heart Journal Advance Access published online on July 2, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn293
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry

Eduardo Missel, Gary S. Mintz*, Stephane G. Carlier, Jie Qian, Shoujie Shan, Celia Castellanos, Ryan Kaple, Sinan Biro, Martin Fahy, Jeffrey W. Moses, Gregg W. Stone and Martin B. Leon

Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA

Received 20 August 2007; revised 14 May 2008; accepted 11 June 2008.

* Corresponding author: Cardiovascular Research Foundation, 611 Pennsylvania Avenue, SE No 386, Washington, DC 20003, USA. Tel: +1 202 548 2610, Fax: +1 202 548 2643, Email: gsm18439{at}aol.com; gmintz{at}crf.org

Aims: We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and risk factors histopathologically associated with sudden coronary death (SCD) in men: cigarette smoking and an increased total cholesterol-to-high-density lipoprotein cholesterol (HDL-C) ratio (TC/HDL > 5).

Methods and results: We assessed volumetric VH-IVUS parameters in a consecutive series of 473 male patients: fibrous, fibro-fatty, dense calcium (DC), necrotic core (NC), and a calculated NC/DC ratio. Patients’ age was 61 ± 11 years, with 27% smokers and 69% having a lipid disorder. The NC/DC ratio was the only VH-IVUS parameter related to both TC/HDL ratio (r = 0.18, P= 0.0008) and low-density lipoprotein cholesterol levels (r = 0.17, P= 0.002); had a negative correlation with HDL-C levels (r = –0.11, P= 0.03); and was higher for smokers [median 1.98 (1.35–3.18)] vs. non-smokers [median 1.70 (1.23–2.53), P= 0.006]. An NC/DC value >3 was the threshold that best identified smokers and/or patients presenting TC/HDL >5 (odds ratio 3.0, 95% CI 1.7–4.9, P= 0.0001), and receiver-operator curves showed the superiority of the NC/DC ratio [area under curve (AUC) 0.64, P < 0.0001] over %DC (AUC 0.58, P= 0.006) or %NC (AUC 0.51, P= 0.43) to identify these patients.

Conclusion: The ratio of NC to calcification detected by VH-IVUS in diseased coronary segments is related to known risk factors for SCD and, thus, may be associated with a worse prognosis.

Key Words: Sudden death • Vulnerable plaque • Ultrasonics • Calcium • Necrotic core • Virtual histology


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