At present, ischemic heart disease is still the leading cause of death worldwide. It is important to identify vulnerable plaques that cause myocardial infarction early and take measures to stabilize the plaques and improve patient outcomes. The hybrid imaging technology of near infrared fluorescence (NIRS) and intravenous ultrasound (IVUS) (NIRS-IVUS) is a coronary artery imaging method for identifying vulnerable plaques. The PROSPECT II study presented at the TCT 2020 conference To explore whether NIRS-IVUS imaging can identify untreated plaques that can cause clinical events. This journal specially invited Professor David Erlinge from the University of Skrim in Sweden to answer related questions.
What is the application effect of NIRS-IVUS hybrid imaging technology in acute myocardial infarction patients?
David Erlinge: We use this IVUS and spectroscopy technology to detect lipid-rich plaques and a high plaque burden. We did the study in patients with myocardial infarction. Those patients have a lot of extra plaques. In fact, they had around four plaques per patient in our study. We found that if they had a lot of plaque burden or a lot of lipid-rich plaques, they had a higher risk of having a new myocardial infarction event. In the future however, I think we will use this technology in all kinds of patients, including stable patients. A lot of those patients would come from CT angiography where large vulnerable plaques can be seen, but not yet stenotic, and they could be treated.
In terms of the ability to detect lipid plaques, what are the advantages of NIRS-IVUS hybrid imaging compared with OCT?
David Erlinge: The biggest advantage is that it is so easy to use and easy to interpret. You see a large yellow spot that says there is a lot of lipid present, and apply a scale of 0-1000 to determine how much lipid there is in the plaque (1000 being around 100%). It is very easy to see when there is a dangerous plaque that can cause myocardial infarction or sudden death. If using OCT, it is more complicated to interpret. Several doctors looking at the same OCT can arrive at several different results from their analyses. So, simplicity of use is one of the biggest advantages. Of course, it is also validated now in two studies, that the technique can detect plaques that cause myocardial infarction.
At present,NIRS-IVUS hybrid imaging is the only hybrid vascular imaging technology used in clinical practice. What are the shortcomings in the application and how to improve?
David Erlinge: It is actually very good. The spectroscopy is fantastic, and the IVUS is fantastic. The IVUS is high resolution up to 60mHz. The resolution of the IVUS is the best of all the IVUS I have seen. It is very good technology. What I think could be improved is its integration into X-ray systems and simpler use so a console is not required. It could be part of the classical angiography system. That is something that could be improved, but otherwise, I think it is very good.
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