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Preliminary study of the significance of reverberation by IVUS detection for patients with severe calcified lesions

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Abstract

To explore the potential significance of the reverberation of calcification by comparing both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) measurement post manual coregistration. The reverberation phenomenon is often detected by IVUS for severe calcified lesions post rotational atherectomy (RA), which is thought to be due to the glassy and smooth inner surfaces of calcifications. Because of the poor penetration of IVUS, it is impossible to measure the thickness of calcifications, and the relationship between multiple reverberations and the thickness of calcification lesions has not been reported before. A total of forty-nine patients with severe calcified coronary lesions that were detected by IVUS and OCT simultaneously were enrolled in our retrospective study. If reverberation phenomena were detected by IVUS, intravascular imaging (IVI) data (including distance between the IVUS catheter center and the inner surface of the reverberation signal, the intervals between all adjacent reverberation signals, the number of layers of reverberation in IVUS, and the thickness of the calcification in OCT) were measured at the same position and same direction (each cross-section had 4 mutually perpendicular directions) at 1-mm intervals. The correlation between each reverberation observational value and OCT data was the primary target in this retrospective study, and the correlation between reverberation and calcium crack post predilatation was analyzed in other 15 patients. Four hundred twenty-eight valid observational points were analyzed simultaneously by IVUS and OCT; among them, 300 points had a single layer of reverberation, 83 had double layers of reverberation and 42 had multiple layers (≥ 3 layers) of reverberation by IVUS detection post-RA. Multivariate logistic regression analysis showed that the number of layers of reverberation by IVUS was significantly related to the thickness of calcifications by OCT at the same point and in the same direction (p < 0.001). Single, double, and multiple layers of reverberation in IVUS correspond to median calcification thicknesses (interquartile ranges (IQRs)) of 0.620 mm (0.520–0.720), 0.950 mm (0.840–1.040) and 1.185 mm (1.068–1.373), respectively, by OCT detection. Another 100 points in other 15 patients with integrated IVUS data pre- and post-predilatation showed that only single layer of reverberation was related to calcium crack (p < 0.001). The number of layers of reverberation signal detected by IVUS is positively correlated with the thickness of calcifications measured by OCT post-RA and single layer of reverberation is correlated to calcium crack post-predilatation.

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Abbreviations

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

IQR:

Interquartile range

IVI:

Intravascular imaging

IVUS:

Intravascular ultrasound

OCT:

Optical coherence tomography

PCI:

Percutaneous coronary intervention

RA:

Rotational atherectomy

References

  1. Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P (2014) Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol 63(17):1703–1714. https://doi.org/10.1016/j.jacc.2014.01.017

    Article  CAS  PubMed  Google Scholar 

  2. Bourantas CV, Zhang Y-J, Garg S, Iqbal J, Valgimigli M, Windecker S, Mohr FW, Silber S, de Vries T, Onuma Y, Garcia-Garcia HM, Morel M-A, Serruys PW (2014) Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart 100(15):1158–1164. https://doi.org/10.1136/heartjnl-2013-305180

    Article  PubMed  Google Scholar 

  3. Généreux P, Redfors B, Witzenbichler B, Arsenault M-P, Weisz G, Stuckey TD, Rinaldi MJ, Franz-Josef Neumann D, Metzger C, Henry TD, Cox DA, Duffy PL, Mazzaferri Jr EL, Francese DP, Marquis-Gravel G, Mintz GS, Kirtane AJ, Maehara A, Mehran R, Stone GW (2017) Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents. Int J Cardiol 231:61–67. https://doi.org/10.1016/j.ijcard.2016.12.150

    Article  PubMed  Google Scholar 

  4. Lorenz Räber, Gary S Mintz, Konstantinos C Koskinas, Thomas W Johnson, Niels R Holm, Yoshinubo Onuma, Maria D Radu, Michael Joner, Bo Yu, Haibo Jia, Nicolas Meneveau, Jose M de la Torre Hernandez, Javier Escaned, Jonathan Hill, Francesco Prati, Antonio Colombo, Carlo di Mario, Evelyn Regar, Davide Capodanno, William Wijns, Robert A Byrne, Giulio Guagliumi, ESC Scientific Document Group (2018). Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 39(35):3281–3300. doi: https://doi.org/10.1093/eurheartj/ehy285.

  5. Wang X, Matsumura M, Mintz GS, Lee T, Zhang W, Cao Y, Fujino A, Lin Y, Usui E, Kanaji Y, Murai T, Yonetsu T, Kakuta T, Maehara A (2017) In vivo calcium detection by comparing optical coherence tomography, intravascular ultrasound, and angiography. JACC Cardiovasc Imaging 10(8):869–879. https://doi.org/10.1016/j.jcmg.2017.05.014

    Article  CAS  PubMed  Google Scholar 

  6. Zeng Y, Tateishi H, Cavalcante R, Tenekecioglu E, Suwannasom P, Sotomi Y, Collet C, Nie S, Jonker H, Dijkstra J, Radu MD, Räber L, McClean DR, van Geuns RJ, Christiansen EH, Fahrni T, Koolen J, Onuma Y, Bruining N, Serruys PW (2017) JACC Cardiovasc Imaging 10:1151–1161. https://doi.org/10.1016/j.jcmg.2016.11.016

    Article  PubMed  Google Scholar 

  7. Mintz GS (2015) Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging 8(4):461–471. https://doi.org/10.1016/j.jcmg.2015.02.003

    Article  PubMed  Google Scholar 

  8. Scalone G, Niccoli G, Monterrosas OG, Grossi P, Aimi A, Mariani L, Di Vito L, Kuku K, Crea F, Garcia-Garcia HM (2019) Intracoronary imaging to guide percutaneous coronary intervention: Clinical implications. Int J Cardiol 274:394–401. https://doi.org/10.1016/j.ijcard.2018.09.017

    Article  PubMed  Google Scholar 

  9. Gary S Mintz, S E Nissen, W D Anderson, S R Bailey, R Erbel, P J Fitzgerald, F J Pinto, K Rosenfield, R J Siegel, E M Tuzcu, P G Yock (2001) American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS) A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 37(5):1478–92. doi: https://doi.org/10.1016/s0735-1097(01)01175-5.

  10. Sharma SK, Vengrenyuk Y, Kini AS (2017) IVUS, OCT, and coronary artery calcification: is there a bone of contention? JACC Cardiovasc Imaging 10(8):880–882. https://doi.org/10.1016/j.jcmg.2017.06.008

    Article  PubMed  Google Scholar 

  11. Mintz GS, Ali Z, Maehara A (2021) Use of intracoronary imaging to guide optimal percutaneous coronary intervention procedures and outcomes. Heart 107(9):755–764. https://doi.org/10.1136/heartjnl-2020-316745

    Article  CAS  PubMed  Google Scholar 

  12. Guillermo J Tearney, Evelyn Regar, Takashi Akasaka, Tom Adriaenssens, Peter Barlis, Hiram G Bezerra, Brett Bouma, Nico Bruining, Jin-man Cho, Saqib Chowdhary, Marco A Costa, Ranil de Silva, Jouke Dijkstra, Carlo Di Mario, Darius Dudek, Erling Falk, Marc D Feldman, Peter Fitzgerald, Hector M Garcia-Garcia, Nieves Gonzalo, Juan F Granada, Giulio Guagliumi, Niels R Holm, Yasuhiro Honda, Fumiaki Ikeno, Masanori Kawasaki, Janusz Kochman, Lukasz Koltowski, Takashi Kubo, Teruyoshi Kume, Hiroyuki Kyono, Cheung Chi Simon Lam, Guy Lamouche, David P Lee, Martin B Leon, Akiko Maehara, Olivia Manfrini, Gary S Mintz, Kyiouchi Mizuno, Marie-angéle Morel, Seemantini Nadkarni, Hiroyuki Okura, Hiromasa Otake, Arkadiusz Pietrasik, Francesco Prati, Lorenz Räber, Maria D Radu, Johannes Rieber, Maria Riga, Andrew Rollins, Mireille Rosenberg, Vasile Sirbu, Patrick W J C Serruys, Kenei Shimada, Toshiro Shinke, Junya Shite, Eliot Siegel, Shinjo Sonoda, Melissa Suter, Shigeho Takarada, Atsushi Tanaka, Mitsuyasu Terashima, Troels Thim, Shiro Uemura, Giovanni J Ughi, Heleen M M van Beusekom, Antonius F W van der Steen, Gerrit-Anne van Es, Gijs van Soest, Renu Virmani, Sergio Waxman, Neil J Weissman, Giora Weisz, International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT). Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012;59(12):1058–72. doi: https://doi.org/10.1016/j.jacc.2011.09.079.

  13. Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW (2017) IVUS-guided versus OCT-guided coronary stent implantation: a critical appraisal. JACC Cardiovasc Imaging 10(12):1487–1503. https://doi.org/10.1016/j.jcmg.2017.09.008

    Article  PubMed  Google Scholar 

  14. Feldman MK, Katyal S, Blackwood MS (2009) US artifacts. Radiographics 29(4):1179–1189. https://doi.org/10.1148/rg.294085199

    Article  PubMed  Google Scholar 

  15. Baad M, Lu ZF, Reiser I, Paushter D (2017) Clinical significance of US artifacts. Radiographics 37(5):1408–1423. https://doi.org/10.1148/rg.2017160175

    Article  PubMed  Google Scholar 

  16. Kim SS, Yamamoto MH, Maehara A, Sidik N, Koyama K, Berry C, Oldroyd KG, Mintz GS, McEntegart M (2018) Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions. Int J Cardiovasc Imaging 34(9):1365–1371. https://doi.org/10.1007/s10554-018-1352-y

    Article  PubMed  Google Scholar 

  17. Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y (2021) Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther 36(1):1–18. https://doi.org/10.1007/s12928-020-00715-w

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Xiaoyu Huang and Ruolan Gao, MBBS, for their assistance in the determination of the corrected intracoronary images.

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  1. Wei You, Hong-li Zhang, Tian Xu are co-first authors.

Authors and Affiliations

  1. Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China

    Wei You, Tian Xu, Pei-na Meng, Xiang-qi Wu, Zhi-ming Wu, Ya-jie Guo, Jia-cong Nong & Fei Ye

  2. Department of Cardiology, Qinhuai Medical District, Eastern Theater General Hospital of PLA, Nanjing, 210002, China

    Hong-li Zhang & Yu-he Zhou

  3. Department of Epidemiology and Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Ave., Nanjing, 211166, China

    Bilin Tao

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You, W., Zhang, Hl., Xu, T. et al. Preliminary study of the significance of reverberation by IVUS detection for patients with severe calcified lesions. Int J Cardiovasc Imaging 39, 667–676 (2023). https://doi.org/10.1007/s10554-022-02537-8

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  • DOI: https://doi.org/10.1007/s10554-022-02537-8

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