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High-definition intravascular ultrasound versus optical frequency domain imaging for the detection of calcium modification and fracture in heavily calcified coronary lesion

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Abstract

While optical frequency domain imaging (OFDI) can delineate calcium modification and fracture, the capability of high-definition intravascular ultrasound (HD-IVUS) for detecting these remains unclear. This study evaluated diagnostic accuracy of HD-IVUS for assessing calcium modification and fracture as compared to OFDI. HD-IVUS and OFDI were used during orbital or rotational atherectomy procedures conducted for 21 heavily calcified coronary lesions in 19 patients. With OFDI assessment used as the gold standard, diagnostic accuracies of HD-IVUS for calcium modification and fracture were compared every 1 mm to the matched pre-stenting images (n = 1129). Calcium modification, as assessed by OFDI, was defined as polished and concave-shaped calcium. For HD-IVUS, calcium modification was defined as the presence of reverberation with concave-shaped calcium. In both assessments, the definition of calcium fracture was defined as a slit or complete break in the calcium plate. Calcified plaque was found in 86.4% of analyzed OFDI images. Calcium modification and fracture were detected in 20.6% and 11.0% of detected calcified plaques. Sensitivity, specificity, positive and negative predictive values of HD-IVUS detection for calcium modification and fracture were 54.4%, 97.8%, 86.7%, 89.1% and 86.0%, 94.5%, 58.2%, 96.8%, respectively. Discordance cases between both assessments demonstrated that heterogeneous calcium visualized by OFDI, separated calcium, and guide wire artifact can be misdiagnosed. Diagnostic accuracies of HD-IVUS for assessing calcium modification and fracture were acceptable as compared to OFDI. Such findings can be of utility during imaging guided interventional procedures with atherectomy.

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Acknowledgements

This work was supported by KAKENHI Grant Number 20K08142 from the Japan Society for the Promotion of Science (JSPS). The authors are deeply grateful to Tatsuya Shinke (image technician) for assisting in the performance of the image matching.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Shiwa-gun, Yahaba-cho, Iwate, 028-3695, Japan

    Masaru Ishida, Yuya Oshikiri, Takumi Kimura, Yudai Shimoda, Yu Ishikawa, Yorihiko Koeda, Yuya Taguchi, Tomonori Itoh & Yoshihiro Morino

  2. Department of Cardiology, Nakadori General Hospital, Akita, Japan

    Ryohei Sakamoto

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  1. Masaru Ishida
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  2. Yuya Oshikiri
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  3. Takumi Kimura
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  4. Ryohei Sakamoto
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  5. Yudai Shimoda
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  6. Yu Ishikawa
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Correspondence to Masaru Ishida.

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Conflict of interest

Dr. Ishida receives lecture honoraria from Abbott Vascular Japan, Boston Scientific Japan, Daiichi Sankyo, Japan Lifeline, Kowa, Medikit and Terumo Corporation. Dr. Itoh receives lecture honoraria from Daiichi Sankyo, and Abbott Vascular. Dr. Morino received lecture honoraria from Abbott Vascular, Boston Scientific, Sanofi, and Daiichi-Sankyo. None of the other authors have any conflicts of interest or financial disclosures.

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Ishida, M., Oshikiri, Y., Kimura, T. et al. High-definition intravascular ultrasound versus optical frequency domain imaging for the detection of calcium modification and fracture in heavily calcified coronary lesion. Int J Cardiovasc Imaging 38, 1203–1212 (2022). https://doi.org/10.1007/s10554-021-02521-8

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  • DOI: https://doi.org/10.1007/s10554-021-02521-8

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