Did you know one in four Americans die each year from heart disease? 1
While most people can identity a few risk factors for heart disease, such as high blood pressure, unhealthy eating and stress, very few can identify the cause. A major contributing factor is known to be lipid core plaque. Understood to be plaque vulnerable to rupture, LCP is well-documented as the cause of most serious heart attacks. Due to recent technological advancements, early detection and treatment of LCP via intravascular imaging tools, holds enormous promise for the health and well-being of patients. It also provides financial incentives for hospitals of all sizes. Near-Infrared Spectroscopy is an emerging technology that can detect lipid core plaque, and when combined with IVUS, can simultaneously determine coronary plaque structure.
Unlike other lipids, which are assessed using conventional blood tests, LCP in coronary arteries is detectable through intravascular imaging like IVUS+NIRS. What sets NIRS apart from other intravascular imaging tools? NIRS can determine the chemical composition of plaques, including lipid cores within lesions.2,3,4 The imaging tool produces a color-coded map, called a Chemogram, which depicts the probability of cholesterol presence within an artery wall. Identifying low probabilities of cholesterol in red and high probabilities of cholesterol in yellow, a Chemogram provides cardiologists with an easy-to-interpret map to identify LCP and may transform how patients are stratified for potential risk of a serious cardiac event. Today, 95 percent of ST-elevation myocardial infarctions are associated with LCP. 5,6 The Chemogram can help physicians significantly reduce the number of anticipated incidents, and possibly minimize the risk of peri-procedural complications.7
Why is this significant? The current methodology standard, IVUS, a breakthrough when introduced years ago, conveys vital information about coronary lesions has helped physicians improve stenting outcomes. By adding NIRS, cardiologists gain more information from one procedure – vessel structure and plaque composition. Cardiology has always been a highly evidence-based field, and increasingly, cardiologists see the IVUS+NIRS combination as the next innovative tool to characterize dangerous plaques.
Large-scale outcomes studies are underway to study plaques identified by IVUS+NIRS. If positive, these studies will provide substantial evidence for increased hospital and cardiologist adoption of the technology. Highly anticipated results of the Lipid-Rich Plaque Study, due later this year, aim to demonstrate the association of imaging LCP and the ability to predict future major adverse cardiac events. In addition, the PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II) Study is evaluating the potential of NIRS in the further discrimination of plaques, including LCP. Although these studies are ongoing, we know one thing’s for sure: the use of IVUS+NIRS can help cardiologists garner twice the insights compared to single imaging modalities.
This added information provided by combination imaging will empower cardiologists to make more informed, tailored decisions for each patient. This will lead to decreasing the risk of future cardiac events, faster recovery times and fewer hospital readmissions. For both the patient and the cardiologist, all these benefits lead to more peace of mind, as well as a clear path forward for treatment.
Additionally, this dual-modality technology will benefit hospitals. Forward-thinking hospital administrators routinely consider all advancements that improve quality of care, reduce readmissions and enhance efficiencies. Embracing intravascular imaging techniques such as IVUS+NIRS allows physicians to quickly analyze critical information they could not obtain before, resulting in fewer procedural complications and enhanced treatment planning. This will also lead to decreased procedure times and hospital resources. Ultimately, IVUS+NIRS has the potential to maximize the value-based healthcare by improving the quality of care and reducing costs.
Pioneering cardiologists have the power to shape the future of cardiac care with IVUS+NIRS. This cutting-edge technology will increase confidence in interventional decision making and could set a new standard of care for the prediction, and ultimately the prevention, of major heart attacks. This is a goal that will benefit everyone: cardiologists, hospital administrators and, most importantly, patients.
Jason Bottiglieri is the president and CEO of Infraredx, a Nipro company. Infraredx is advancing the diagnosis and management of coronary artery disease by providing cardiologists with the most precise imaging tools required to predict and ultimately prevent heart attacks. Its Makoto™ Intravascular Imaging System, with accompanying Dualpro™ IVUS+NIRS catheter, is the only technology on the market FDA-cleared for the detection of LCP.
References
1 Cardiovascular Disease Fact Sheet, 2017. World Health Organization, http://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds), accessed on June 14, 2018.
2 Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20:1262–75. https://www.ncbi.nlm.nih.gov/pubmed/10807742
3 Sanon S, Dao T, Sanon VP, Chilton R. Imaging of vulnerable plaques using near-infrared spectroscopy for risk stratification of atherosclerosis. Curr Atheroscler Rep. 2013;15:304. https://www.ncbi.nlm.nih.gov/pubmed/23299644
4 Sharif F, Murphy RT. Current status of vulnerable plaque detection. Catheter Cardiovasc Interv. 2010;75:135 https://onlinelibrary.wiley.com/doi/pdf/10.1002/ccd.22164
5 Madder RD, Goldstein JA, Madden SP, et al. Detection by near-infrared spectroscopy of large lipid core plaques at culprit sites in patients with acute ST-segment elevation myocardial infarction. JACC: Cardiovascular Interventions. 2013;6(8), 838-846. http://interventions.onlinejacc.org/content/6/8/838
6 Goldstein JA, Maini B, Dixon SR, et al. Detection of lipid-core plaques by intracoronary near-infrared
spectroscopy identifies high risk of periprocedural myocardial infarction. Circulation Cardiovascular Interventions. 2011;4, 429–437. http://circinterventions.ahajournals.org/content/4/5/429
7 Gardner CM, Tan H, Hull EL, et al. Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system. JACC: Cardiovascular Imaging. 2008;1(5), 638-648. https://www.ncbi.nlm.nih.gov/pubmed/19356494