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Ultrasound Helps Fill Out Cardiac Risk Picture

January 25, 2011
Written by: , Filed in: Cardiac Imaging
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Two imaging methods, or even three, are better than one when it comes to identifying the types of coronary plaque that are most likely to cause a heart attack or other sudden unexpected adverse cardiac event.

So indicate results from the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) clinical trial, as published January 20 in the New England Journal of Medicine.

PROSPECT was conducted at 37 sites in the United States and Europe. From late 2004 through mid-2006, it enrolled 697 patients with acute coronary syndromes. It then followed them for a median of 3.4 years.

The researchers discovered, among other surprises, that most untreated plaques that cause unexpected heart attacks or other cardiac events are not mild lesions, as previously thought, but rather involve a large plaque burden, a small lumen, or both. A coronary angiogram won’t detect that. But grayscale intravascular ultrasound (IVUS) will.

They also found that examining the structure of the plaque with radiofrequency IVUS (also known as FH-IVUS) could detect areas of atheroma covered with only a thin fibrous layer of intimal tissue (thin-cap fibroatheromas), the most dangerous type of plaque.

“These results mean that using a combination of imaging modalities, including IVUS to identify lesions with a large plaque burden and/or small lumen area, and FH-IVUS to identify a large necrotic core without a visible cap (a thin-cap fibroatheroma), identifies the lesions that are at especially high risk of causing future adverse cardiovascular events,” said Gregg W. Stone, MD, principal investigator, as quoted in a Cardiovascular Research Foundation news release.

Dr. Stone is professor of medicine at Columbia University College of Physicians and Surgeons, director of cardiovascular research and education at the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, and codirector of the medical research and education division at the Cardiovascular Research Foundation.

“As a result of the PROSPECT trial, we are closer to being able to predict—and therefore prevent—sudden unexpected adverse cardiac events,” Dr. Stone said.

Related seminar: Cardiac Imaging

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