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Near-infrared spectroscopy detected lipid core plaque at culprit sites
Findings from a small retrospective report of five cases have shown that intracoronary near-infrared spectroscopy may be able to identify the presence of large lipid core plaque implicated in causing sudden cardiac arrest.
The report, which was published in the Journal of Invasive Cardiology, included five patients who experienced a documented sudden cardiac arrest and were successfully resuscitated. Ryan D. Madder, MD, of the Frederik Meijer Heart and Vascular Institute at Spectrum Health in Grand Rapids, Mich., and colleagues studied these patients with a combined near-infrared spectroscopy (NIRS) and IVUS catheter (TVC, Infraredx) to determine the extent and location of lipid core plaque.
In one case, cardiac arrest occurred in the ED while the patient was awaiting transfer to the cath lab, whereas the other four cases occurred out of hospital.
In all cases, NIRS detected the presence of large lipid core plaque in the culprit segment.
“Although the detection of lipid core plaque at the culprit site in victims of sudden death is not novel, the novelty of the present report is that NIRS permitted identification of the large lipid core plaque underlying sudden cardiac arrest in vivo, a finding in striking accord with prior autopsy observations implicating ruptured lipid core plaque in the pathogenesis of sudden cardiac death,” Madder and colleagues wrote. “... The present observations provide evidence that lipid core plaque detected by NIRS is ... implicated in the most extreme presentation of acute coronary syndrome — sudden cardiac death.”
Perspective
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What’s unique about this paper is that Madder and colleagues collected five individuals who were all resuscitated and had high lipid content within the area of the infarcted artery. If you put these findings together with the other trial publications to date, near-infrared spectroscopy (NIRS) is intriguing as a tool to possibly detect patients at risk before they develop an acute MI. However, we have to be careful when interpreting the findings of a small retrospective report.
Future research may help us better understand the potential utility of NIRS. There is a prospective study that has been announced called the Lipid-Rich Plaque (LRP) study. The trial will include sites in the United States, Japan and Europe, and will enroll up to 9,000 patients presenting for coronary angiography in whom IVUS and/or NIRS evaluation is planned or could be utilized as part of their clinically indicated evaluation. We are getting more and more data to support that the presence of lipid core plaque is there at the time of an acute MI. What we need to find out is whether it is a predictor of acute MI, and if it is, whether we should treat those plaques to prevent future events. This will be evaluated in the LRP study, which is the largest study to date to address this question.