Coronary Imaging Modalities for Forecasting the "Eruption of the Volcano".

using iMap-IVUS and OCT. They defined OCT-TCFA as lipid-rich plaques with <65 mm-thick fibrous caps, which were subsequently identified in 22 (26%) lesions. Significantly larger percentages of necrotic area, absolute lipidic and necrotic areas, and a smaller percentage of fibrotic area were found in OCT-TCFA than in non-TCFA. Multivariate analysis showed that absolute necrotic area was an independent predictor of OCT-TCFA. The area under the receiver-operator characteristics curve of the absolute necrotic area required to identify OCT-TCFA was 0.86. The sensitivity, specificity, positive, and negative predictive values of absolute necrotic area ≥7.3 mm2 for identifying OCT-TCFA were 77%, 88%, 68%, and 92%, respectively. The data from the present study are comparable with those of previous similar investigations using virtual histology-IVUS, which is a variation of the RF-IVUS system.11 The results of the present study are indeed promising, particularly for interventionists who perform IVUS-guided PCI. On the basis of this study, it is possible to assess the risk of future coronary events in daily clinical settings by reviewing the absolute necrotic area measured using iMap-IVUS. It may also be possible to clarify the pharmaceutical stabilization of vulnerable plaques by analyzing the serial changes of absolute necrotic area as a surrogate marker. By considering the several oronary plaque rupture can be likened to a volcanic eruption, given its abrupt occurrence and the “natural disaster” that follows the episode. Numerous cardiovascular researchers have aimed to identify vulnerable atherosclerotic plaques, which lead to plaque rupture and coronary thrombosis, because they are the major cause of acute myocardial infarction (AMI) and sudden cardiac death.1 Morphological studies from autopsy have suggested the importance of necrotic core size, inflammation, and fibrous cap thickness.2 These clinical features are similar to the amount of magma, volcanic tremor, and the distance from magma to the ground surface forecasting the explosion of the volcano. Thin-cap fibro-atheroma (TCFA), which is characterized by a large necrotic core with an overlying thin-fibrous cap measuring <65 μm, is known to lead to AMI.3