AIMS Intravascular ultrasound (IVUS) imaging can visualize vulnerable plaque features including attenuation (AP) and echolucency (ELP). While IVUS-derived vulnerable plaque features associate with microvascular obstruction during percutaneous coronary intervention, the relationship between these plaque features and clinical outcomes has not been established. This analysis aimed to evaluate the association of AP/ELP with cardiovascular events. METHODS AND RESULTS Serial IVUS imaging was reviewed in 1497 patients, followed for 18-24 months, with coronary artery disease from two clinical trials. Attenuated plaque and ELP were identified to measure each characteristics (AP arc, ELP area, and lengths), which permitted calculation of an AP index (API) and ELP volume. Attenuated plaque/ELP progression was defined as patients with any increase of API or ELP volume on serial imaging. The major cardiovascular events (MACEs) were defined as death, myocardial infarction, stroke, and coronary revascularization. AP or ELP was identified in 282 patients (18.8%) at baseline and 160 (10.7%) patients demonstrated an increase in AP or ELP at follow-up. The incidence of MACE was higher in patients with baseline AP/ELP than those without (8.2% vs. 3.9%, P = 0.002). Patients with AP/ELP progression were more likely to be acute coronary syndrome (41.9 vs. 33.2%, P = 0.03) and have greater baseline percent atheroma volume (40.0% vs. 35.8%, P < 0.001) than those without. On multivariable analysis, AP/ELP progression was more strongly associated with MACE [baseline AP/ELP: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.05-2.97, AP/ELP progression: HR 2.19, 95% CI 1.24-3.86]. CONCLUSION Attenuation/ELP progression was associated with a higher prevalence of cardiovascular events, supporting a potential role for the identification of high-risk vulnerable plaques in patients with coronary artery disease.

中文翻译：

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超声斑块衰减和低回声的进展与主要不良心血管事件有关

AIMS 血管内超声 (IVUS) 成像可以可视化易损斑块特征，包括衰减 (AP) 和回声透光 (ELP)。虽然 IVUS 衍生的易损斑块特征与经皮冠状动脉介入治疗期间的微血管阻塞有关，但这些斑块特征与临床结果之间的关系尚未确定。该分析旨在评估 AP/ELP 与心血管事件的关联。方法和结果 对来自两项临床试验的 1497 名冠状动脉疾病患者的连续 IVUS 成像进行了回顾，随访时间为 18-24 个月。确定衰减斑块和 ELP 以测量每个特征（AP 弧、ELP 面积和长度），这允许计算 AP 指数 (API) 和 ELP 体积。减弱的斑块/ELP 进展定义为连续成像中 API 或 ELP 体积增加的患者。主要心血管事件（MACE）被定义为死亡、心肌梗死、中风和冠状动脉血运重建。基线时 282 名患者 (18.8%) 发现 AP 或 ELP，160 名 (10.7%) 患者在随访时显示 AP 或 ELP 增加。基线 AP/ELP 患者的 MACE 发生率高于没有基线 AP/ELP 的患者（8.2% 对 3.9%，P = 0.002）。AP/ELP 进展的患者更可能是急性冠脉综合征（41.9 对 33.2%，P = 0.03），并且比那些没有进展的患者具有更大的基线粥样斑体积百分比（40.0% 对 35.8%，P < 0.001）。在多变量分析中，AP/ELP 进展与 MACE 的相关性更强 [基线 AP/ELP：风险比 (HR) 1.76，95% 置信区间 (CI) 1.05-2.97，AP/ELP 进展：HR 2.19，95% CI 1.24-3.86]。结论 衰减/ELP 进展与较高的心血管事件发生率相关，支持在冠状动脉疾病患者中识别高风险易损斑块的潜在作用。