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With great interest I read the article by Surmely et al.1 comparing plaque composition of patients with acute coronary syndrome (ACS) and stable angina pectoris (AP) using virtual histology intravascular ultrasound (VH-IVUS). The authors reported that ‘At the minimal lumen site, … necrotic core and dense calcium plaque area were smaller in ACS lesions (Necrotic core: 6.8 ± 6.0 vs. 11.0 ± 8.3%, P = 0.02; Dense calcium: 2.6 ± 3.0 vs. 4.9 ± 5.8%, P = 0.03).’ However, the authors previously reported that ‘the frequency of necrotic core was significantly higher in the ACS group than in the stable AP group (in vitro histopathology: 22.6% vs. 12.6%, p = 0.02; in vivo virtual histology: 24.5% vs. 10.4%, p = 0.002)’ in another study.2 Given both studies conducted were of similar design and from the same institute, the patient/lesion characteristics seem similar. Potential explanations for the contradictions include the difference of the IVUS system used; a 30 MHz mechanically rotating catheter (Boston Scientific Scimed Inc., Maple Grove, MN, USA) in the previous study and a 20 MHz phased-array IVUS catheter (Eagle Eye, Volcano therapeutics, Rancho Cordova, CA, USA) in this study. Previous studies with grey-scale IVUS imaging have suggested that there is a significant difference in image representation among the IVUS systems studied in the diagnosis of tissue components of complex atherosclerotic plaque.3,4 Therefore, it would be of great help if the authors would provide VH-IVUS data comparing these two IVUS systems in same patient/lesion.

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Letters to the Editor
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