FYI from the NHLBI Index

January 2010: Vol. 10, Issue 3
In the News

News from Capitol Hill

Science Advance from the NHLBI

  • Advanced Imaging May Improve Management of Coronary Artery Disease


News from Capitol Hill

Health Care Reform

At the time of publication of the FYI from the NHLBI, the final details of health care reform legislation are uncertain. One area of particular interest to the NHLBI is Comparative Effectiveness Research (CER). The NHLBI has been a leader in this area for many years and has funded a number of new CER projects under the American Recovery and Reinvestment Act. The Senate version of the bill would establish a private non-profit entity to oversee CER, while the House version would establish a Council with oversight by the Department of Health and Human Servicesí Agency for Healthcare Research and Quality. The NIH would be a member of this Council. Both the Senate and House versions would prohibit exclusion of coverage for care delivered as part of participation in clinical trials.

Fiscal Year 2010 Funding for NHLBI

The Consolidated Appropriations Bill was signed into law by the President on December 16, 2009. It contained six appropriations bills, including funding for the NIH. The bill provides $3,096,916,000 for the NHLBI for FY 2010, reflecting an increase of $81.2 million over FY 2009 (+2.69%) and an increase of $46.5 million above the Presidentís request.

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Recent Advance from the NHLBI

Advanced Imaging May Improve Management of Coronary Artery Disease

Identification of atherosclerotic plaques that are vulnerable to rupture remains an elusive goal, due in large part to the limited resolution of existing imaging techniques. Optical coherence tomography (OCT) is a high-resolution intracoronary imaging modality that can visualize and quantify coronary plaque microstructures, including thin fibrous caps, collagen, thrombi, macrophages, and stent coverage. Despite its substantial promise in plaque imaging, OCT has limited clinical application because blood severely attenuates its signal. Obtaining a clear image requires temporarily interrupting blood flow through the vessel, which is undesirable because it can cause myocardial ischemia and vessel injury.

To address this shortcoming, an NHLBI-supported team has developed a second-generation form of OCT, called optical frequency domain imaging (OFDI), which can acquire images at much higher frame rates, enabling higher resolution and rapid 3-dimensional imaging of long coronary segments after a brief, non-occlusive saline purge. This new methodology was used successfully in 3 patients after intracoronary stent placement to identify a diverse range of microscopic findings, including thin-capped fibroatheroma, calcium, cholesterol crystals, macrophages, and bare stent struts. The investigators reported the first human experience with intracoronary OFDI and demonstrated its ease of use and potential diagnostic value. Although this was a proof-of-principle study with few patients, the results are very promising.

OFDI may become a powerful tool for studying human coronary artery disease and in personalizing its management, but first it must be evaluated in larger patient samples to determine its clinical utility in identifying vulnerable plaques in high-risk patients.

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