Clinical Challenges

About Heart Disease

Myocardial infarction (MI), or heart attack, is a major cause of death, with an estimated 45% of the 1.1 million Americans experiencing the event dying as a result, according to the American Heart Society.


For those people who survive MI, the long-term prognosis is poor. Experiencing an MI is a risk factor for experiencing a second heart attack. In addition, these patients are at increased risk for other heart problems, including heart failure, arrhythmias, heart valve damage, and stroke.


In nearly all cases, coronary artery disease is caused by atherosclerosis, a condition resulting from the buildup of cholesterol and other materials that form plaques that restrict blood flow through the coronary arteries. In some cases, the coronary blockages grow slowly and only become evident when they prevent adequate flow of blood to the heart muscle during periods of increased exertion or stress. This lack of flow causes chest discomfort that is called angina pectoris. In other cases, the plaque can rapidly produce a complete blockage of an artery leading to a heart attack or sudden cardiac death. This occurs when a plaque ruptures and its contents are exposed to blood, creating a thrombus (blood clot) that, in turn, leads to a rapid, complete blockage of an artery.

The Role of Lipid Core Plaques (LCP)

In 1989, three cardiologists, Geoffrey H. Tofler, Peter H. Stone, and Infraredx founder James E. Muller, proposed that plaques with a lipid core and which are prone to rupture could be considered to be complication-prone or high-risk plaques, and that methods should be developed to identify such plaques before they rupture, and preventive therapy should be developed.

Identifying Lipid Core Plaques: the Challenge

Today there is widespread agreement that lipid core plaques of interest (LCP) are associated with acute coronary syndromes and other coronary events. However, the majority of intravascular imaging techniques do not accurately and reliably detect LCP.


In interventional cardiology today, there is the need for advanced imaging technology that provides a more accurate and complete assessment of the vessel than is possible from angiography alone.


A complete assessment of the vessel requires looking deeper than the lumen to understand both plaque composition and structure. It also requires identifying those clinically significant LCP which are associated with acute coronary syndromes and other coronary events.