Contemporary rationale for non-invasive imaging of adverse coronary plaque features to identify the vulnerable patient: a Position Paper from the ESC Working Group on Atherosclerosis and Vascular Biology and the Association of Cardiovascular Imaging

L'imaging non invasivo, in combinazione con biomarcatori e parametri biomeccanici, può identificare i soggetti a maggior rischio di IMA? (Eur Heart J Cardiovasc Imaging . 2020 Sep 4)

14 Settembre Set 2020 11 days ago
  • Pontone G

Atherosclerotic plaques prone to rupture may cause acute myocardial infarction (MI) but can also heal without causing an event. Certain common histopathological features, including inflammation, a thin fibrous cap, positive remodelling, a large necrotic core, microcalcification, and plaque haemorrhage are commonly found in plaques causing an acute event.

Recent advances in imaging techniques have made it possible to detect not only luminal stenosis and overall coronary atherosclerosis burden but also to identify such adverse plaque characteristics. However, the predictive value of identifying individual adverse atherosclerotic plaques for future events has remained poor.

In this Position Paper, the relationship between vulnerable plaque imaging and MI is addressed, mainly for non-invasive assessments but also for invasive imaging of adverse plaques in patients undergoing invasive coronary angiography. Dynamic changes in atherosclerotic plaque development and composition may indicate that an adverse plaque phenotype should be considered at the patient level rather than for individual plaques.

Imaging of adverse plaque burden throughout the coronary vascular tree, in combination with biomarkers and biomechanical parameters, therefore holds promise for identifying subjects at increased risk of MI and for guiding medical and invasive treatment.


Reference
1. Dweck MR, Maurovich-Horvat P, Leiner T, Cosyns B, Fayad ZA, Gijsen FJH, Van der Heiden K, Kooi ME, Maehara A, Muller JE, Newby DE, Narula J, Pontone G, Regar E, Serruys PW, van der Steen AFW, Stone PH, Waltenberger JL, Yuan C, Evans PC, Lutgens E, Wentzel JJ, Bäck M.Contemporary rationale for non-invasive imaging of adverse coronary plaque features to identify the vulnerable patient: a Position Paper from the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2020. Go to PubMed