Prediction of cardiovascular outcomes by imaging coronary atherosclerosis

Abstract

Over the last two decades, several invasive and non-invasive coronary atherosclerosis imaging modalities have emerged as predictors of cardiovascular outcomes in at-risk population. These modalities have demonstrated independent or incremental prognostic information over existing/standard risk stratification schemes, such as the Framingham risk score (FRS), by identifying characteristics of coronary artery diseases (CADs). In this review, we begin with discussing the importance of pre-test probability and quality of outcome measure, followed by specific findings of each modality in relation to prognosis. We focused on both short and long term prognostic aspects of coronary computed tomography (CT) (including coronary calcium score and coronary angiography) and magnetic resonance imaging as non-invasive tools, as well as invasive modalities including intravascular ultrasound (IVUS), optical coherence tomography (OCT), near infrared spectroscopy and Angioscopy.

Keywords: Coronary atherosclerosis; cardiovascular outcomes; coronary imaging; prediction.

Figure 1

Adverse prognostic sings on CTCA. (A) Napkin ring sign with positive remodeling; (B) curve-linear LAD view; (C) spotty calcification with positive remodeling. CTCA, computed tomographic coronary angiography; LAD, left anterior descending artery.

Figure 2

Characteristics of high risk plaque. (A) T1-weighted magnetic resonance imaging of high-signal intensity of the right coronary artery with a plaque to myocardium signal intensity ratio of 3.09 (yellow arrow indicates lesion); (B) a coronary angiogram showing severe stenosis in the proximal portion of the right coronary artery; (C) gray-scale intravascular ultrasound image showing ultrasound attenuation; (D) integrated backscatter intravascular ultrasound showing lipid-rich plaque (blue area). Reprint from Hoshi et al. (52). Reproduced with permission of the publisher. Copyright © 2015, Oxford University Press.

Figure 3

IVUS positive remodeling. Courtesy of Dr Hiroko Tsuchiya. IVUS, intravascular ultrasound.

Figure 4

OCT TCFA. Courtesy of Dr Hiroko Tsuchiya. OCT, optical coherence tomography; TCFA, thin-cap fibroatheroma.