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Review
. 2023 Mar 17:10:1095806.
doi: 10.3389/fcvm.2023.1095806. eCollection 2023.

Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia

Ryoko Kitada  1 , Kenichiro Otsuka  1 , Daiju Fukuda  1
Affiliations
Review

Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia

Ryoko Kitada et al. Front Cardiovasc Med. .

Abstract

Chronic coronary syndrome (CCS) is a progressive disease, which often first manifests as acute coronary syndrome (ACS). Imaging modalities are clinically useful in making decisions about the management of patients with CCS. Accumulating evidence has demonstrated that myocardial ischemia is a surrogate marker for CCS management; however, its ability to predict cardiovascular death or nonfatal myocardial infarction is limited. Herein, we present a review that highlights the latest knowledge available on coronary syndromes and discuss the role and limitations of imaging modalities in the diagnosis and management of patients with coronary artery disease. This review covers the essential aspects of the role of imaging in assessing myocardial ischemia and coronary plaque burden and composition. Furthermore, recent clinical trials on lipid-lowering and anti-inflammatory therapies have been discussed. Additionally, it provides a comprehensive overview of intracoronary and noninvasive cardiovascular imaging modalities and an understanding of ACS and CCS, with a focus on histopathology and pathophysiology.

Keywords: acute coronary syndrome; atherosclerosis; chronic coronary syndrome; coronary microvascular dysfunction; imaging; inflammation; ischemia; plaque vulnerability.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Role of imaging in the management of patients with coronary artery disease.
Figure 2
Figure 2
Diagnosis and management of INOCA. Modified from reference (47).
Figure 3
Figure 3
Coronary computed tomography angiography and angiographic images of a patient with acute chest pain. CCTA images of a patient with acute chest pain without ST-segment changes on electrocardiography. CCTA images (A–D) indicate 70–99% luminal stenosis with high-risk plaque features (positive remodeling, low-attenuation plaque, napkin ring sign, and spotty calcification) in the proximal left ascending coronary artery (LAD). After CCTA examination, the patient’s chest pain worsened, and ST-segment elevation was detected. (E) Emergent coronary angiography revealed total occlusion of the LAD, which corresponded to the location of the high-risk plaque visualized on CCTA. (F) Intravascular ultrasonography revealed an intraluminal thrombus secondary to plaque rupture. (G,H) Post-hoc analysis demonstrated an increased pericoronary artery attenuation of >−70 HU. Modified from reference (61).
Figure 4
Figure 4
Optical frequency domain imaging of ST-segment elevation myocardial infarction. (A,B) Invasive coronary angiography revealed total occlusion of the mid-portion of the right coronary artery with collateral flow to the left descending coronary artery. (C–F) optical frequency domain imaging (OFDI) images after thrombectomy. (C) Thin capped fibroatheroma, (D,E) calcified nodules (yellow arrows), and (F) calcification.
See this image and copyright information in PMC

References

    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. (2020) 141:e139–e596. 10.1161/CIR.0000000000000757 - DOI - PubMed
    1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. (2020) 41:407–77. 10.1093/eurheartj/ehz425 - DOI - PubMed
    1. Fuster V, Kovacic JC. Acute coronary syndromes: pathology, diagnosis, genetics, prevention, and treatment. Circ Res. (2014) 114:1847–51. 10.1161/CIRCRESAHA.114.302806 - DOI - PMC - PubMed
    1. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. (2007) 356:1503–16. 10.1056/NEJMoa070829 - DOI - PubMed
    1. Shaw LJ, Berman DS, Maron DJ, Mancini GBJ, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial nuclear substudy. Circulation. (2008) 117:1283–91. 10.1161/CIRCULATIONAHA.107.743963 - DOI - PubMed

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