The Vulnerable Plaque: Recent Advances in Computed Tomography Imaging to Identify the Vulnerable Patient
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CORONARY HEART DISEASE (S. VIRANI AND S. NADERI, SECTION EDITOR)
The Vulnerable Plaque: Recent Advances in Computed Tomography Imaging to Identify the Vulnerable Patient Faheemullah Beg 1 & Hasan Rehman 1 & Mouaz H. Al-Mallah 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review aims to summarize the role of coronary computed tomography plaque analysis in identifying high-risk patients and plaques. Recent Findings In this review, we will describe the histopathological features of a vulnerable plaque as well as the coronary computed tomography characteristics including spotty calcification, low-attenuation fatty core, positive remodeling, and thin fibrous cap. We will also review several studies that assessed features of a vulnerable plaque on non-invasive imaging and evaluated them as risk predictors of future acute coronary events. Summary Multiple recent studies suggested that coronary computed tomography angiography can accurately identify high-risk features of plaque that will predict future events. Keywords Coronary computed tomography . Plaque . Acute coronary syndrome
Introduction An estimated 16.5 million Americans are currently living with coronary heart disease (CHD), with an estimated 800,000 of them expected to have a first or a recurrent myocardial infarction (MI) in a given year [1]. Since acute myocardial infarction (AMI) is associated with significant mortality and morbidity, there have been significant efforts to identify the vulnerable patients, i.e., the subgroup that is likely to have an acute MI. This has led to the identification of several modifiable and non-modifiable risk factors of AMI over the years [2–4]. More recently, the emphasis has transitioned beyond these traditional risk factors to more lesion-specific characteristics This article is part of the Topical Collection on Coronary Heart Disease * Mouaz H. Al-Mallah [email protected] Faheemullah Beg [email protected] Hasan Rehman [email protected] 1
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA
based on non-invasive imaging, focusing on the vulnerable plaques per se [5, 6]. Prior studies have suggested that acute changes in a plaque are the central events of an AMI. Plaque characteristics may determine plaque instability and hence the risk of a subsequent AMI. In this review, we will review the evidence describing the histopathological features of vulnerable plaques. We will also review several studies that assessed features of a vulnerable plaque on non-invasive imaging and evaluated the possibility of using these as risk predictors of future acute coronary events.
Pathogenesis of Acute Myocardial Infarction The atherosclerotic plaque is the site where the majority of the changes occur prior to acute myocardial infarctions [5]. While the presence of any coronary artery atherosclerosis in all adults above the age of 40 is as high as 83%, based on one population-b
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