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Updated: May 3, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
[New insights in pathogenesis and etiology of coronary artery disease]
1Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen.
Insights
Traditional coronary heart disease diagnostics miss early plaque buildup. Advanced imaging like intravascular ultrasound can detect subtle atherosclerosis, improving diagnosis for unexplained cardiovascular events.
Area of Science:
- Cardiology
- Medical Imaging
- Pathophysiology
Context:
- Current non-invasive diagnosis of coronary heart disease relies on clinical findings, ischemia detection, and cardiac enzymes.
- Coronary angiography often misses early atherosclerosis due to the Glagov effect, where vessels enlarge to compensate for plaque.
- This limitation leads to discrepancies, such as positive troponin tests without visible coronary narrowing.
Purpose:
- To highlight the limitations of traditional diagnostic methods for coronary heart disease.
- To introduce advanced imaging techniques for detecting early-stage atherosclerosis.
- To advocate for revised terminology in cardiac catheterization reports.
Summary:
- Early atherosclerosis, characterized by plaque development, is often missed by conventional diagnostic tools like ECG, stress tests, and coronary angiography due to compensatory vessel enlargement (Glagov effect).
- Advanced imaging modalities including intravascular ultrasound (IVUS), optical coherence tomography (OCT), vasomotion measurements, and computed tomography (CT) can identify earlier stages of coronary artery disease.
- These techniques are crucial for clarifying the pathophysiology of unexplained cardiovascular events, including those related to plaque rupture or erosion leading to microembolism and myocardial necrosis.
Impact:
- Improved detection of subclinical atherosclerosis, enabling earlier intervention.
- Enhanced understanding of cardiovascular event mechanisms in patients with initially unexplained symptoms.
- Recommendation to replace "ruled out coronary heart disease" with "No signs of obstructive coronary heart disease" in reports, prompting further investigation when necessary.
Abstract:
In clinical practice the non-invasive diagnosis of "coronary heart disease" is based on the clinical findings, the detection of ischemia at rest or during exercise, and elevations of cardiac enzymes. However, due to the compensatory enlargement of the vessel diameter at the beginning of plaque growth, the so-called Glagov effect, early stages of plaque development are missed by the angiography. By means of coronary angiography, changes of the coronary arteries become visible only in patients with angiographically recognizable lumen narrowing compared to the reference vessel segment. Thus, early or diffuse stages of atherosclerosis cannot be detected by ECG, stress-tests or coronary angiography. This limitation explains discrepancies, like positive troponin-test and even transmural ischemia, without angiographic visible coronary lumen narrowing. Diagnostic procedures such as intravascular ultrasound, optical coherence tomography, measurements of vasomotion and computed tomography can, in contrast, detect earlier stages of coronary artery disease and thus contribute to clarification in these patients. In addition, plaque rupture and plaque-erosion lead to acute or recurrent microembolism to distal myocardium with subsequent myocardial necrosis. In patients with formerly unexplained cardiovascular events, intravascular ultrasound, optical coherence tomography, and measurements of vasomotion help to understand the underlying pathophysiology. In the report after cardiac catheterization, the term "ruled out coronary heart disease" should be replaced by "No signs of obstructive coronary heart disease" and additional testing should be performed as necessary.
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